Peptic Ulcer Disease (Ulcers)

Peptic ulcer disease occurs when the lining of the stomach or small intestine becomes damaged, leading to open sores (ulcers). It is a common and highly treatable condition, most often caused by Helicobacter pylori infection or regular use of NSAID medications. While symptoms may include burning upper abdominal pain, some people have mild or no symptoms. With appropriate treatment, targeting the underlying cause and reducing stomach acid, most ulcers heal effectively, and recurrence can often be prevented.

What is Peptic Ulcer Disease?

Peptic ulcer disease occurs when the protective lining of the stomach or upper small intestine becomes damaged, allowing an ulcer to form. This is a common digestive condition and, in most cases, can be managed very effectively. With appropriate treatment and careful attention to contributing factors, ulcers typically heal and can often be prevented from returning.

What Causes Ulcers to Form?

In most cases, ulcers develop due to one of two underlying causes:

• Helicobacter pylori (H. pylori) infection
  H. pylori is a common stomach bacterium and is responsible for about 40% of peptic ulcers in the United States.
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
  Regular use of NSAID medications such as aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and celecoxib (Celebrex®) accounts for approximately one-third of peptic ulcers.

Can Stress Cause Ulcers?

The short answer is: stress can contribute to ulcer formation, but it’s more complicated than you might think.

For many years, doctors believed that stress and spicy foods were the main causes of ulcers. Then, in the 1980s, scientists discovered that bacteria called H. pylori and pain medications (NSAIDs) were actually the primary causes. This led many people to believe that stress had nothing to do with ulcers at all. However, recent research shows that the truth lies somewhere in between: stress does play a real role in causing ulcers, but it usually works together with other factors.

How Stress Affects Your Stomach

When you’re under stress, your body goes into “fight or flight” mode. This causes several changes to occur in your stomach:

• Blood flow is redirected away from your digestive system toward your vital organs like your heart and brain
• Your stomach may produce more acid
• The protective mucus layer in your stomach becomes weaker
• Your stomach’s ability to heal minor injuries slows down

These changes can make your stomach lining more vulnerable to damage from acid, which can lead to ulcer formation.

While stress alone does not usually cause peptic ulcers, it can increase risk and interfere with healing. Large studies have found that people with high stress levels are more likely to develop ulcers even in the absence of H. pylori infection or NSAID use. Stress appears to act as a contributing factor rather than a single cause.

Stress may raise ulcer risk by:

• Increasing behaviors such as smoking, alcohol use, missed meals, or frequent pain-medication use
• Making the stomach lining more vulnerable when H. pylori infection is present
• Slowing the healing of existing ulcers

In other words, stress often amplifies other risk factors rather than acting on its own. This is why effective ulcer care may include addressing both medical causes and lifestyle factors that affect overall digestive health.

What are the Symptoms of an Ulcer?

The most common symptom of a peptic ulcer is a burning or gnawing pain in the upper abdomen, typically felt between the breastbone and the belly button. This pain often occurs when the stomach is empty but it can happen at any time. Episodes may last from a few minutes to several hours and, in some cases, may wake you from sleep. Many people notice that the discomfort improves temporarily after eating, drinking fluids, or taking antacids.

Other possible symptoms may include:

• Nausea
• Belching or excessive burping
• Heartburn or acid reflux
• Acid regurgitation
• Feeling full sooner than usual
• Bloating or abdominal discomfort
• Decreased appetite

Less common but more serious symptoms include:

• Vomiting
• Vomiting blood
• Black or bloody stools

These symptoms should be evaluated promptly, as they may indicate bleeding or a more complicated ulcer.

How Are Peptic Ulcers Diagnosed?

If peptic ulcer disease is suspected, your gastroenterologist will recommend the most appropriate evaluation based on your symptoms, age, and medical history.

Testing for H. pylori

Because Helicobacter pylori infection is a common cause of peptic ulcers, testing for this bacteria is often an important first step. The most accurate non-invasive options include:

• A breath test
• A stool test

Both are simple, reliable, and widely used.

Upper Endoscopy (EGD)
An upper endoscopy is the most definitive test for diagnosing peptic ulcers. During this procedure, a thin, flexible tube with a small camera is gently passed through the mouth to examine the esophagus, stomach, and upper small intestine. This allows your doctor to directly visualize any ulcers and, if needed, take small tissue samples (biopsies) to test for H. pylori or inflammation. The procedure is typically performed under light sedation and is generally painless.

How are Peptic Ulcers Treated?

The encouraging news is that peptic ulcers are highly treatable. Treatment is designed to heal the ulcer, address the underlying cause, and reduce the risk of recurrence. With appropriate care, most ulcers heal within 4 to 8 weeks. Depending on the location of the ulcer, a repeat endoscopy may be performed to confirm complete resolution of the ulcer.

• • Acid reducing medications

• Medications to coat the stomach and small intestinal lining

• • Treating H. pylori infection
  • Adjusting pain medications (NSAIDs)

• Dietary and lifestyle modifications

Potential Complications of Peptic Ulcer Disease

Most peptic ulcers heal with proper treatment. However, about 10–20% of people with peptic ulcer disease may develop a complication, particularly if ulcers are untreated or treatment is delayed. While complications are uncommon, they can be serious and require prompt medical attention.

• Bleeding
• Perforation
• Gastric outlet obstruction

Peptic ulcers are very treatable, and complications are largely preventable with proper care. If you have symptoms of an ulcer, see your gastroenterologist promptly. If you experience warning signs of a complication, such as vomiting blood, black stools, sudden severe abdominal pain, or feeling faint, seek emergency medical care immediately.