What Is a Stomach Ulcer?

A stomach ulcer, also called a peptic ulcer, is an area (or multiple areas) where the stomach lining is injured due to excess stomach acid. While some people can have stomach ulcers and not experience symptoms, others may have symptoms that include stomach pain, feelings of abdominal fullness, and bloating they can't explain. The most common cause of stomach ulcer disease is an H. pylori bacterial infection.

An estimated 10% of people in the world have a stomach ulcer. While most do not cause significant effects, an untreated stomach ulcer can lead to bleeding or damage to the stomach lining. Treatments include medications such as antibiotics to cure the infection, as well as making certain lifestyle modifications if needed.

Types

Healthcare providers typically divide stomach ulcers into two types based on their location: stomach ulcers and duodenal ulcers.

A stomach ulcer causes sores to develop on the stomach lining. Pain associated with stomach ulcers tends to get worse when you eat, which is one way healthcare providers may be able to tell your ulcer type.

A duodenal ulcer causes sores to develop in the duodenum, which is the first part of your small intestine. Pain related to duodenal ulcers will usually get better after you eat.

Stomach Ulcer Symptoms

An estimated two-thirds of people with stomach ulcers do not have any symptoms. For those who do have symptoms, the most common one is upper abdominal pain. This pain will usually occur between two and five hours after eating.

Other symptoms may include:

• Bloating
• Dyspepsia, or stomach discomfort caused by indigestion
• Feelings of stomach fullness
• Nausea, which may be accompanied by vomiting

However, stomach ulcers can also lead to serious symptoms, such as gastrointestinal bleeding and stomach perforation. In severe cases, stomach ulcers can cause the following symptoms:

• Feeling dizzy or faint
• Passing black or tarry stools (a sign of blood in the stool)
• Rapid pulse or other symptoms of shock
• Blood in your vomit
• Sudden, severe abdominal pain

If you experience these symptoms, they indicate a medical emergency. You should seek immediate medical attention.

What Causes Stomach Ulcers?

The most common cause of a stomach ulcer is an infection with the H. pylori bacteria. This bacteria can have several effects that lead to stomach ulcers, which include:

• The bacteria makes an enzyme called urease, which makes your stomach acid less acidic. This can keep the stomach lining from being as protective.
• The weakened stomach lining from H. pylori means digestive fluids can cause further damage to the stomach lining.
• The bacteria can "stick" to stomach cells and cause inflammation and irritation.

Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen), can also damage the stomach lining by decreasing blood flow to the stomach lining as well as reducing mucus secretion that helps keep the stomach lining healthy.

Other potential stomach ulcer causes include:

• History of cancer or Crohn's disease
• History of surgery to the stomach
• Presence of severe, chronic illness, such as cirrhosis (scarring of the liver)
• Previous infections with bacteria, fungi, or viruses other than H. pylori

However, a healthcare provider may be unable to identify the cause of an underlying stomach ulcer. A stomach ulcer due to an unknown cause is called an idiopathic ulcer.

Risk Factors

Risk factors for developing a stomach ulcer include the following:

• History of H. pylori infection
• History of excess alcohol or tobacco consumption
• Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)
• History of Zollinger-Ellison syndrome

Taking NSAIDs, anticoagulants, or aspirin can also increase your risk of getting a stomach ulcer.

Diagnosis

A healthcare provider can diagnose a stomach ulcer by first asking you about your symptoms as well as what makes them worse or better. They can also give you a breath test, where your breath is tested for the presence of H. pylori.

Undergoing a procedure called an upper endoscopy can help a gastroenterologist (a doctor who specializes in the digestive system) view your stomach lining, identify stomach ulcers, and take biopsies or tissue samples of the ulcers. A laboratory test of the tissue sample can determine the presence of H. pylori or even cancerous cells.

Additional tests include:

• Stool testing for the presence of H. pylori
• Blood testing for electrolyte abnormalities
• Stool testing for the presence of blood in your stool

Treatments for Stomach Ulcers

Stomach ulcer treatments depend on what is causing your stomach ulcers (if your healthcare provider can identify the cause). For example, healthcare providers treat H. pylori with antibiotics, which can cure the infection that causes stomach ulcers.

Your healthcare provider may also prescribe proton pump inhibitors. These medications keep the stomach from making too much acid that can damage your stomach lining. Examples of proton pump inhibitors include Prilosec (omeprazole); Nexium (esomeprazole); and Prevacid (lansoprazole).

If these treatments are not effective, a healthcare provider will likely prescribe additional antibiotics. An estimated 5 to 10% of people will experience a persistent H. pylori infection.

Prevention

Peptic ulcer prevention involves avoiding known causes of stomach ulcers. Prevention examples include:

• Avoiding excess alcohol intake
• Refraining from mixing alcohol with medications such as NSAIDs
• Using the minimum amount of NSAIDs whenever possible
• Engaging in frequent handwashing to prevent infections, such as those from H. pylori
  
• Refraining from smoking cigarettes or using other tobacco products

Related Conditions

You're at greater risk for experiencing a stomach ulcer if you have one or more of the following medical conditions:

• Crohn's disease: This condition causes inflammation in the gastrointestinal tract and increases risk for ulcer development.
• Heart failure: This is a condition where the heart doesn't pump blood as effectively as the body needs. Researchers don't know exactly why heart failure and ulcers tend to occur together.
• Liver cirrhosis: This is characterized as scarring of the liver that affects its function. The liver makes compounds that prevent bleeding, so damage and scarring can make stomach ulcers more likely to bleed.
• Stomach cancer: This causes uncontrolled replication of cancer cells and can lower your immune system's ability to fight off H. pylori bacteria.
• Zollinger Ellison syndrome: This is a digestive disorder that causes your stomach to secrete too much acid, which can further increase damage from ulcers.
  

If you have one or more of these conditions, talk to your healthcare provider about your risks for stomach ulcers.

Living With Stomach Ulcers

Most people with stomach ulcers that don't cause severe symptoms can successfully treat and overcome their stomach ulcers. If you have had ulcers in the past, taking preventive steps by avoiding smoking and excess alcohol intake can help reduce the risks for future stomach ulcers.