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OVERVIEW

What is an ulcer?

Ulcers are sores on the lining of your digestive tract. Your digestive tract consists of the esophagus, stomach, duodenum (the first part of the intestines) and intestines. Most ulcers are located in the duodenum. These ulcers are called duodenal ulcers. Ulcers located in the stomach are called gastric ulcers. Ulcers in the esophagus are called esophageal ulcers.

SYMPTOMS

Possible signs of an ulcer

• Feel better when you eat or drink and then worse 1 or 2 hours later (duodenal ulcer)
• Feel worse when you eat or drink (gastric ulcer)
• Stomach pain that wakes you up at night
• Feel full fast
• Heavy feeling, bloating, burning or dull pain in your stomach
• Vomiting
• Unexpected weight loss

CAUSES & RISK FACTORS

What causes ulcers?

Healthcare providers used to think ulcers were caused by stress or by eating food with too much acid in it. We now know this isn’t true.

Most ulcers are caused by an infection. The infection is caused by a bacteria (germ) called Helicobacter pylori (say: hellee-ko-back-ter pie-lore-ee”), or H. pylori for short. Acid and other juices made by the stomach can contribute to ulcers by burning the lining of your digestive tract. This can happen if your body makes too much acid or if the lining of your digestive tract is damaged in some way. Physical or emotional stress may not necessarily cause an ulcer, but it can aggravate an ulcer if you have one.

Ulcers can also be caused by anti-inflammatory medicines. Although most people take these medicines without problems, long-term use may damage the stomach lining and cause ulcers. Anti-inflammatory drugs include aspirin, ibuprofen (one brand name: Motrin), naproxen (brand name: Aleve), and some prescription drugs for arthritis.

DIAGNOSIS & TESTS

How can my healthcare provider tell if I have an ulcer?

Your healthcare provider will ask about your symptoms and may start you on some medicine before doing tests. This is because ulcers usually feel better within a week or so of treatment. You may not need tests if you’re getting better.

If you don’t get better, your healthcare provider may do an endoscopy or a special X‑ray to study your digestive tract. During an endoscopy, your healthcare provider looks into your stomach through a thin tube. They may take a biopsy (a sample of the stomach lining) to test for H. pylori. Blood and breath tests can also be used to test for H. pylori.

TREATMENT

How can ulcers be treated?

One way to treat ulcers is to get rid of the H. pylori bacteria. Treatment may also be aimed at lowering the amount of acid that your stomach makes, neutralizing the acid and protecting the injured area so it can heal. It’s also very important to stop doing things, such as smoking and drinking alcohol, that damage the lining of your digestive tract.

What is triple therapy?

Triple therapy is a treatment to eliminate H. pylori. It is a combination of 2 antibiotics and bismuth subsalicylate (one brand name: Pepto-Bismol). Other combinations may also be effective. This treatment may be used with medicine that reduces the amount of acid your stomach makes.

What about other medicines?

Several other medicines can be used to help treat ulcers. Two types of medicines (H2 blockers and proton pump inhibitors) reduce the amount of acid that your stomach makes. They usually help people start to feel better within 3 days.

Antacids neutralize acid that the stomach makes. A medicine called sucralfate coats the ulcer to protect it from the acid so it has time to heal.

Another medicine, misoprostol, reduces the amount of acid and protects the lining of the stomach. It is usually used to prevent gastric ulcers in people who need to take anti‑inflammatory drugs and who have had stomach irritation or ulcers in the past.

How long will I have to take medicine?

Treatment to get rid of H. pylori usually takes about 2 to 3 weeks. Your healthcare provider may want you to take medicine that lowers the stomach acid for up to 8 weeks. Most ulcers heal within this time.

If your symptoms come back after you stop taking medicine, your healthcare provider may want you to take a different medicine or take a low dose of medicine even when you’re not having symptoms to keep the ulcer from coming back.

Tips on healing your ulcer

• Don’t smoke.
• Avoid anti-inflammatory drugs such as aspirin and ibuprofen.
• Avoid caffeine and alcohol (or have them only in small amounts and on a full stomach).
• Avoid spicy foods if they cause heartburn.

Does what I eat affect my ulcer?

It may. But this isn’t true for everyone. Certain foods and drinks may be more likely to make your pain worse. These include both regular and decaffeinated coffee, tea, chocolate, meat extracts, alcohol, black pepper, chili powder, mustard seed and nutmeg. You may want to avoid these things if they bother you. But keep your diet balanced. Try eating small, frequent meals when you’re having pain.

COMPLICATIONS

Are ulcers serious?

Most people with ulcers just have stomach pain. Some people don’t have any symptoms at all. But ulcers may cause other health problems. Sometimes they bleed. If the ulcers become too deep, they can break through the stomach. This is called perforation. Ulcers can block food from going through the stomach (called obstruction). This causes nausea, vomiting and weight loss. Get help right away if you have any of the warning signs listed below.

Warning signs that your ulcer is getting worse

• You vomit blood.
• You vomit food eaten hours or days before.
• You feel cold or clammy.
• You feel unusually weak or dizzy.
• You have blood in your stools (blood may make your stools look black or like tar).
• You have ongoing nausea or repeated vomiting.
• You have sudden, severe pain.
• You keep losing weight.
• Your pain doesn’t go away when you take your medicine.
• Your pain reaches to your back.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What is causing my ulcer?
• Where is my ulcer?
• How is an H. pylori infection treated?
• Am I at risk of getting another ulcer?
• What medicines are used to treat ulcers, and what are the possible side effects?
• How long will it take to treat my ulcer?
• Are ulcers a sign of another health condition?