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Peptic Ulcer


A peptic ulcer is a break in the lining of usually the stomach, due to the corrosive effects of acid, or due to a breakdown in mechanisms that protect the lining of the stomach.  In addition to the stomach (gastric ulcer), peptic ulcers can also occur in the first part of the small intestine called the duodenum (duodenal ulcer), and in the esophagus (esophageal ulcer).


Most peptic ulcers can be contributed to the following causes:

  • Infection with a bacteria called Helicobacter Pylori (link) that causes inflammation and alters the ability of the stomach lining to resist acid damage
  • Use of non-steroidal anti-inflammatory drugs (NSAIDs), which includes aspirin, ibuprofen, naproxen) which reduce production of chemicals that protect  the stomach lining from acid
  • Rarely, there is overproduction of acid because of a growth that produces a hormone (gastrin) that makes the stomach produce more acid. This accounts for less than 1% of peptic ulcers.
  • Lifestyle choices like smoking double the risk of peptic ulcer


Symptoms are very poor indicators of the presence of ulcers, as stomach symptoms are similar in many disorders affecting the stomach.  Sometimes, patients report abdominal pain that may be temporarily relieved by antacids or eating food.  This pain can be felt anywhere in the top half of the abdomen.  Severe, unrelenting abdominal pain in a patient with a known ulcer sometimes indicates that the ulcer has burrowed through the wall of the stomach and is irritating the outside lining of the stomach wall (perforation or penetration)  – this situation may require surgery for management.

Additional symptoms may include the following:

  • Nausea
  • Vomiting
  • Lack of appetite
  • Fullness and bloating
  • Unexplained weight loss
  • Fatigue
  • Blood in the stool or vomit


The gastroenterologist may use the following tests to diagnose a peptic ulcer:

  • Endoscopy:  This is the most frequent test used to diagnose a peptic ulcer. In addition to visually seeing an ulcer, this test also allows the gastroenterologist to take biopsies to diagnose H pylori infection, and to make sure there is no cancer in the stomach mimicking an ulcer.
  • Barium upper gastrointestinal series: the patient swallows a fluid called barium (a metallic, chalky liquid) that will coat the inside of the digestive organs. The radiologist will take x-rays to examine any abnormalities in the esophagus, stomach, or intestine – which show up on the x-ray due to the barium coating.  This test is not used very much anymore to diagnose ulcers.
  • Blood and stomach tissue tests: these tests can find H. pylori (link) infection, the most common cause of peptic ulcers.


  • Patients are recommended to quit smoking.
  • In all instances, ulcers are treated with acid lowering medications. This includes H2 blockers (e.g. zantac, ranitidine) or proton pump inhibitors (e.g. Prilosec).
  • Patients with ulcers from NSAIDs are recommended to either stop the NSAIDs, reduce the dose of NSAIDs, or take medications to protect the stomach lining together with the NSAIDs (this includes acid lowering medications and medications that protect the lining of the stomach).
  • Surgery: surgery to physically limit the production of stomach acid is an option for ulcers that do not respond to medication or those that develop complications.



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