Stomach Ulcers


An ulcer is a disruption of the surface of the skin or a mucus membrane, which results in an open sore that may heal very slowly. Ulcers can develop on many areas of the body but the most common ulcers are found in the gastrointestinal tract. About one in every 10 Americans will suffer from a stomach ulcer, which results in abdominal pain and sometimes bleeding. Stomach ulcers are also known as gastric ulcers.

Causes of Stomach Ulcers

There is no single cause for ulcers. Ultimately, ulcers are the result of an imbalance between irritating and neutralizing digestive fluids in the stomach. The three most common causes of stomach ulcers are:

  • Infection
  • Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, sodium naproxen, etc.
  • Excess acid production from gastrinomas—tumors of the acid-producing cells in the stomach that results in increased acid secretion

Stomach ulcers are most often caused by an infection with Helicobacter pylori (H. pylori) bacteria. The bacteria infect the lining of the stomach, which may lead to gastric ulcers. Unless the H. pylori is treated, you may still suffer from symptoms.

H. pylori can be spread from person to person, but it is not completely understood how this happens. Although many individuals are infected at a young age, symptoms usually do not occur until adulthood.

Common Symptoms of Stomach Ulcers

Most people assume that ulcers develop from over-production of acid. However, reduced stomach acid can produce similar symptoms. Reduced acid production can make you more susceptible to H. pylori because the bacteria can thrive in a low acid environment. Therefore, people with H. pylori are more likely to have low stomach acid. Whether you have high acid production or low acid production, these are common symptoms of stomach ulcers:

  • Abdominal pain—caused by overproduction of acid or by H. pylori. Painful inflammation of the stomach and small intestinal lining can be caused by H. pylori.
  • Heartburn—caused by high stomach acid or H. pylori. If stomach acid production decreases, it is harder for the stomach to digest efficiently. This causes food to sit in the stomach longer, which in turn gives off gas and causes a burning sensation in the stomach and esophagus.
  • Anemia—may be caused by a bleeding ulcer
  • Chest pain—may be due to high or low acid production. H.pylori infection causes inflammation in the stomach, and the pain signals from the abdomen can be felt in the chest.
  • Halitosis (bad breath)—H.pylori creates ammonia, which creates bad breath
  • Nausea—commonly accompanies heartburn due to high or low acid production
  • Weight loss—can be caused by inadequate digestion

Rare Symptoms of Stomach Ulcers

Some symptoms of stomach ulcers can be life-threatening and require immediate medical attention. These symptoms occur in rare cases but should not be ignored. Life-threatening symptoms include:

  • Severe abdominal pain
  • Bloody stool (may appear red, black or tarry)
  • Vomiting blood or black material (resembling coffee grounds)

Risk Factors of Stomach Ulcers

Certain risk factors affect your likelihood of developing stomach ulcers. Some of these factors may include:

  • H. pylori infection
  • Age over 50
  • Family history of ulcers
  • Liver, kidney or lung disease
  • Alcohol use
  • Tobacco use
  • Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDS) like Advil, Motrin, Aleve or aspirin
  • Severe illness

Tests to Diagnose Stomach Ulcers

To confirm that you may have an ulcer, your doctor may ask you to take an acid-blocking medication for a set amount of time to see if your symptoms improve.

Your doctor may also order an upper endoscopy. This procedure uses a flexible tube with a light and camera attached so your doctor can inspect your esophagus, stomach and small intestine for signs of an ulcer.

If your doctor suspects that your ulcer may be due to an infection of H. pylori, you may be given a test that detects H. pylori. If the test is positive, your doctor will administer antibiotics.

Treatment Options for Stomach Ulcers

Depending on the cause of your stomach ulcer, treatment options will vary. If your stomach ulcer is not caused by H. pylori, your doctor will most likely prescribe antacids or other medications. Proton pump inhibitors (PPIs) and histamine (H2) receptor antagonists are common medications that doctors may prescribe to relieve your symptoms of a stomach ulcer.

PPI medications may include:

  • Esomeprazole (Nexium)
  • Lansaprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Pantoprazole (Protonix)
  • Rabeprazole (Aciphex)

H2 receptor antagonists may include:

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)
  • Ranitidine (Zantac)

If H. pylori is the cause of your gastric ulcers, your doctor can prescribe antibiotics. You must follow your antibiotic regimen exactly as prescribed by your doctor or you will risk recurrence of infection.

Most often, your doctor will prescribe two antibiotics for 14 days. You may be given antibiotics such as:

  • Amoxicillin
  • Clarithromycin (Biaxin)
  • Metronidazole (Flagyl)
  • Tetracycline

Complications from Stomach Ulcers

If you do not seek medical treatment for your stomach ulcer, your condition may worsen and put you at risk for serious complications such as:

  • Perforated gastric ulcer
  • Severe pain
  • Internal bleeding- mild blood loss can result in anemia, but significant blood loss can require hospitalization and a blood transfusion. In most severe cases, blood loss can cause black or bloody vomit and/or stools.
  • Scar tissue- Ulcers are sores and healing can create scar tissue. Scar tissue from stomach ulcers can block food in the intestines, causing you to feel full and lose weight.

Preventing Stomach Ulcers

There is currently no vaccine to prevent stomach ulcers. Since some people develop stomach ulcers without being infected with H. pylori, it is difficult to determine the reason or source of the ulcer. You can greatly decrease the risk of developing a stomach ulcer or you can reduce the severity of ulcer symptoms if you:

  • Avoid smoking- Smokers are more likely to develop ulcers than nonsmokers.
  • Take NSAIDs only in moderation—Ibuprofen, aspirin and other nonsteroidal anti-inflammatory drugs should only be taken for a few days at a time. If you take aspirin to prevent heart problems, talk to your doctor about how to reduce the risk of an ulcer while taking this medication.
  • Limit alcohol intake—Men should have no more than two drinks per day and women should have no more than one drink per day.
  • Avoid foods that irritate your digestive system—know your own stomach and pay attention to what irritates your stomach. Limit the foods that cause heartburn and irritation. Common foods that irritate the stomach are spicy foods, citrus, tomato-based foods, chocolate and fatty foods.
  • Exercise regularly—stress may be connected to ulcers. Regular exercise and relaxation techniques can keep stress at a manageable level.
  • Wash hands regularly— No one knows exactly how H. pylori spreads from one person to another. Since H. pylori is communicable, you can reduce your risk of infection by H. pylori by good hygiene habits such as washing your hands thoroughly and often with soap and water.

Since ulcers have such a variety of sources and symptoms, a diagnosis and plan of treatment should be made by your doctor. Make an appointment to see your doctor if you are experiencing symptoms of a stomach ulcer. Relief and effective treatment may only be a phone call away.