Peptic ulcers are open sores that develop in the lining of your stomach or the first part of your small intestine. These painful sores affect millions of people worldwide and can significantly impact your quality of life if left untreated.

Warning
In April 2020, the FDA requested removal of all ranitidine (Zantac) products from the U.S. market due to contamination with NDMA, a probable cancer-causing chemical (1). If you’re taking ranitidine, stop taking OTC products and talk to your healthcare provider about prescription alternatives. Safe alternatives include famotidine (Pepcid), cimetidine (Tagamet), and proton pump inhibitors.

What Are Peptic Ulcers?

Peptic ulcers are breaks in the protective lining of your digestive system. They occur when stomach acid damages the walls of your stomach or duodenum (the first part of your small intestine).

There are three types of peptic ulcers:

  • Gastric ulcers: These form in your stomach lining
  • Duodenal ulcers: These develop in your duodenum (first part of small intestine)
  • Esophageal ulcers: These occur in the lower part of your esophagus

Duodenal ulcers are the most common type. They tend to heal faster but can come back more easily than gastric ulcers.

Fun Fact
For many years, doctors thought stress and spicy food caused ulcers. We now know that most ulcers are actually caused by bacteria or certain medications.

What Causes Peptic Ulcers?

The two main causes of peptic ulcers have been well established through extensive research.

Helicobacter pylori (H. pylori) Bacteria

H. pylori infection is the most common cause of peptic ulcers. This bacteria is found in about 95% of duodenal ulcers and 70% of gastric ulcers (2).

The bacteria weakens your stomach’s protective mucus coating. This allows stomach acid to damage the underlying tissue, creating an ulcer.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Regular use of NSAIDs like aspirin, ibuprofen, and naproxen can cause peptic ulcers. These medications can damage your stomach lining and reduce its ability to protect itself from acid.

Research shows that using NSAIDs increases your risk of developing ulcers. The risk is even higher if you’re older or have had ulcers before (3).

Other Less Common Causes

While less frequent, other factors can contribute to ulcer development:

  • Smoking
  • Excessive alcohol consumption
  • Severe stress from major illness or surgery
  • Certain rare conditions like Zollinger-Ellison syndrome
Note
Contrary to popular belief, eating spicy food doesn’t cause ulcers. However, it may make your symptoms worse if you already have an ulcer.

Symptoms of Peptic Ulcers

The most common symptom of a peptic ulcer is stomach pain. However, symptoms can vary depending on the location and severity of your ulcer.

Common Symptoms

  • Burning stomach pain: This is the most typical symptom. The pain often feels worse when your stomach is empty
  • Feeling full or bloated: You might feel uncomfortably full even after eating small amounts
  • Heartburn: A burning sensation in your chest
  • Nausea: Feeling sick to your stomach
  • Intolerance to fatty foods: These foods may worsen your symptoms

When to Seek Immediate Medical Care

Some symptoms indicate a serious complication and require immediate medical attention:

  • Vomiting blood (may look red or like coffee grounds)
  • Black, tarry stools
  • Sudden, severe stomach pain
  • Difficulty breathing
  • Feeling faint or actually fainting

These symptoms could mean your ulcer is bleeding or has created a hole in your stomach wall.

Risk Factors

Understanding your risk factors can help you and your doctor prevent ulcers or catch them early.

Major Risk Factors

  • H. pylori infection: Having this bacteria greatly increases your risk
  • Regular NSAID use: Taking these medications frequently, especially at high doses
  • Age: Older adults have a higher risk, especially with NSAID use
  • Smoking: Tobacco use can increase your risk and slow healing
  • Family history: Having close relatives with ulcers may increase your risk

Factors That Can Worsen Ulcers

While these don’t directly cause ulcers, they can make existing ulcers worse:

  • Alcohol consumption
  • Stress
  • Untreated H. pylori infection

Diagnosis

If your doctor suspects you have a peptic ulcer, several tests can confirm the diagnosis.

Tests for H. pylori

Since H. pylori causes most ulcers, testing for this bacteria is usually the first step:

  • Breath test: You drink a special solution and breathe into a bag. This test is very accurate
  • Blood test: Checks for antibodies to H. pylori
  • Stool test: Looks for H. pylori proteins in your stool

Endoscopy

An endoscopy allows your doctor to see your ulcer directly. A thin, flexible tube with a camera is passed down your throat to examine your stomach and duodenum. This test can also take tissue samples if needed.

Upper GI Series

This X-ray test involves drinking a chalky liquid that coats your digestive tract. It’s less commonly used now that endoscopy is widely available.

Treatment Options

Treatment for peptic ulcers has improved dramatically over the years. Most ulcers can now be cured with proper medication.

Treating H. pylori Infection

If you have H. pylori, getting rid of the bacteria is crucial. Treatment usually involves “triple therapy” or “quadruple therapy.”

Triple Therapy

This common treatment combines:

  • A proton pump inhibitor (PPI) to reduce stomach acid
  • Two antibiotics (usually clarithromycin and amoxicillin)

Studies show that different H. pylori treatment regimens have varying success rates. Concomitant therapy has been shown to achieve some of the highest eradication rates among various treatment strategies (4).

Quadruple Therapy

For cases where triple therapy fails or in areas with high antibiotic resistance, quadruple therapy may be used. This adds bismuth to the treatment regimen.

Tip
It’s extremely important to take all your medications exactly as prescribed. Stopping early can lead to antibiotic resistance and treatment failure.

Acid-Reducing Medications

These medications help ulcers heal by reducing stomach acid production.

Proton Pump Inhibitors (PPIs)

PPIs are the most effective acid reducers. They can heal ulcers in 4-8 weeks in most cases. Common PPIs include:

  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)

Research shows that PPIs can heal over 90% of duodenal ulcers within 4 weeks (5).

H2 Receptor Blockers

These medications also reduce acid but are less powerful than PPIs. Available options include:

  • Famotidine (Pepcid)
  • Cimetidine (Tagamet)
  • Nizatidine (Axid)

Note: Ranitidine (original Zantac) was previously a common H2 blocker but has been removed from the market due to safety concerns. The brand name Zantac is now used for a different medication containing famotidine (Zantac 360). If you were taking ranitidine, your doctor can recommend one of the alternatives listed above.

Protective Medications

Some medications protect your stomach lining rather than reducing acid:

  • Sucralfate: Forms a protective coating over ulcers
  • Misoprostol: Helps protect against NSAID-induced ulcers

Antacids

Over-the-counter antacids can provide quick, temporary relief from ulcer pain. However, they don’t heal ulcers and shouldn’t be used as the main treatment. Common antacids include:

  • Tums (calcium carbonate)
  • Mylanta (aluminum and magnesium)
  • Maalox (aluminum and magnesium)

Lifestyle Changes and Home Care

Along with medication, certain lifestyle changes can help your ulcer heal and prevent new ones.

Dietary Recommendations

While diet doesn’t cause ulcers, some foods may worsen symptoms:

  • Avoid foods that trigger your symptoms
  • Eat smaller, more frequent meals
  • Don’t eat close to bedtime
  • Limit alcohol and caffeine

Other Important Changes

  • Quit smoking: Smoking can prevent healing and increase recurrence
  • Manage stress: While stress doesn’t cause ulcers, it can worsen symptoms
  • Avoid NSAIDs: Talk to your doctor about alternatives for pain relief
Warning
Never stop taking prescribed medications without talking to your doctor first. This includes NSAIDs that may have been prescribed for other conditions.

Complications of Peptic Ulcers

Without proper treatment, peptic ulcers can lead to serious complications.

Bleeding

This is the most common complication. Ulcers can erode blood vessels, causing bleeding that ranges from slow and chronic to sudden and life-threatening.

Studies show that endoscopic treatment can significantly reduce rebleeding rates in patients with bleeding ulcers (6).

Perforation

An ulcer can create a hole through your stomach or intestinal wall. This is a medical emergency requiring immediate surgery.

Obstruction

Swelling and scarring from ulcers can block food from passing through your digestive tract. Scar tissue can develop after an ulcer heals, creating a narrow passage. This may cause:

  • Repeated vomiting
  • Feeling full quickly
  • Unexplained weight loss
  • Inability to eat normal amounts of food

Gastric Cancer

While rare, chronic H. pylori infection can increase your risk of stomach cancer. This is one reason why treating H. pylori is so important.

Prevention

You can take several steps to reduce your risk of developing peptic ulcers.

Protect Yourself from H. pylori

  • Wash your hands frequently
  • Eat food that’s been properly prepared
  • Drink water from safe sources

Use NSAIDs Safely

If you need to take NSAIDs regularly:

  • Take the lowest effective dose
  • Take them with food
  • Ask your doctor about protective medications

Research shows that PPIs can effectively prevent NSAID-related ulcers in high-risk patients (7).

Healthy Lifestyle Choices

  • Don’t smoke
  • Limit alcohol consumption
  • Manage stress through exercise, meditation, or other relaxation techniques

Living with Peptic Ulcers

Most people with peptic ulcers recover completely with proper treatment. However, it’s important to follow your treatment plan and attend follow-up appointments.

Follow-Up Care

Your doctor may recommend:

  • Repeat testing to ensure H. pylori is gone
  • Follow-up endoscopy for gastric ulcers to ensure healing
  • Long-term acid suppression if you must continue NSAIDs

When to Contact Your Doctor

Contact your healthcare provider if:

  • Your symptoms don’t improve with treatment
  • You develop new or worsening symptoms
  • You have side effects from medications
  • You need to start taking NSAIDs
Summary
Peptic ulcers are treatable conditions that usually heal completely with proper medication. The key is getting an accurate diagnosis and following your treatment plan. Most ulcers are caused by H. pylori bacteria or NSAIDs, both of which can be effectively managed.

Refractory Ulcers (Ulcers That Won’t Heal)

Some ulcers don’t heal despite proper treatment. These are called refractory ulcers and may occur for several reasons.

Common Causes of Refractory Ulcers

  • Continuing NSAID use: Even small amounts can prevent healing
  • Smoking: Tobacco use significantly slows healing
  • H. pylori resistance: The bacteria may be resistant to standard antibiotics
  • Zollinger-Ellison syndrome: A rare condition causing excess acid production
  • Stomach cancer: In rare cases, what appears to be an ulcer may be cancer

Treatment Approaches

If your ulcer isn’t healing:

  • Your doctor may increase your medication dose
  • Different antibiotics may be tried for H. pylori
  • Additional testing may be needed to rule out other conditions
  • Surgery may be considered in severe cases

Frequently Asked Questions

How long does it take for a peptic ulcer to heal?

With proper treatment, most duodenal ulcers heal within 4-6 weeks, while gastric ulcers may take 6-8 weeks. However, you’ll likely feel better much sooner, often within a few days of starting treatment.

Can peptic ulcers come back?

Yes, ulcers can recur, especially if H. pylori isn’t completely eliminated or if you continue taking NSAIDs. Studies show that successful H. pylori eradication significantly reduces recurrence rates.

Do I need to follow a special diet?

There’s no specific “ulcer diet,” but you should avoid foods that worsen your symptoms. Most people can return to their normal diet once the ulcer heals.

Can stress cause peptic ulcers?

Stress alone doesn’t cause ulcers, but severe physical stress (like from major surgery or critical illness) can contribute to ulcer formation. Regular life stress may worsen symptoms but isn’t a direct cause.

Can peptic ulcers be completely cured?

Yes, most peptic ulcers can be completely cured with proper treatment. However, some ulcers (called refractory ulcers) may not heal with standard treatment and require additional testing and different medications. The key is following your treatment plan and working with your doctor if the first treatment doesn’t work.

Conclusion

Peptic ulcers are common but treatable conditions. With modern medicine, most people can expect complete healing and return to normal life. The key is recognizing symptoms early and getting proper treatment.

If you think you might have an ulcer, don’t delay seeking medical care. Early treatment can prevent complications and get you feeling better faster. Remember that successful treatment usually involves taking all prescribed medications, making necessary lifestyle changes, and following up with your healthcare provider.

With the right approach, you can heal your ulcer and take steps to prevent future ones. Your digestive health is important for your overall well-being, so don’t hesitate to seek help when you need it.

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