Peptic Ulcer Disease: Your GoodRx Guide

Definition

Peptic ulcer disease (PUD) is a condition in which small sores develop in the lining of the stomach or the beginning of the small intestine. “Ulcer” means sore, and “peptic” refers to stomach acid.

There are two common types of ulcers in peptic ulcer disease:

• Gastric ulcer: A sore in the lining of the stomach.

• Duodenal ulcer: A sore in the first part of the small intestine (the duodenum).

Some people with PUD have gastric ulcers, others have duodenal ulcers, and some may even have both at the same time. In general, duodenal ulcers are more common than gastric ulcers.

Sometimes, acid reflux can also cause ulcers to form in the esophagus — which is the tube that connects the mouth to the stomach — but these are not as common.

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Causes

There are two most common causes of PUD:

• A stomach bacteria known as H. pylori

• Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)

H. pylori is a very common bacteria that can live in the stomach and first part of the small intestine. It causes 70% to 90% of gastric ulcers and 90% of duodenal ulcers. But it doesn’t always cause problems — some people can have H. pylori and never develop ulcers or even any symptoms.

NSAIDs are medications commonly used to treat pain, swelling, and fever. Examples include ibuprofen, naproxen, and meloxicam. Long-term use of NSAIDs can break down the protective lining of the stomach, making it more likely to develop ulcers.

Less common causes of PUD include medications, like steroids, bisphosphonates, and fluorouracil. Medical conditions like Zollinger-Ellison syndrome, hyperparathyroidism, and cystic fibrosis can increase the amount of acid in the stomach. And, in some cases, having a family history of PUD can increase the risk of developing the condition.

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Symptoms

Common symptoms of PUD include:

• A dull or burning pain in the upper middle abdomen that comes and goes

• Bloating or a sense of fullness

• Nausea and vomiting

• Weight loss

For some people, eating food may make the pain better. For others, eating may make the pain worse. Sometimes, antacid medications may relieve the pain for a short time.

In some cases, the ulcer may start bleeding. When an ulcer bleeds, it can sometimes cause bloody vomiting that may be bright red or may look like coffee grounds. Other times, the blood passes through the rest of the gastrointestinal tract instead. When this happens, stool can develop a dark and sticky appearance.

If an ulcer bleeds quickly, you may feel lightheaded or faint. But if the bleeding is slow, you may not notice anything at all. But, over time, it can cause anemia, which can lead to fatigue, weakness, pale skin, and shortness of breath.

Many people with PUD may never have symptoms. Without symptoms, you may not even know you have a peptic ulcer unless it bleeds or you have an endoscopy for a different reason.

Diagnosis

One of the biggest clues that leads to a PUD diagnosis is the way someone describes their symptoms. Although testing is often performed to confirm the diagnosis. And the most definitive way to do this is with an upper endoscopy, or EGD.

An EGD is a medical procedure where a gastroenterologist passes a small camera through the mouth, down the esophagus, and into the stomach and first part of the intestine. If there is an ulcer in the esophagus, stomach, or duodenum, it is often visible. Gastroenterologists can biopsy ulcers during the procedure to check for H. pylori and can treat bleeding if necessary.

But an EGD is not always necessary. In some people, their symptoms and a test for H. pylori may be enough to make the diagnosis. This can be done with a blood, breath, or stool test.

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Medications

Medications for PUD are geared toward treating the underlying cause of the problem as well as alleviating any symptoms. This is because treating the cause is what will help the ulcer heal. Because H. pylori is the most common cause of PUD, treatment often includes a 1-to-2 week course of antibiotics. Commonly used antibiotics include clarithromycin, metronidazole, and amoxicillin.

Acid-reducing medications, called proton pump inhibitors or H2 blockers, are also commonly used to treat PUD. Examples include omeprazole or pantoprazole. Often, antibiotics and acid-reducing medications are used together.

Stopping medications that may be making the ulcer worse, like NSAIDs, is also important in helping the ulcer heal.

Treatments

Besides medication, endoscopy can also play a role in treatment for PUD. Endoscopy lets gastroenterologists see the ulcer so they can evaluate how well medications are working, biopsy the tissue, and treat any bleeding. Some people with PUD need to have repeat endoscopies during the course of treatment.

If an ulcer does not heal despite medications, or if someone is at high risk of complications from the ulcer, the next step may be surgery. Surgeries for peptic ulcer disease include vagotomy and partial gastrectomy. But these procedures are becoming less common and may only be necessary in emergency cases, like if the ulcer causes serious bleeding or organ perforation. 

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Prevention

If you have had an ulcer before or may be at higher risk of having an ulcer, there may be a couple of things you can do to try to prevent an ulcer from forming. For example, avoiding medications and other substances that can irritate the stomach lining, like NSAIDs, tobacco, alcohol, and caffeine, may help keep you from developing an ulcer. Weight loss has also helped some people with PUD.

Many people wonder if avoiding certain foods or decreasing stress may prevent peptic ulcers, but there is no definitive evidence to suggest this is true.

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