Overview
A burning pain in the upper stomach, often worse on an empty stomach or in the middle of the night, is the classic sign of a peptic ulcer. What surprises many people is that the most common cause is not stress or spicy food, as was long believed, but a common, treatable bacterial infection.
Disease Summary
- Category
- Infectious Disease
- Cause
- Most often infection with Helicobacter pylori bacteria; also caused by long-term use of NSAID pain medications
- Transmission
- H. pylori spreads through contaminated food or water, and close contact such as sharing utensils; ulcers caused by NSAID use are not infectious
- Body System
- Digestive System
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Some people with a peptic ulcer have no symptoms at all. When symptoms occur, they typically include the following.
Burning Stomach Pain
Often felt in the upper abdomen, and classically worse when the stomach is empty, such as at night or between meals.
Bloating
A feeling of fullness or bloating can accompany the discomfort.
Nausea
Can occur alongside the pain, particularly after eating.
Heartburn
A burning sensation that can extend up toward the chest.
Discomfort After Eating
Some people notice their pain worsens, rather than improves, after meals.
Danger Signs
Seek emergency medical attention immediately if any of the following develop.
Vomiting Blood or Dark, Coffee-Ground-Like Vomit
A sign of active bleeding from the ulcer and needs emergency care.
Black or Tarry Stools
Indicates bleeding higher in the digestive tract and needs urgent medical attention.
Sudden, Severe Abdominal Pain
Can indicate the ulcer has perforated the stomach or intestinal wall, a surgical emergency.
Feeling Faint or Dizzy
Can indicate significant blood loss and needs prompt evaluation.
Diagnosis
Clinical History
Doctors ask about the pattern of pain, medication use, particularly NSAIDs, and any family history of ulcers.
H. pylori Testing
A breath, stool, or blood test can detect this bacterium, the leading cause of peptic ulcers.
Upper Endoscopy
A thin, flexible camera is used to directly examine the stomach and duodenum, confirm the ulcer, and take a tissue sample if needed.
Laboratory Tests
Urea Breath Test
Detects an active H. pylori infection by measuring a substance the bacteria produce.
Stool Antigen Test
Detects H. pylori proteins in the stool and is commonly used both to diagnose infection and to confirm it has been cleared after treatment.
Blood Antibody Test
Checks for antibodies to H. pylori, though it cannot distinguish between a current and a past infection.
Upper Endoscopy with Biopsy
Allows direct visual examination of the ulcer and testing of a tissue sample for H. pylori.
Treatment
H. pylori Eradication Therapy
A combination of antibiotics and an acid-reducing medication clears the infection and allows the ulcer to heal, significantly reducing the chance it will return.
Acid-Reducing Medication
Reduces stomach acid to allow the ulcer to heal, used for ulcers caused by NSAIDs as well as those caused by H. pylori.
Prevention
Practise good hygiene
Regular handwashing and avoiding sharing utensils or cups can reduce the spread of H. pylori.
Use NSAIDs cautiously
Using the lowest effective dose for the shortest time needed, or taking a protective medication if long-term use is necessary, lowers ulcer risk.
Avoid smoking
Smoking slows ulcer healing and increases the risk of complications.
Limit alcohol
Heavy alcohol use can irritate the stomach lining and interfere with healing.
Risk Factors
Higher Risk
These factors are the leading causes of peptic ulcer disease.
- H. pylori infection
- Regular or long-term use of NSAIDs, such as aspirin or ibuprofen
Contributing Factors
These factors increase the risk or slow healing of peptic ulcers.
- Smoking
- Heavy alcohol use
- Older age
Additional Considerations
Less common but important contributing factors.
- A family history of peptic ulcers
- Severe physical stress, such as critical illness or major injury
Complications
Bleeding
The most common serious complication, ranging from slow, ongoing blood loss to sudden, severe bleeding.
Perforation
A hole through the stomach or intestinal wall is a surgical emergency that can lead to a serious abdominal infection.
Gastric Outlet Obstruction
Scarring from repeated ulceration can narrow the passage out of the stomach, causing persistent vomiting.
When to Seek Medical Care
Vomiting Blood or Dark, Coffee-Ground-Like Vomit
Needs emergency medical attention.
Black or Tarry Stools
Needs urgent medical evaluation.
Sudden, Severe Abdominal Pain
Can indicate a serious complication and needs emergency care.
Persistent Stomach Pain Despite Over-the-Counter Antacids
Should be evaluated by a healthcare provider rather than managed indefinitely on your own.
Prognosis
Excellent With Appropriate Treatment
Most peptic ulcers heal completely within a few weeks once the underlying cause is treated.
Recurrence Is Uncommon After Successful H. pylori Treatment
Confirmed eradication of the infection significantly reduces the chance of a new ulcer developing.
Untreated Ulcers Can Lead to Serious Complications
Ongoing bleeding, perforation, or obstruction can develop if the underlying cause is not addressed.
Differential Diagnosis
Gastritis
Inflammation of the stomach lining without a distinct ulcer, sometimes caused by the same factors as peptic ulcers.
Gastroesophageal Reflux Disease (GERD)
Causes heartburn and discomfort but arises from acid moving up into the oesophagus rather than a break in the stomach or duodenal lining.
Gallbladder Disease
Can cause upper abdominal pain that is sometimes mistaken for a peptic ulcer, particularly after fatty meals.
References
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Diagnosis
Clinical guidance on diagnosing peptic ulcers and identifying their underlying cause.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Treatment
Clinical guidance on treating peptic ulcers, including H. pylori eradication therapy.
World Gastroenterology Organisation Global Guidelines: Helicobacter pylori
Global clinical guidelines on H. pylori diagnosis, treatment, and its role in peptic ulcer disease worldwide.
Frequently Asked Questions
Can peptic ulcers be cured?
Yes, in most cases. When H. pylori infection is the cause, a course of antibiotics along with acid-reducing medication cures the underlying infection and allows the ulcer to heal, greatly reducing the chance it comes back.
Is H. pylori contagious?
Yes. It spreads through contaminated food or water, and through close contact such as sharing utensils, most often within families.
Do spicy foods cause ulcers?
No, though they can sometimes worsen symptoms in people who already have an ulcer. The two leading causes are H. pylori infection and long-term use of NSAID pain medications.
Can I take ibuprofen if I've had an ulcer before?
This is worth discussing with a doctor. If NSAIDs are necessary, a protective medication can sometimes be used alongside them to reduce the risk of another ulcer.