Peptic Ulcers

A peptic ulcer is a variably painful open sore that forms when acid erodes the inner lining of the digestive system. When a peptic ulcer occurs in the stomach it is called a gastric ulcer. When it is located in the upper part of the small intestine, it is called a duodenal ulcer.

Symptoms of Peptic Ulcers

Many people with a peptic ulcer do not experience discomfort and may present with GI bleeding or stomach obstruction. It is important to talk to your provider even if you are experiencing mild symptoms. Without treatment, peptic ulcers can get worse and may cause more serious problems.

Common symptoms can include:

  • Burning or dull stomach pain, most often that:
    • Can come and go for several days, weeks or months
    • Lasts for minutes to hours
    • Occurs when the stomach is empty — between meals and at night
    • Stops briefly when eating or taking acid reducing medication
  • Feeling of fullness, bloating
  • Heartburn
  • Nausea

Severe signs or symptoms may include:

  • Appetite changes
  • Feeling faint
  • Red or dark blood in stools, including black stools which resemble tar
  • Vomiting blood — which may appear red or black
  • Weight loss

Causes of Peptic Ulcers

Common causes of peptic ulcers include:

  • Excess stomach acid
  • Helicobacter pylori (H. pylori) infection
  • Overuse of medications:
    • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen
    • Taking NSAIDs along with steroids, anticoagulants, particularly with selective serotonin reuptake inhibitors (SSRIs)

Stress and spicy foods do not cause peptic ulcers, but they can cause peptic ulcers to worsen and be more challenging to heal. Rare tumors, both cancerous and noncancerous, in the stomach, duodenum or pancreas — known as Zollinger-Ellison syndrome — are uncommon causes of peptic ulcers.

Diagnosis of Peptic Ulcers

A gastroenterologist will complete a physical exam and inquire about your medical history, and may be able to diagnose a peptic ulcer according to your symptoms. Diagnostic tests may include:

  • Endoscopy: A long, thin, flexible tube containing a light is inserted through the throat and into the esophagus, stomach and small intestine allowing the gastroenterologist to inspect the digestive tract lining and look for abnormalities. At this time a biopsy might also be performed, removing a small tissue sample to identify if H. pylori is present.
  • Upper GI Series: This imaging test uses X-rays and barium sulfate, a substance that coats your digestive tract, to visualize deformities and ulcers.
  • Breath Test: This noninvasive test identifies presence of H. pylori by revealing carbon dioxide in your breath after swallowing a pill or liquid that contains tagged carbon molecules. Other measures to diagnose H. pylori include stool and blood tests.

Treatment of Peptic Ulcers

There are several ways to treat a peptic ulcer, depending on the cause.


  • Alternative pain relievers, including acetaminophen, might be recommended in an effort to eliminate or reduce the use of NSAIDs.
  • Antibiotics can be used to eliminate H. pylori bacterium, which allows the ulcer to heal.
  • Histamine blockers (H-2) and proton pump inhibitors (PPIs) can diminish acid production, relieving ulcer pain and prompting healing.
  • Antacids containing calcium carbonate can provide symptom relief by neutralizing stomach acid. They are not used as a primary treatment because of their side effects of constipation.

Lifestyle Changes

Relief from stomach pain may be supported by:

  • Avoid smoking: Nicotine increases stomach acid, which can affect the protective lining of the stomach, causing it to be more vulnerable to ulcers.
  • Control Stress: Although stress does not cause ulcers, there is evidence that it can exacerbate them.
  • Diet:
    • Foods containing turmeric, licorice root extract and probiotics — such as yogurt and aged cheeses, have been identified to aid in healing peptic ulcers, but are usually ineffective as sole treatments.
    • Eat foods rich in vitamins A and C — primarily found in fruits, vegetables, and whole grains. Not consuming a healthy diet will make it challenging for the ulcer to heal.
    • Decrease milk consumption. Although it can temporarily relive pain by coating the stomach lining, it also causes your stomach to produce excess acid and digestive juices, which will increase pain overall and can make ulcers worse.
    • Avoid alcohol, as it can aggravate and wear down the mucous lining in your stomach and intestines, causing inflammation and bleeding.
  • Sleep: Getting the appropriate amount of sleep can improve your immune system, which can offset stress.

An operation may be needed if the ulcer has created a perforation in the stomach or duodenal wall or if there is serious bleeding that cannot be endoscopically controlled.

To schedule an appointment with Virginia Mason's Gastroenterology Department call (206) 223-2319.