Stomach Ulcer

What is a stomach ulcer?

A stomach ulcer, also called a gastric ulcer, is an open sore that develops in your stomach lining. You can also get one in your duodenum, the first part of the small intestine that your stomach feeds into. Duodenal ulcers and stomach ulcers are both types of peptic ulcers. They’re named for pepsin, one of the digestive juices that are found in the stomach and that sometimes leak into the duodenum. These juices are a contributing factor in peptic ulcer disease.

Peptic ulcers occur when the protective mucous lining in your stomach and duodenum has been eroded, allowing gastric acids and digestive enzymes to eat away at your stomach and duodenal walls. This eventually results in open sores that are continually irritated by the acid. If left untreated, they can begin to cause serious complications, such as internal bleeding. Over time, they can even wear a hole all the way through. This is a medical emergency.

How common are stomach ulcers?

Stomach ulcers are very common in Western countries. In the United States, there are about 4 million cases per year. Some estimates say that 1 in 10 people will have one at some point in their lives. That’s because many of the causes that contribute to stomach ulcers are common in Western life. Fortunately, these causes are usually easy to trace and to reverse, giving ulcers a chance to heal and your stomach lining a chance to repair.

What causes stomach ulcers?

The two most common causes are:

• H. pylori infection. This common bacterial infection affects up to half of people worldwide. It primarily lives in the stomach. In many people, it doesn’t seem to cause problems. Their gut immune systems keep it in check. But a portion of those infected have H. pylori overgrowth. The bacteria continue to multiply, eating into the stomach lining and causing chronic inflammation and peptic ulcer disease. H. pylori infection is associated with about 60% of duodenal ulcers and 40% of gastric ulcers.
• Overuse of NSAIDs. NSAID stands for “non-steroidal anti-inflammatory drug." These include common over-the-counter pain relief medications such as ibuprofen, naproxen and aspirin. NSAIDs contribute to ulcers in several ways. They irritate the stomach lining on contact and repress some of the chemicals that defend and repair the mucous lining. Up to 30% of people who take NSAIDs regularly develop peptic ulcers. Up to 50% of all peptic ulcers are caused by the overuse of NSAIDs.

Less common causes of stomach ulcers include:

• Zollinger-Ellison Syndrome. This is a rare condition that causes your stomach to produce too much gastric acid.
• Severe physiological stress. Severe illness, burns or injuries can produce stress ulcers in the stomach. Physiological stress changes your body’s PH balance, increasing stomach acid. Stress ulcers develop very quickly in response to stress, unlike normal stomach ulcers that develop gradually.

What are the symptoms of peptic ulcer disease?

Some peptic ulcers don’t cause symptoms. These are called “silent ulcers." But the following symptoms are common with both duodenal and gastric ulcers:

• Burning stomach pain.
• Bloated stomach.
• Indigestion, especially of fatty foods.
• Nausea and vomiting.

What does a stomach ulcer feel like?

The classic symptoms of peptic ulcers are stomach pain and indigestion. Ulcer pain feels like burning or gnawing inside your stomach, which is between your breastbone and your belly button. It may improve temporarily when you eat or drink or when you take an antacid, medication to reduce stomach acid. It may feel worse between meals and at night when stomach acid builds up without food to digest. It may also make you feel like you don’t want to eat.

How do I know if I have an ulcer or gastritis?

Gastritis and gastric ulcers share many symptoms and often go hand in hand. Gastritis can be a precursor to stomach ulcers, caused by the same conditions that will eventually cause ulcers, including H. pylori infection and mucous erosion. You may also have both.

Both gastritis and stomach ulcers can cause stomach pain, as well as symptoms of indigestion. Usually, the pain from an ulcer will feel more localized — like it’s coming from one particular spot. But since some ulcers are “silent,” you might not feel it if you do have one.

If you have symptoms of either gastritis or stomach ulcer, you should seek medical care. Gastritis can lead to ulcers if it hasn’t already. It can also indicate an infection or other condition that needs to be treated. Medical testing can quickly determine the causes of your stomach pain.

How can I tell if I have ulcer pain or heartburn?

Ulcer pain in your stomach area can feel very similar to heartburn. It’s often described as a burning kind of pain. Usually, ulcer pain will be localized at the site of the ulcer, which is in the stomach or small intestine. Heartburn covers a broader area and tends to be higher into the chest. However, you could have heartburn and ulcer pain at the same time.

Heartburn is usually caused by acid reflux, which is when acid from your stomach travels back up through your esophagus. So, heartburn may start as low as your stomach, but it will also travel upwards from there. If your pain is higher than your breast bone, that’s probably heartburn — but it doesn’t mean you don’t have an ulcer too. Acid reflux can also be a symptom of a stomach ulcer.

What triggers stomach ulcer symptoms?

Stomach ulcers are irritated by stomach acid. Some people notice this irritation more after they eat, and some people notice it more on an empty stomach. There are also certain irritants that seem to make ulcer symptoms worse and make them more difficult to heal. Smoking and alcohol are the biggest ones.

What are the possible complications of peptic ulcer disease?

An ulcer left untreated may cause serious complications, including:

• Internal bleeding: While most people with ulcers won’t have bleeding, this is the most common complication that can occur. A slow bleeding ulcer can cause anemia or even severe blood loss.
• Perforation: An ulcer that is continuously eroded by acid can eventually become a hole in the stomach or intestinal wall. This is intensely painful and also dangerous. It allows bacteria from the digestive tract to enter the abdominal cavity, which can lead to an infection of the abdominal cavity called peritonitis. From there, the infection is at risk of spreading to the rest of the body (septicemia). This can lead to a life-threatening condition called sepsis.
• Obstruction: An ulcer in the pyloric channel, the narrow passageway that leads from the stomach into the duodenum, can become an obstruction that blocks the flow of food into the small intestine. This can happen after the ulcer has healed. Ulcers that have gone through a healing process may build up scar tissue that enlarges them. An ulcer that is big enough to obstruct the small intestine can stall the digestive process, with numerous side effects.
• Stomach cancer: Some gastric ulcers can become malignant over time. This is more likely when your ulcer is caused by H. pylori infection. H. pylori is a contributing cause of gastric cancer, though fortunately, this is uncommon.

What are the symptoms of a bleeding ulcer?

Bleeding ulcers don’t always cause pain. Sometimes the first signs of a bleeding ulcer are signs of anemia. These include:

• Dizziness or lightheadedness.
• Weakness.
• Fatigue.
• Shortness of breath.

You might have a heavier bleed if you notice:

• Blood in your poop, or black poop that resembles tar.
• Bloody vomit.

These symptoms require urgent medical attention.

How is a stomach ulcer diagnosed?

Your healthcare provider will ask you about your symptoms and medical history. They will want to know if you frequently use NAIDs or have a history of H. pylori infection. If signs point to an ulcer, they will want to take a look inside your stomach and duodenum.

What tests will be done to diagnose a peptic ulcer?

Endoscopy. An upper endoscopy exam is expedient because allows healthcare providers to see inside your digestive tract and also take a tissue sample to analyze in the lab. The test is done by passing a thin tube with a tiny camera attached down your throat and into your stomach and duodenum. You’ll have medication to numb your throat and help you relax during the test. Your healthcare provider may use the endoscope to take a tissue sample to test for signs of mucous damage, anemia, H. pylori infection or malignancy. If they take a sample, you won’t feel it.

Imaging tests. Imaging tests to look inside the stomach and small intestine include:

• Upper GI series. An upper GI X-ray exam examines the stomach and duodenum through X-rays. It’s less invasive than an endoscopy. For the X-ray, you’ll swallow a chalky fluid called barium, which will coat your esophagus, stomach and duodenum. The barium helps your digestive organs show up better in black and white images.
• CT scan. Your healthcare provider might recommend a CT scan if they need to see your organs in more detail. A CT scan can show complications such as a perforation in the stomach or intestinal wall. For the test, you’ll lie on a table inside a scanner machine while X-rays are taken. You may drink or have an injection with contrast fluid to make your organs show up better in images.

Tests for H. pylori. Your healthcare provider might want to test you separately for H. pylori infection. Tests may include:

• Blood test. A blood test is a quick and simple way to test for prior H. pylori infection. The lab looks for evidence of antibodies to the bacteria in your blood. It’s not as accurate for diagnosing an active infection, though.
• Stool test. Healthcare providers can also find H. pylori in your poop. They might want to look at your poop if you have noticed changes in it.

Breath test. The H. pylori breath test is an accurate test for diagnosing an active H. pylori infection. For the test, you’ll drink a flavored solution containing an organic chemical compound called urea. If H. pylori bacteria are present in your digestive tract, they will break down the urea and convert it to carbon dioxide. The carbon dioxide will come out in your breath. When you breathe into a bag, healthcare providers will be able to measure it.

How are stomach ulcers treated?

Ulcers can heal if they are given a rest from the factors that created them. Healthcare providers treat uncomplicated ulcers with a combination of medicines to reduce stomach acid, coat and protect the ulcer during healing and kill any bacterial infection that may be involved. Medicines may include:

• Antibiotics. If H. pylori was found in your digestive tract, your healthcare provider will prescribe some combination of antibiotics to kill the bacteria, based on your medical history and condition. Commonly prescribed antibiotics include tetracycline, metronidazole, clarithromycin and amoxicillin.
• Proton pump inhibitors (PPIs). These drugs help reduce stomach acid and protect your stomach lining. PPIs include esomeprazole, dexlansoprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole.
• Histamine receptor blockers (H2 blockers). These reduce stomach acid by blocking the chemical that tells your body to produce it (histamines). H2 blockers include famotidine, cimetidine and nizatidine.
• Antacids. These common over-the-counter medicines help to neutralize stomach acid. They may bring some symptom relief, but they aren’t enough to heal your ulcer. They also might interfere with some antibiotics.
• Cytoprotective agents. These medicines help to coat and protect your stomach lining. They include sucralfate and misoprostol.
• Bismuth Subsalicylate. This over-the-counter medicine, commonly found as Pepto-Bismol, can help coat and protect your ulcer from stomach acid. (Note: Bismuth might turn your poop black, but this effect looks different from the sticky, tarry appearance of blood in your poop.)

What about complicated ulcers?

While most ulcers are successfully treated with medication, some complicated ulcers may require surgery. Ulcers that are bleeding, or that have perforated your stomach or intestinal wall, will need to be surgically repaired. An ulcer that is malignant, or obstructing a passageway, will need to be surgically removed. In severe cases, an ulcer that keeps coming back may be treated by surgery to cut off some of the nerve supply to the stomach that produces stomach acid.

How soon after treatment will I feel better?

If you take all medicines as prescribed and avoid irritating the ulcer with NSAIDs, alcohol or smoking, your ulcer should heal well within a few weeks. Surgical cases may take a few weeks more. Your healthcare provider will follow up with you at the end of your course of medication to make sure the ulcer has healed and any infection has cleared. They will probably take follow-up tests, including an upper endoscopy to look at the site of the ulcer and tests for H. pylori, if you had it, to make sure the infection is gone.

Should I follow a diet while my ulcer is healing?

It’s a good idea to be conscious of your diet and avoid things that might aggravate your ulcer and prolong the healing process. Balance overly acidic foods, including grains, dairy and meat products, with alkaline foods such as fruits and vegetables. Avoid alcohol and caffeine while healing.

How can I prevent a stomach ulcer from occurring or returning?

• Reduce NSAID use, if possible. Consider whether acetaminophen (Tylenol®) might substitute. If you take NSAIDs for medical reasons, talk to your doctor about reducing your dosage or switching your medication. Your doctor may also prescribe another medicine to take with NSAIDs to protect your stomach lining.
• Reduce other irritants that may contribute to too much stomach acid or erode your stomach lining, including smoking and alcohol use.
• Take an H. pylori breath test to find out if you have an overgrowth of the bacteria.

Can stomach ulcers just go away?

Some ulcers follow a chronic pattern of healing temporarily on their own and then returning. This might happen if the factors contributing to your ulcer, such as NSAID use, smoking and alcohol, are temporarily reduced and then resumed. You won’t completely heal your ulcer until you eliminate the cause, whether that is chronic NSAID use, H. pylori infection or an overactive stomach. Even after successful treatment, you can get another ulcer.

What should I do if I think I have a stomach ulcer?

Always seek medical care for a stomach ulcer. While you may be able to manage symptoms temporarily with over-the-counter medications, these won’t heal the ulcer. You need to identify and treat the underlying cause. An untreated ulcer can lead to serious complications, even if your symptoms are mild. The major cause of stomach ulcers, H. pylori infection, can also lead to other complications.

When should I go to ER?

Seek emergency care if you have:

• Severe pain that doesn’t go away.
• Signs of blood in your poop or bloody vomit.
• Signs of severe blood loss, such as paleness and faintness.

A note from Cleveland Clinic

Stomach ulcers are common and treatable, but they should be taken seriously. Even when they don’t cause symptoms, they aren’t a good sign. A stomach ulcer means that your natural stomach acid is overwhelming your protective stomach lining. That’s a situation that can only get worse if it isn’t managed. Lifestyle changes may help, but you’ll still need to treat the underlying cause. It’s probably either NSAID use or a common bacterial infection. Your healthcare provider can help prescribe the right medicines for your condition.