St. Luke's Hospital
Located in Chesterfield, MO
Main Number: 314-434-1500
Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
Find a Physician Payment Options Locations & Directions
Follow us on: facebook twitter Mobile Email Page Email Page Print Page Print Page Increase Font Size Decrease Font Size Font Size
Meet the Doctor
Spirit of Women
Community Health Needs Assessment
Home > Health Information

Multimedia Encyclopedia


    Peptic ulcer

    Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers

    A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum.

    A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.


    Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in your stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation (gastritis) or an ulcer.

    Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency.

    The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

    The following also raise your risk for peptic ulcers:

    • Drinking too much alcohol
    • Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people.
    • Smoking cigarettes or chewing tobacco
    • Being very ill, such as being on a breathing machine
    • Having radiation treatments

    A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid.

    Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home.


    Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

    Abdominal pain is a common symptom, but it doesn't always occur. The pain can differ from person to person.

    Other symptoms include:

    • Feeling of fullness -- unable to drink as much fluid
    • Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
    • Mild nausea (vomiting may relieve this symptom)
    • Pain or discomfort in the upper abdomen
    • Upper abdominal pain that wakes you up at night

    Other possible symptoms include:

    • Bloody or dark tarry stools
    • Chest pain
    • Fatigue
    • Vomiting, possibly bloody
    • Weight loss

    Exams and Tests

    To diagnose an ulcer, your doctor will order one of the following tests:

    • Esophagogastroduodenoscopy (EGD, upper endoscopy, or gastroscopy) is a special test performed by a gastroenterologist. A thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine.
    • Upper GI is a series of x-rays taken after you drink a thick substance called barium.

    Upper endoscopy is also done on people who are at high risk for stomach cancer. Risk factors include being over age 45 or having symptoms such as:

    • Anemia
    • Difficulty swallowing
    • Gastrointestinal bleeding
    • Unexplained weight loss

    Testing for H. pylori is also needed.

    Your doctor may also order these tests:

    • Hemoglobin blood test to check for anemia
    • Stool occult blood test to test for blood in your stool


    Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.

    Take all of your medications exactly as prescribed.

    If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:

    • Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl)
    • Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
    • Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

    If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.

    You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

    Other medications that may be used for ulcer symptoms or disease are:

    • Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis
    • Medications that protect the tissue lining (such as sucralfate)

    If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include injecting medicine, or applying metal clips to the ulcer. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a tear (perforation).

    Outlook (Prognosis)

    Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will likely be cured and you'll be much less likely to get another ulcer.

    Possible Complications

    • Bleeding inside the body (internal bleeding)
    • Gastric outlet obstruction
    • Inflammation of the tissue that lines the wall of the abdomen (peritonitis)
    • Perforation of the stomach and intestines

    When to Contact a Medical Professional

    Seek urgent help if you:

    • Develop sudden, sharp abdominal pain
    • Have a rigid, hard abdomen that is tender to touch
    • Have symptoms of shock, such as fainting, excessive sweating, or confusion
    • Vomit blood or have blood in your stool (especially if it's maroon or dark, tarry black)

    Call your doctor if:

    • You feel dizzy or lightheaded
    • You have ulcer symptoms


    Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:

    • Test you for H. pylori first
    • Have you take proton pump inhibitors (PPIs) or an acid blocker
    • Have you take a drug called misoprostol

    The following lifestyle changes may help prevent peptic ulcers:

    • Do not smoke or chew tobacco.
    • Limit alcohol to no more than two drinks per day.


    Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 53.

    Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-1825.

    Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.

    McColl KEL. Helicobacter pylori infection. NEJM. 2010;362:1597-1604.


    • Stomach ulcer


    • Cause of peptic ulcers


    • Ulcer emergencies


    • Location of peptic ulcer...


    • Gastroscopy procedure


    • Stomach ulcer


    • Cause of peptic ulcers


    • Ulcer emergencies


    • Location of peptic ulcer...


    • Gastroscopy procedure


    A Closer Look

    Talking to your MD

      Self Care

        Tests for Peptic ulcer

        Review Date: 8/11/2011

        Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

        A.D.A.M. content is best viewed in IE9 or above, Fire Fox and chrome browser.

        Back  |  Top
        About Us
        Contact Us
        Locations & Directions
        Quality Reports
        Annual Reports
        Honors & Awards
        Community Health Needs

        Brain & Spine
        Sleep Medicine
        Urgent Care
        Women's Services
        All Services
        Patients & Visitors
        Locations & Directions
        Find a Physician
        Tour St. Luke's
        Patient & Visitor Information
        Contact Us
        Payment Options
        Financial Assistance
        Send a Card
        Mammogram Appointments
        Health Tools
        My Personal Health
        Spirit of Women
        Health Information & Tools
        Clinical Trials
        Employer Programs -
        Passport to Wellness

        Classes & Events
        Classes & Events
        Spirit of Women
        Donate & Volunteer
        Giving Opportunities
        Physicians & Employees
        For Physicians
        Remote Access
        Medical Residency Information
        Pharmacy Residency Information
        Physician CPOE Training
        St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
        Copyright © St. Luke's Hospital Website Terms and Conditions  |  Privacy Policy  |  Notice of Privacy Practices PDF  |  Patient Rights PDF Sitemap St. Luke's Mobile