Gastric and Duodenal Ulcers: Symptoms and Treatment
Key takeaways:
An ulcer can form anywhere along the digestive tract, but the most common locations are the stomach and first part of the small intestine (duodenum).
The most common cause of an ulcer is increased stomach acid, which breaks down the lining of the digestive tract. This process leads to a wound that may bleed or cause burning abdominal pain.
The treatment for most ulcers is medication to help decrease stomach acid and allow the ulcer to heal. When present, treatment of Helicobacter pylori — an infection that causes ulcers — can also help to heal the ulcer.
Almost 6% of people will experience a peptic ulcer at some point in their lifetime. An ulcer is an area of erosion that develops in the lining of the gastrointestinal (GI) tract. You can develop an ulcer anywhere along the GI tract. They are most common in the stomach (a peptic ulcer) and in the first part of the small intestine (a duodenal ulcer). We’ll review the differences between these two types of ulcers along with their symptoms and treatment.
What are the most common types of ulcers?
The two most common types and places that an ulcer forms are:
Gastric ulcers that form in the lining of the stomach
Duodenal ulcers that form in the duodenum, the very first part of the small intestine
Peptic ulcer disease (PUD) refers to both gastric and duodenal ulcers.
Duodenal ulcers are actually more common than gastric ulcers. But both types of ulcers have become less common over time. That’s probably because there are fewer people affected by Helicobacter pylori — a bacteria that causes ulcers (more on this below).
Ulcers can also form in other parts of the GI tract, although this isn’t as common. For example, people who have inflammatory bowel disease (like ulcerative colitis or Crohn's disease) can form ulcers in the intestine. And ulcers can occasionally form in the esophagus.
Causes of gastric and duodenal ulcers
The environment in the stomach is very acidic. This helps to break down food. But an ulcer can form if there’s too much acid or the lining of the stomach or duodenum becomes prone to injury.
The two main reasons that ulcers form are:
Nonsteroidal anti-inflammatory drug (NSAID) and aspirin use, which can affect the lining of the GI tract and make it more susceptible to injury
H. pylori bacteria, which can live in the lining of the digestive tract, causing inflammation that can damage the lining
Although NSAID use and H. pylori cause most peptic ulcers, there are other, much less common causes. Some studies have linked psychological stress to ulcer formation, but research on this is still ongoing. And other studies suggest that cigarette smoking may also increase the risk of peptic ulcer disease.
Symptoms of peptic ulcer disease
Peptic ulcers don’t always cause symptoms. When they do, pain is often the main symptom of both gastric and duodenal ulcers. While everyone experiences their pain differently, people often describe it as follows:
A burning pain in the upper abdomen that lasts for minutes to several hours
Pain that’s often worse on an empty stomach and may improve with eating or antacids — or the pain may get worse a few hours after a meal
Other common symptoms that may be associated with a peptic ulcer include:
Nausea or vomiting
A burning sensation in the chest
Reflux or regurgitation of stomach contents, which may lead to a cough or acidic taste in the mouth
Decreased appetite or feeling full quickly
Weight loss
One of the more serious complications of a peptic ulcer is bleeding. A bleeding peptic ulcer can cause:
Stools that are black and tarry or maroon in color
Vomiting of bright red blood, or vomit that appears to have coffee grounds in it
Fatigue, weakness, and shortness of breath (due to low blood counts, or anemia)
When an ulcer is bleeding, especially if it’s only a small amount, you might not notice it right away. If the bleeding continues at a slow rate over a long period of time, you may need a test to identify low blood counts.
Peptic ulcer treatment
If you have a peptic ulcer, there are a few ways to go about treatment. The recommended treatment depends on your symptoms and your individual health history.
The initial treatment for peptic ulcers always includes a course of proton pump inhibitors (PPIs), medications to help decrease acid in the stomach. And it’s important to let your provider know if you’re taking any NSAIDs or aspirin. They may recommend that you stop taking these medications, since they can worsen ulcers. But don’t stop any medication, especially aspirin, before checking with your provider to make sure it’s safe.
Your provider may also initially recommend testing for H. pylori infection. That’s because it’s such a common cause of ulcers. And if the test is positive, treatment with antibiotics often takes care of the problem.
They may also recommend an endoscopy if you have any factors or symptoms that put you at higher risk of a more serious condition, such as stomach cancer or an ulcer that needs urgent treatment. These risk factors include:
Age over 60
History of ulcers
Family history of stomach or esophageal cancer
Weight loss
Long-standing symptoms that don’t improve with medications
Your provider may also recommend an endoscopy if you have clear signs of active bleeding from an ulcer. Your provider can treat the bleeding during an endoscopy. And they can also do a biopsy to check for H. pylori during the endoscopy.
Most peptic ulcers heal on their own with a course of PPIs and, if necessary, antibiotics for H. pylori. Healing can take anywhere from several weeks to a couple of months.
The bottom line
Ulcers are becoming less common over time, as H. pylori affects fewer people. But they are still a significant cause of abdominal pain and, in some cases, bleeding from the GI tract. Luckily, before they cause any major complications, most ulcers can be treated with a regimen of acid-blocking medication and, if necessary, antibiotics for H. pylori. With the proper treatment, most peptic ulcers will heal after a couple of months.
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References
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