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Alternative Names Return to topUlcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer
Definition Return to top
A peptic ulcer is erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum.
If the peptic ulcer is located in the stomach it is called a gastric ulcer.
Causes Return to top
Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in your stomach. But for a variety of different reasons, the protective process can stop working correctly, and the lining breaks down. The results in inflammation (gastritis) or an ulcer.
Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through is called a perforation. A perforation is a medical emergency.
The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have such bacteria in their stomach do not develop an ulcer.
The following also raise your risk for peptic ulcers:
If you have a family history of ulcers or the blood type O, you are more likely to get a duodenal ulcer.
A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas that releases high levels of a hormone, which causes an increase in stomach acid.
Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home. However, a very ill patient who is on a breathing machine is at risk for so-called “stress ulceration.”
Symptoms Return to top
Small ulcers may not cause any symptoms. Large ulcers can cause serious bleeding.
Abdominal pain is a common symptom but it doesn't always occur. The pain can differ a lot from person to person. For example, it may get better or worse after eating a meal.
Other possible symptoms include:
Exams and Tests Return to top
To diagnose an ulcer, your doctor will order one of the following tests:
Your doctor may also order these tests:
Treatment Return to top
Treatment involves a combination of medications to kill the H. pylori bacteria (if present), reduce acid levels, and protect the GI tract. This strategy allows your ulcer to heal and reduces the chance it will come back.
Take all of your medications exactly as prescribed.Medications may include one or more of the following:
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.
Outlook (Prognosis) Return to top
Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will be cured and you'll be much less likely to get another ulcer.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Call 911 if you:
Call your doctor if:
Prevention Return to top
Lifestyle changes may help prevent peptic ulcers:
References Return to top
Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005-12.
Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. Aug 2007;102(8):1808-25.
Malagelada JR, Kuipers EJ, Blaser MJ. Acid peptic disease: clinical manifestations, diagnosis, treatment, and prognosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 142.Update Date: 9/7/2008 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.