Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.


What Causes Ulcers?

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

  • Infection with a type of bacteria called Helicobacter pylori (H. pylori). H. pylori can cause chronic inflammation of the stomach (gastritis) and/or ulcer.
  • Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
  • Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.

What Are the Symptoms of an Ulcer?

An ulcer may or may not have symptoms. When symptoms occur, they include:

In severe cases, symptoms can include:

  • Dark or black stool (due to bleeding)
  • Vomiting blood (can have a “coffee-grounds” appearance)
  • Weight loss
  • Severe pain in the mid to upper abdomen

Diagnostic evaluation is done with an upper endoscopy, a routine painless procedure during which time a thin flexible scope is passed through the mouth into the esophagus, stomach and duodenum while the patient is under anesthesia.

Helicobacter pylori can be tested for with blood, stool or breath testing in addition or in place of endoscopy when appropriate. People with H. pylori can have symptoms similar to ulcers but not actually have true ulcer damage to the stomach, the infection can be cured with standard therapy.

The hallmark of therapy is with medications called Proton Pump Inhibitors (PPIs), ie. Nexium, Prilosec, and several others. H. pylori can be eradicated with a combination of antibiotics and PPI for a duration of 10-14 days. Follow-up testing can be performed in our office to ensure that H. pylori infection has been cured after therapy.