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Patient Education

Stomach Ulcers

What is a stomach ulcer?

A stomach ulcer is a sore in the lining of your stomach. The medical term for them is peptic ulcers. A peptic ulcer can be in the stomach or in the beginning of the small intestine, , which is called the duodenum. You may also hear them called:

  • Gastric ulcer: an ulcer in the stomach
  • Duodenal ulcer: an ulcer in the small intestine

Peptic ulcers are named after pepsin, a digestive enzyme made in the stomach lining that helps digest proteins. If the stomach lining is damaged or your stomach makes too much acid, pepsin can attack the stomach and cause ulcers. It can also leak into the duodenum and contribute to duodenal ulcers.

Stomach Ulcer - Peptic UlcerStomach Ulcer Symptoms

Stomach ulcers often have no symptoms. Some people will experience:

  • Burning stomach pain that:
    • May last for hours
    • Starts and stops for days or weeks
  • Feeling of fullness, bloating, belching
  • Intolerance to fatty foods
  • Heartburn
  • Nausea

Pain that goes away after taking an antacid, like Tums or Maalox, and then returns may also be a symptom of stomach ulcers. Discomfort and pain are frequently worse at night and between meals when your stomach is empty.

Occasionally, stomach ulcer symptoms will include:

  • Vomiting or vomiting blood
  • Dark blood in stools
  • Stools that are black and tarry
  • Trouble breathing
  • Unexplained weight loss
  • Appetite changes

Stomach ulcer causes

Stomach ulcers are most commonly caused by a Helicobacter pylori (H. pylori) infection or overuse of nonsteroidal anti-inflammatory drugs (NSAIDs). Less common causes are Zollinger-Ellison Syndrome and severe physiological stress.

H. pylori infection
The most common cause of stomach ulcers is an infection caused by H. pylori. The transmission of this bacteria is not fully understood. Direct contact with bodily fluids and contaminated food or water may cause infection. H. pylori can damage the lining of the stomach and duodenum, but not all people who are infected with H. pylori will get an ulcer. In fact, it may live in the stomachs of up to 75% of the population, and in most cases doesn’t cause an infection.

NSAID overuse
Long-term use of non-steroidal anti-inflammatory drugs is another possible cause of stomach ulcers. NSAIDs include over-the-counter aspirin (Excedrin), ibuprofen (Advil), and naproxen (Aleve). Prescription NSAIDs that are prescribed for diseases like rheumatoid arthritis or other orthopedic conditions can also cause ulcers with long-term use.

When NSAIDs are taken with some other medications, there is a greater risk of getting a stomach ulcer. These medications include:

  • Corticosteroids
  • Anticoagulants
  • Low-does aspirin (“baby” aspirin)
  • Selective serotonin reuptake inhibitors (SSRIs) – antidepressants like Paxil and Zoloft
  • Osteoporosis medications – Actonel and Fosamax

Zollinger-Ellison syndrome (ZES)
ZES is a disorder where tumors form in the pancreas and duodenum and release excessive amounts of a hormone called gastrin. High levels of gastrin prompt the stomach to overproduce gastric acid. High levels of gastric acid can then lead to ulcers.

Severe physiological stress
Severe stress on your body, like burns or trauma, can change your body’s pH balance. In response, your stomach increases the production of acid which can lead to ulcers. Compared to normal stomach ulcers, these stress ulcers can develop very quickly.

*It’s a myth that emotional stress and spicy foods cause stomach ulcers. They can, however, make stomach ulcer symptoms worse.

Stomach ulcer risk factors

Although they don’t cause stomach ulcers, a few risk factors can make it more likely that a peptic an ulcer will develop, worsen an existing ulcer, or make healing difficult.

  • Smoking – especially in people who are already infected with H. pylori
  • Drinking alcohol
  • Having a family history of ulcers
  • Having unmanaged stress
  • Eating spicy food

Additionally, people who take NSAIDs are more likely to develop an ulcer if they:

  • Are over 65
  • Take high doses of NSAIDs
  • Take a combination of antiplatelet medications, anticoagulants, and/or corticosteroids
  • Are female
  • Have a personal history of ulcer disease
  • Have heart disease

Stomach ulcer complications

An untreated ulcer can cause serious complications, including:

Blood loss is one of the complications associated with stomach ulcers. It can be slow andsy lead to anemia over time. If an ulcer starts bleeding suddenly, it can cause severe blood loss that may require a blood transfusion and hospitalization.

Over time, stomach acid can erode an ulcer until it opens a hole in the stomach or intestinal wall. This painful and dangerous condition can lead to a severe infection of the abdomen called peritonitis. Untreated, peritonitis can lead to a life-threatening response to the infection, called sepsis.

Obstructions are also possible due to scarring or inflammation from an ulcer. Symptoms of obstruction may be a feeling of fullness or nausea and vomiting. A large obstruction can block the movement of food through the small intestine, interfering with the absorption of fluids and nutrients.

Stomach cancer
It’s rare, but sometimes an ulcer can become cancerous over time. It’s more common with ulcers caused by an H. pylori infection.

Stomach ulcer diagnosis

Stomach ulcers are diagnosed based on medical history and physical examination by a doctor. If your doctor suspects an ulcer, they may schedule tests, including:

An upper endoscopy allows the gastroenterologist to view the inside of your stomach with a small camera and take tissue samples if needed. The camera is attached to a very small tube that is inserted down the throat into the stomach and duodenum.

An Upper GI Series and a CT scan are both imaging tests that use X-rays to see your digestive tract. For an Upper GI Series, you may need to drink a chalky fluid called barium to help your esophagus, stomach, and duodenum show up better on the X-rays. For a CT scan, you may have an injection or drink contrast fluid to make your digestive tract more visible on the X-rays.

Laboratory testing
You may also need lab tests to look for H. pylori. You may have a blood test, a stool test, or a breath test. (Read more about testing for H. pylori)

Stomach ulcer treatment

Medications are used to treat the cause of the ulcer and to protect it while healing. In most cases, medications are successful. Complicated ulcers that have caused bleeding, a perforation, an obstruction, or that have become cancerous may need surgery.

Common medications to stomach ulcer treatments include:

Treatment with antibiotics may be necessary when there is an H. pylori infection causing the ulcer.

Over-the-counter antacids can help neutralize stomach acid and bring you temporary relief. However, they can’t heal your ulcer and shouldn’t be taken with some antibiotics.

Bismuth subsalicylate
You might know this over-the-counter medicine as Pepto-Bismol. It coats the ulcer and helps protect it from stomach acid.

Histamine blockers
Also called H2 blockers, these medications block histamine, the chemical that prompts your body to produce stomach acid. Famotidine (Pepcid) and cimetidine (Tagamet) are H2 blockers.

Protectants coat the ulcer, protecting it from the damaging effects of stomach acid and enzymes. For stomach ulcers, doctors often prescribe sucralfate (Carafate) which adds a protective layer to the surface of the ulcer while it heals.

Proton-pump inhibitors (PPIs)
PPIs like omeprazole (Prilosec) and esomeprazole (Nexium) reduce stomach acid and protect the stomach lining.

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