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Peptic ulcer

A peptic ulcer (stomach ulcer) is a sore in the lining of your stomach or upper small intestine. Ulcers form when the protective layer in the lining has broken down, often because of a bacterial infection or frequent use of aspirin or similar medicine.

Peptic ulcers can cause pain in the belly, above the belly button. Ulcers can also bleed.

  • Symptoms

    What are the symptoms of a peptic ulcer?

    Different people have different symptoms of peptic ulcers. And some people have no symptoms at all.

    Common symptoms of peptic ulcer

    Common peptic ulcer symptoms include:

    • A burning, aching pain—or a pain that feels like hunger—between the navel and the breastbone. The pain sometimes extends to the back.
    • Belly pain that can last from a few minutes to a few hours. It usually goes away for a while after you take an antacid or acid reducer.
    • Weeks of pain that comes and goes. It may alternate with pain-free periods.
    • Loss of appetite and weight loss.
    • Bloating or nausea after eating.

    Less common symptoms

    Less common but more serious symptoms of peptic ulcers include:

    • Vomiting after meals.
    • Vomiting blood or material that looks like coffee grounds.
    • Black stools that look like tar, or stools that contain dark red blood.

    Ulcers and pains

    Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the stomach (gastric ulcers) are similar, except for when pain occurs.

    • Pain from a duodenal ulcer may occur several hours after you eat (when the stomach is empty). It may improve after you eat. Pain also may wake you in the middle of the night.
    • Pain from a gastric ulcer may occur shortly after you eat (when food is still in your stomach).

    Silent ulcers

    Some ulcers don't cause symptoms. These are known as silent ulcers. Silent ulcers are more common in:

    • Older adults.
    • People with diabetes.
    • People who use nonsteroidal anti-inflammatory drugs (NSAIDS), including aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).

    Symptoms in children

    In children, symptoms vary with age.

    • Toddlers and young children may complain of general stomach pain.
    • Teens may have symptoms more like those of adults.
  • Causes

    What causes peptic ulcers?

    The two most common causes of peptic ulcers are:

    • Infection with Helicobacter pylori (H. pylori) bacteria.
    • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen.

    H. pylori and NSAIDs break down the protective mucus layer in the stomach or intestine.

    A rare cause of peptic ulcers is Zollinger-Ellison syndrome. In this condition, the stomach makes too much acid, damaging the stomach lining.

  • Prevention

    Preventing peptic ulcers

    You can greatly reduce the chance that you will get a peptic ulcer if you follow these tips.

    • Don't smoke.

      Smokers are much more likely than nonsmokers to get ulcers.

    • Avoid NSAIDs.

      Avoid taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) for longer than a few days at a time. If you are taking one of these medicines daily, for example taking aspirin for heart problems, ask your doctor about taking medicine to help protect your stomach and intestines from ulcers.

    • Drink alcohol only in moderation.

      Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

  • Diagnosis

    Who can diagnose and treat peptic ulcer disease?

    To evaluate your symptoms, see your:

    • Family medicine physician.
    • Internist.
    • General practitioner.
    • Nurse practitioner (NP).
    • Physician assistant (PA).
    • Pediatrician (for children and teens).

    If further testing or treatment is needed, you may need to see someone who specializes in the treatment of diseases of the digestive tract (gastroenterologist).

    If surgery is needed, your doctor may refer you to a general surgeon. But surgery is rarely needed to treat ulcers.

  • Treatment

    How are peptic ulcers treated?

    To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics.

    You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. If you keep using medicines such as aspirin, ibuprofen, or naproxen, you may increase the chance of your ulcer coming back.

    Surgery is rarely used to treat an ulcer. But if your ulcer doesn't heal, or if you have life-threatening complications, you may need surgery.

    Ignoring symptoms of an ulcer isn't a good idea. An ulcer needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.

  • When to call

    Peptic ulcer disease: When to call

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You vomit blood or what looks like coffee grounds.
    • You pass maroon or very bloody stools.

    Call your doctor now or seek immediate medical care if:

    • You have new or worse belly pain.
    • Your stools are black and look like tar, or they have streaks of blood.
    • You vomit.

    Watch closely for changes in your health, and be sure to contact your doctor if:

    • You do not get better as expected.
  • Self-care

    How can you care for peptic ulcer disease?

    • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
    • Do not take aspirin or other NSAIDs such as ibuprofen (Advil or Motrin) or naproxen (Aleve). Ask your doctor what you can take for pain.
    • Do not smoke. Smoking can make ulcers worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
    • Drink in moderation or avoid drinking alcohol.
    • Eat a balanced diet of small, frequent meals. See a dietitian if you need help planning your meals.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.