Peptic ulcer risk factors: H. pylori, NSAIDs and other causes

What a peptic ulcer is

A peptic ulcer is a sore on the lining of your stomach or duodenum, the first part of your small intestine (NIDDK) (MedlinePlus). Peptic ulcers are sometimes called stomach ulcers, duodenal ulcers, or peptic ulcer disease (NIDDK). Researchers estimate that about 1% to 6% of people in the United States have peptic ulcers (NIDDK).

Peptic ulcers happen when the acids that help you digest food damage the walls of the stomach or duodenum (MedlinePlus).

The two most common causes

Infection with the bacteria Helicobacter pylori (H. pylori) and taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, are the two most common causes of peptic ulcers (NIDDK).

H. pylori infection

H. pylori infection is a common cause of peptic ulcers. Researchers are still studying how people become infected. The bacteria may spread from person to person through contact with an infected person's vomit, stool or saliva, and food or water contaminated with them may also spread the bacteria (NIDDK). To see if you have an H. pylori infection, your doctor will test your blood, breath or stool (MedlinePlus).

Long-term H. pylori infection is also a major risk factor for stomach cancer; see stomach cancer risk factors.

NSAIDs

NSAIDs relieve pain, but they also make the stomach lining more prone to damage and ulcers, and some types of NSAIDs are more likely to cause ulcers than others (NIDDK). You have a higher chance of developing a peptic ulcer due to NSAIDs if you take (NIDDK):

• NSAIDs for a long time
• a type of NSAID that is more likely to cause an ulcer
• high doses of an NSAID or more than one NSAID
• NSAIDs along with other medicines that increase the risk for ulcers
• NSAIDs and you are also infected with H. pylori

Other risk factors

People also are more likely to develop peptic ulcers if they (NIDDK):

• are older adults
• had a peptic ulcer before
• smoke

Stress and spicy foods do not cause ulcers, but can make them worse (MedlinePlus).

NSAIDs can also cause GERD or make it worse; see GERD risk factors (NIDDK).

Less common causes

Other causes of peptic ulcers are uncommon or rare (NIDDK). They include:

• infections caused by certain viruses, fungi, or bacteria other than H. pylori
• medicines that increase the risk of developing ulcers, including corticosteroids, medicines used to treat low bone mass, and some antidepressants, especially when taken with NSAIDs
• surgery or medical procedures that affect the stomach or duodenum
• diseases that can affect the stomach, such as cancer or Crohn's disease
• injury, blockage, or lack of blood flow that affects the stomach or duodenum
• life-threatening health conditions that require critical care
• severe chronic diseases, such as cirrhosis or chronic obstructive pulmonary disease
• Zollinger-Ellison syndrome, a condition in which one or more tumors called gastrinomas cause your stomach to make too much acid

In rare cases, doctors cannot find the cause; they may call these idiopathic peptic ulcers (NIDDK).

Symptoms

Peptic ulcers may cause symptoms of indigestion. Common symptoms include (NIDDK):

• pain or discomfort in the upper part of your abdomen, anywhere between your belly button and breastbone
• feeling full too soon while eating a meal, or uncomfortably full after a meal
• nausea and vomiting
• bloating
• belching

Abdominal pain is the most common symptom. The pain may be dull or burning and may come and go over time; for some people it occurs when the stomach is empty or at night and goes away for a short time after they eat, while for others eating makes it worse (NIDDK). Many people who have peptic ulcers do not have any symptoms until an ulcer leads to complications (NIDDK).

Symptoms that need a doctor right away

Peptic ulcers can lead to complications such as bleeding, a hole (perforation) in the wall of the stomach or duodenum, penetration into a nearby organ, or a blockage that stops food from moving from the stomach into the duodenum (NIDDK). Call or see your doctor right away if you have symptoms that could be caused by a complication (NIDDK):

• black or tarry stool, or red or maroon blood mixed with your stool
• red blood in your vomit or vomit that looks like coffee grounds
• sudden, sharp, or severe abdominal pain that does not go away
• feeling dizzy or fainting
• a rapid pulse or other symptoms of shock
• a change in or worsening of your peptic ulcer symptoms

Treatment

Peptic ulcers will get worse if not treated. Treatment may include medicines to reduce stomach acids or antibiotics to kill H. pylori. Antacids and milk cannot heal peptic ulcers. Not smoking and avoiding alcohol can help, and you may need surgery if your ulcers do not heal (MedlinePlus).

Common questions

Do stress or spicy foods cause ulcers?

No. Stress and spicy foods do not cause ulcers, but they can make them worse (MedlinePlus).

Can aspirin or ibuprofen cause an ulcer?

Yes. Aspirin and ibuprofen are NSAIDs, and taking NSAIDs is one of the two most common causes of peptic ulcers (NIDDK).

Can you have an ulcer without symptoms?

Yes. Many people who have peptic ulcers do not have any symptoms, and may not develop symptoms until an ulcer leads to complications (NIDDK).