Ulcers were believed to be caused by stress, anxiety, and/or a diet rich in spicy foods. However, research has demonstrated that most ulcers are caused by a spiral-shaped bacterium known as
Helicobacter pylori (H. pylori)
. The other common cause of ulcers is nonsteroidal anti-inflammatory drugs (NSAIDs).
Anatomy of an Ulcer
When we eat, food passes down the esophagus (throat) and into the stomach. There, hydrochloric acid and pepsin (an enzyme) continue the digestive process that started with the saliva in your mouth. Next, food passes to the duodenum (small intestine) where the digestive process continues. An ulcer is an area of stomach or duodenum that has been damaged by the digestive enzymes and stomach acid.
causes ulcers is not yet fully understood. Researchers do know the following:
- H. pylori
bacteria can live in the stomach because they produce an enzyme that stops the corrosive effects of stomach acid.
- H. pylori's
spiral shape allows it to get into the protective mucous layers of both the stomach and the duodenum.
- H. pylori
can also weaken the stomach and duodenum by attaching to cells. This further weakens the stomach and duodenum's defense system.
Not everyone who harbors the
bacteria will develop an ulcer.
- Being infected with H.pylori is a risk factor for developing stomach cancer.
An ulcer that goes untreated can cause several problems in the abdomen, such as:
- Internal bleeding
- Perforation (a hole) in the stomach or duodenum allowing food and bacteria to spill into the abdomen and cause infection and irritation
- Blockage of the opening between the stomach and duodenum due to chronic inflammation that leads to swelling and scarring
Discovering the Causes of Ulcers
The story behind the discovery of the
bacteria and its relationship to ulcers is an unusual one. In 1982, two Australian researchers, Drs. Barry Marshall and Robin Warren, detected
in the stomach lining of people suffering from
. When further study demonstrated the presence of
in nearly 100% of patients with duodenal ulcers and 80% of people with stomach ulcers, Drs. Marshall and Warren proposed that
might be the cause.
When their hypothesis was met with a great deal of skepticism, Dr. Marshall ingested a teaspoonful of
bacteria. Within 24 hours, he developed severe gastritis. Further research by Dr. Marshall, Dr. Warren, and others established that
does in fact cause 50% of stomach ulcers and 90% of the much more common duodenal ulcers.
Of the ulcers that are not caused by
bacteria, most are caused by NSAIDs (nonsteroidal anti-inflammatory drugs), such as
, and naproxen sodium. NSAIDs block the production of mucous in the stomach that protects the lining from the damaging effects of the stomach acid.
The Telltale Burn
The most common symptom of an ulcer is a chronic burning pain localized in the upper part of the abdomen. The pain is usually between the breastbone and the naval and it can last from minutes to hours. Pain often recurs in the middle of the night, upon waking, and/or 2-3 hours after a meal. It may be relieved by eating or taking antacid medicines. Less common symptoms include:
- Vomiting (can be bloody or appear like coffee grains) if the ulcer is bleeding
- Loss of appetite
- Loss of weight
- Bloody or black stool (caused by bleeding from the ulcer)
- Weakness (caused by bleeding from the ulcer)
It is important that ulcers be properly diagnosed because the symptoms common to ulcers can also be caused by a number of other conditions. In addition, ulcers caused by
and those caused by NSAID are treated somewhat differently.
Two most commonly used tests for diagnosing an ulcer:
—an examination of the esophagus, stomach, and duodenum via a small, flexible, camera-containing, tube-like instrument inserted through your throat
- Upper GI series
—x-rays of the esophagus, stomach, and duodenum are taken after you drink a chalky substance that outlines the shape of the digestive tract
A test for the presence of
is done to determine whether the ulcer is caused by
bacteria. Several methods exist for detecting
. A test for presence of
bacteria may include a blood test to detect antibodies to the bacteria, a breath test that examines by-products of the bacteria, or a lab analysis of the biopsied tissue sample. These tests differ in sensitivity for detecting the presence of bacteria in your system.
Removing the Offending Agent
Treatment involves removing the underlying cause of the ulcer and healing the ulcer.
One common treatment approach involves taking antibiotics to eliminate the bacteria along with an acid suppressor and sometimes also a bismuth-containing stomach lining shield (eg, Pepto-Bismol). This method is often effective in killing the bacteria, healing the ulcer, and preventing recurrence.
Steering Clear of Ulcers
To prevent NSAID-caused ulcers, try to avoid using NSAIDs in large doses for long periods of time. Unfortunately, researchers do not yet know how to prevent the development of
bacteria in the digestive tract. Some recommended precautions are to:
- Wash hands thoroughly after using the bathroom and before eating
- Drink water from a clean source—H. pylori
is transmitted from person to person through close contact and exposure to body fluids such as vomit.
The American College of Gastroenterology
National Institute of Diabetes & Digestive & Kidney Diseases
College of Family Physicians of Canada
and peptic ulcers. National Digestive Diseases Information Clearinghouse website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/. Updated April 30, 2012. Accessed June 11, 2012.
Helicobacter pylori infection. EBSCO Dynamed website. Available at: http://ebscohost.com/dynamed. Updated June 6, 2012. Accessed June 11, 2012.
International Agency for Research on Cancer. Schistosomes, liver flukes and Helicobacter pylori.
Peptic ulcer disease. EBSCO Dynamed website. Available at: http://ebscohost.com/dynamed. Updated February 3, 2012. Accessed June 11, 2012.
Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer.
N Engl J Med. 2001;345(11):784-789.