Peptic ulcer is a disease occur when an open sore forming predominantly in the lining of the stomach and duodenum, but rarely in the esophagus. It is common disease that may interfere with daily life by causing pain and affecting food intake and sleep.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection are the major causes of peptic ulcer. They can work separately or together to erode upper gastrointestinal tract lining and expose it to acid secretions.

Peptic ulcers will get worse and could lead to dangerous complications if not treated. Treatment may include medications to reduce stomach acids and kill the causative bacteria. Not smoking or drinking alcohol can help reducing the risk of having this disease.

A peptic ulcer is a sore on the lining of the stomach or the first part of small intestine “duodenum” and rarely can develop in the esophagus.

• Helicobacter pylori (H. pylori) bacterial infection: This germ is responsible for most ulcers. The inflammation caused by their infection accounting for 90% of duodenal ulcers and up to 80% of gastric ulcers;
• Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, ketoprofen and oxaprozin. These medications are commonly used as they are available without a prescription and therefore increased cases of peptic ulcers are caused by them;
• Zollinger-Ellison syndrome: rare cancerous and noncancerous tumors in the stomach, duodenum, or pancreas that lead to a large stomach acid secretion;
• Other medications: some prescribed drugs that used to deal with osteoporosis called bisphosphonates and potassium supplements can also lead to ulcers.

• Smoking, as it may work with H. pylori infection to heighten the chance of having peptic ulcers;
• Drinking alcohol that increases acid secretions in stomach and can irritate it’s mucous lining;
• Having a family history of ulcers;
• Suffering from certain illness such as liver, kidney, or lung disease;
• Chronic stress, which could make stomach lining more susceptible to damage from NSAIDs or H. pylori;
• Older age, mainly over 50 are more risky to have this disease;
• Chronic pain from any cause, such as arthritis that require regular use of NSAIDs.

Digestive tract is coated with a mucous layer that normally protects from acids produced by stomach secretions. Peptic ulcers occur when acid in the digestive tract devour this protective couth that lines the esophagus, stomach or small intestine. If the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer.

NSAIDs block or reducing the amount of the enzyme “COX-1” that produces type of chemical to protect the stomach lining from stomach acid and helps control bleeding. In cases of H. pylori, it erodes mucous coating and bare sensitive layer to stomach acid and the bacteria which cause irritation.

A burning or dull pain is the most common symptom of peptic ulcer. It locates often in the upper abdomen, even it may be felt anywhere between the umbilicus and breastbone. Pain happens usually when stomach is empty and could last for minutes to hours. The severity of pain may increase by some foods. The episodes Come and go for several days, weeks, or months and mostly flare up at night.

Some Symptoms are less common, including:

• Bloating and Belching;
• Poor appetite and weight loss;
• Vomiting, sometimes with blood;
• Black or tarry stool.

After taking medical history and doing physical examination, the doctor may expect peptic ulcer based on signs & symptoms of the disease. He will recommend some test for assurance, including:

• Lab tests: A Blood test done to check results of different parameters that refer to disorders or infections. Stool test is another one by analyzing feces sample for the presence of H. pylori. ​​Urea breath test considered helpful. It is done after drinking a special liquid that contains urea, then a sample of exhaled taken to check for abnormal higher levels of carbon dioxide that support H. pylori infection;
• Upper gastrointestinal endoscopy: The presence of an ulcer can only be determined by looking directly at GI tract. Using an endoscope, doctor will see inside esophagus, stomach and duodenum, which allow close examination of the upper GI tract lining. Sometimes Biopsy may be taken for further investigation;
• Upper GI series: Consecutive x-ray imaging after drinking barium liquid that coats the digestive tract and makes an ulcer more visible. This diagnostic procedure helps to looks at the shape of esophagus, stomach and small intestine;
• Computerized tomography (CT) scan: CT scans can help diagnose a peptic ulcer that has led to perforation of the stomach or small intestine. ​A health care professional may give a contrast medium to drink then start taking the images supported by computer technology.

• Medications: Choosing the way of treatment depends on the cause of peptic ulcer. Several types of medications are used to deal with this disease:
  • Antibiotics: If H. pylori bacteria is found in digestive tract, the doctor may recommend a combination of antibiotics to kill that causative agent. Additional medications with these may needed to reduce stomach acid. It is very important to complete all doses of antibiotics exactly as prescribes to eradicate the bacteria and prevent it from building resistance;
  • Proton pump inhibitors (PPI): They reduce stomach acid by blocking the production of acid and promote healing. It can help fight the H. pylori infection as a part of multidrug therapies, like triple therapy that includes taking two antibiotics (Clarithromycin with metronidazole or amoxicillin) with a PPI. These drugs include omeprazole, lansoprazole, rabeprazole, esomeprazole and pantoprazole;
  • Histamine (H-2) blockers: Act by reducing the amount of stomach acid released into digestive tract, which helps treating pain and encourages healing. Examples are: ranitidine, famotidine, cimetidine, and nizatidine;
  • Antacids: These medications neutralize existing stomach acid and can provide rapid pain relief. Antacids can improve symptoms, but generally aren't working in healing the ulcer. Main types include: aluminum hydroxide, calcium carbonate and magnesium trisilicate;
  • Cytoprotective agents: Medications that protect the lining of stomach and duodenum may need to be taken in some cases. Options are: Sucralfate, misoprostol and bismuth subsalicylate.
• Reviewing NSAIDs use: If nonsteroidal anti-inflammatory drugs are causing your peptic ulcer and you don’t have an H. pylori infection, the doctor may tell the patient to stop taking these medications or reducing their amount. Switching to another analgesic that doesn’t known to cause a peptic ulcer is another choice. But if they are inevitable, prescribed medications –like mentioned above- are needed to reduce stomach acid and promote healing.
• Endoscopic therapies and surgical procedures: If a complication such as bleeding occurred, endoscopy is used to treat this serious condition. Scars may also be treated by passing a small balloon through an endoscope and inflating it to widen the site of the obstruction. Surgery may be needed to remove some blocking scars or to patch perforation.
• Dietary changes: Even it is not proven that diet play an important role in causing or preventing peptic ulcers, there are some foods that can reduce or exacerbate the symptoms of the disease. Patient may be encouraged to cut down on coffee, carbonated beverages and spicy food as they can increase stomach acid. Instead, a diet rich in fiber, especially from fruits and vegetables could speed recovery. Foods containing flavonoids, like apples, celery, cranberries, onions and garlic may inhibit the growth of H. pylori.

• Gastrointestinal bleeding: The most common complication of stomach ulcers. It can be slow, long-term bleeding, that leads to anemia, or may be rapid and severe ones that cause vomiting blood or pass sticky, black and tar-like stool;
• Perforation: A rare but serious complication of stomach ulcers is formation of a hole in the stomach. This enables the bacteria to escape and infect the lining of the abdomen, which could spread into the blood before reaching other organs and causing damage or even death;
• Gastric outlet obstruction: A blockage in the normal passage of food through digestive system can occur as a result of an inflamed or scarred stomach ulcer. This condition is noticed by repeated episodes of vomiting, with large amounts of undigested foods, and a persistent feeling of bloating or fullness even with eating little amounts;
• Side effect of some peptic ulcer medications: Using proton pump inhibitors more than one year, particularly at high doses, may increase the risk of hip, wrist and spine fracture. Taking these drugs for a long period may also increase the risk of heart attack.

• Adjusting use NSAIDs, ether by avoiding it, reducing their doses and frequencies, or finding an alternative;
• Taking these drugs with or after eating food and asking the doctor to take gastrointestinal protective drugs with it;
• Abstinence from drinking alcohol or smoking. This may need seeking treatment;
• Reducing chances of H. pylori infection by frequent hand washing and eating well-cooked foods;
• Managing stress through relaxation techniques, such as deep breathing. This can reduce the need for painkillers and help adhering to healthy life style

Cure chances from peptic ulcer disease are high if underlying cause is determined and well-treated with the appropriate medications. Person may undergo a breath or stool test in 4 weeks after completing medication regimen, in order to assure that H. pylori infection has gone.

Sometimes, H. pylori bacteria are still present, even after taking all the prescribed medications correctly. This increases the opportunities of recurrent peptic ulcer and the risk of stomach cancer. Stubbornness on Smoking or NSAIDs use, then peptic ulcers are more likely to come back.

Peptic ulcer disease is a common condition, although reported incidence and prevalence are decreasing. This drop may be due to a decrease in H. pylori-associated peptic ulcer, but NSAIDs use is increasing, which may pose a threat in the future.

According to a systematic review at Institute of Digestive Disease, Chinese University of Hong Kong, the annual incidence rates of peptic ulcer disease were 0.10-0.19% for physician-diagnosed cases and 0.03-0.17% when based on hospitalization data. The 1-year prevalence based on physician diagnosis was 0.12-1.50% and that based on hospitalization data was 0.10-0.19%.