A peptic ulcer is erosion in the lining of the stomach or duodenum (the first part of the
small intestine). The word “peptic” refers to pepsin, a stomach enzyme that breaks down
proteins. If a peptic ulcer is located in the stomach it is called a gastric ulcer.
Small ulcers may not cause any symptoms. Large ulcers can cause serious bleeding. Most
ulcers occur in the first layer of the inner lining. A hole that goes all the way through is
called a perforation of the intestinal lining. A perforation is a medical emergency. It is
also known as Ulcer - peptic; Ulcer - duodenal or gastric; Duodenal ulcer

No single cause has been found for ulcers. However, it is now clear that an ulcer is the
end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers
can be caused by:

• Infection with a type of bacteria called Helicobacter pylori (H. pylori)
• Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
• Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.

Other factors can make it more likely for you to get an ulcer, including:

• Using aspirin, ibuprofen, or naproxen
• Drinking alcohol excessively
• Smoking cigarettes and using tobacco

In addition, if you have a family history of ulcers or you are blood type O, you are more
likely to get a duodenal ulcer. There is also a rare condition called Zolliger-Ellison
syndrome in which a tumor in the pancreas secretes a substance that causes ulcers
throughout the stomach and duodenum.

An ulcer may or may not have symptoms. When symptoms occur, they include:

• A gnawing or burning pain in the middle or upper stomach between meals or at night
• Bloating
• Heartburn
• Nausea or vomiting

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding)
• Vomiting blood (can have a "coffee-grounds" appearance)
• Weight loss
• Severe pain in the mid to upper abdomen

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not
properly treated, ulcers can lead to serious health problems, including:

• Bleeding
• Perforation (a hole through the wall of the stomach)
• Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine.

Taking NSAIDs can cause any of the above without warning. The risk is especially
concerning for the elderly and for those with a prior history of having peptic ulcer
disease.

You may be more likely to develop ulcers if you:

• Are infected with the H. pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen, naproxen, and many others
• Have a family history of ulcers
• Have another illness, such as liver, kidney, or lung disease
• Drink alcohol regularly
• Are 50 years old or older

Your doctor may be able to make an ulcer diagnosis just by talking with you about your
symptoms. However, to confirm the diagnosis one of several tests should be taken. First,
your doctor may ask you to take an acid-blocking medication such as those used to treat
heartburn for a short period of time to see if your symptoms improve.
If needed, your doctor may recommend a procedure called an upper endoscopy. It
involves inserting a small, lighted tube (endoscope) through the throat and into the
stomach to look for abnormalities. This procedure is usually given if you are having
severe symptoms of ulcers.
Often, doctors will frequently treat without confirming the diagnosis using endoscopy. If
the cause is not likely to be from NSAIDs, then it is very likely to be from H. pylori.
Most doctors will now test for H. pylori and will treat specifically for that in addition to
giving medications to reduce the symptoms.

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not
properly treated, ulcers can lead to serious health problems.
There are several ways in which ulcers can be treated, including making changes to ones
lifestyle, taking medication, and/or undergoing surgery.
Lifestyle Changes to Treat an Ulcer
To treat an ulcer, first eliminate substances that can be causing the ulcers. If you smoke
or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they
need to be stopped.
Ulcer Medications
Ulcer medications can include:

• Proton pump medications (PPI): Proton pump medications reduce acid levels and allow the ulcer to heal. They include Omeprazole, Esomeprazole, Lansoprazole, Rabeprazole, and Pantoprazole.
• Antibiotics: If you have H. pylori infection, then antibiotics are used. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Some doctors also recommend taking Pepto-Bismol.
• Upper Endoscopy: Some bleeding ulcers can be treated through the endoscope.
• Surgery: Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach or if there is serious bleeding.

No, milk can make your ulcer worse. Milk provides brief relief of ulcer pain because it
coats the stomach lining. But milk can also stimulate your stomach to produce more acid
and digestive juices, which can aggravate ulcers.

You can greatly reduce the chance that you will get a peptic ulcer if you:

• Don't start smoking. If you smoke, quit. Smokers are much more likely to develop ulcers than nonsmokers.
• Avoid taking certain medicines. Avoid taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) for longer than a few days at a time. If you are taking aspirin regularly for heart problems, ask your doctor about taking another medicine to help protect your stomach and intestines from ulcers.
• Drink alcoholic beverages only in moderation. Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Never drink alcohol on an empty stomach.

If ulcers aren't treated or treatment isn't effective, serious complications may occur. The
most common complications include bleeding, perforation of the stomach or duodenal
walls, and obstruction of the digestive tract.
Bleeding
As an ulcer erodes the muscles of the stomach or duodenal wall, blood vessels may also
be damaged, which causes the bleeding. If the affected blood vessels are small, the blood
may slowly seep into the digestive tract. Over a long period of time, a person may
become anemic. If a damaged blood vessel is large, bleeding is dangerous and requires
prompt medical attention. The symptoms of bleeding include feeling weak and dizzy
when standing, vomiting blood, or fainting. The stool may become a tarry, black color
from the blood. Most bleeding ulcers can be treated endoscopically by locating the ulcer
and cauterizing the blood vessel with a heating device or injecting it with material to stop
bleeding. If endoscopic treatment is unsuccessful, surgery may be required.
Perforation
Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. Bacteria and
partially digested food can spill through the opening into the sterile abdominal cavity
(peritoneum). A perforated ulcer can cause peritonitis, an inflammation of the abdominal
cavity and wall. The symptoms of a perforated ulcer include sudden, sharp, severe pain.
Immediate hospitalization and surgery is usually required.
Narrowing and obstruction
Ulcers located at the end of the stomach where the duodenum is attached may cause
swelling and scarring. These ulcers can narrow or close the intestinal opening, and can
prevent food from leaving the stomach and entering the small intestine. As a result, a
person may vomit the contents of the stomach. Endoscopic balloon dilation may be
performed. The endoscopic balloon procedure uses a balloon to force open a narrowed
passage. If the dilation does not relieve the problem, then surgery may be necessary.
Other Diseases
H. pylori has also been weakly associated with other nonintestinal disorders, including
migraine headache, Raynaud's disease (which causes cold extremities), and skin disorders
such as chronic hives.