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Peptic ulcer

Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.

Peptic ulcers include:

  • Gastric ulcers that occur on the inside of the stomach
  • Esophageal ulcers that occur inside the hollow tube (esophagus) that carries food from your throat to your stomach
  • Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

It's a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial infection or some medications — not stress or diet — cause most peptic ulcers.

Symptoms Causes Risk factors Complications Prevention

Pain is the most common symptom

Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

  • Be felt anywhere from your navel up to your breastbone
  • Be worse when your stomach is empty
  • Flare at night
  • Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
  • Disappear and then return for a few days or weeks

Other signs and symptoms

Less often, ulcers may cause severe signs or symptoms such as:

  • The vomiting of blood — which may appear red or black
  • Dark blood in stools or stools that are black or tarry
  • Nausea or vomiting
  • Unexplained weight loss
  • Appetite changes

When to see a doctor

See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If your pain persists, see your doctor.

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus, stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Common causes include:

  • A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems, but it can cause inflammation of the stomach's inner layer, producing an ulcer.

    It's not clear how H. pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

  • Regular use of certain pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, Anaprox, others), ketoprofen and others.

    Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.

  • Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others) and potassium supplements.

You may have an increased risk of peptic ulcers if you:

  • Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
  • Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.

Left untreated, peptic ulcers can result in:

  • Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  • Infection. Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  • Scar tissue. Peptic ulcers can also produce scar tissue that can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

You may reduce your risk of peptic ulcer if you:

  • Protect yourself from infections. It's not clear just how H. pylori spreads, but there's some evidence that it could be transmitted from person to person or through food and water.

    You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.

  • Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.

    Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.

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