Peptic Ulcer Disease

What is a peptic ulcer?

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine (duodenum). Ulcers develop when the intestine or stomach's protective layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. These strong juices, which contain hydrochloric acid and an enzyme called pepsin, also can injure the esophagus. The esophagus is the tube that leads from your throat to your stomach.

Peptic ulcers are no longer a condition that most people have to live with their entire lives. Treatment cures most ulcers, and symptoms go away quickly.

Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say “doo-uh-DEE-nul” or “doo-AW-duh-nul”) ulcers.

See a picture of the stomach and duodenum.

What causes peptic ulcers?

The two most common causes of peptic ulcers are:

• Infection with Helicobacter pylori (H. pylori) bacteria.
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs).

H. pylori and NSAIDs break down the stomach or intestine’s protective mucus layer. The mucus layer prevents digestive juices from damaging the stomach and intestine.

What are the symptoms?

Symptoms include:

• A burning, aching, gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks.
• Pain that usually goes away for a while after you take an antacid or acid reducer.
• Loss of appetite and weight loss.
• Bloating or nausea after eating.
• Vomiting.
• Vomiting blood or material that looks like coffee grounds.
• Passing black stools that look like tar or stools that have streaks of dark red blood.

Different people have different symptoms, and some people have no symptoms at all.

How are peptic ulcers diagnosed?

Your doctor will ask you questions about your symptoms and your general health, and he or she will do a physical exam.

Sometimes, if your doctor thinks you might have an ulcer or another problem (like indigestion or irritation of the stomach lining) that causes the same symptoms as an ulcer, he or she may try to treat your symptoms with medicine before you have any tests.

If your symptoms are not severe and you are younger than 55, your doctor may do some simple tests (using your blood, breath, or stool) to look for signs of H. pylori infection.

The only way for you and your doctor to know for sure if you have an ulcer is to do a more complicated test, called an endoscopy, to look for an ulcer and to test for H. pylori infection. An endoscopy allows the doctor to look inside your esophagus, stomach and small intestine. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases.

You may also have an endoscopy if your doctor thinks that your symptoms could be caused by stomach cancer, rather than by an ulcer. This does not happen very often. During this test, your doctor may remove small pieces of tissue (biopsy). This tissue may be tested for cancer.

How are they treated?

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics. If your doctor prescribes antibiotics to treat your infection, you need to take all the pills. It is much more likely that the infection will be cured if you take all the antibiotics.

You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.

Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.

Frequently Asked Questions

The two most common causes of peptic ulcer disease are infection with Helicobacter pylori (H. pylori) bacteria and use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Although many people are infected with H. pylori bacteria, only a few of them will develop peptic ulcer disease. Certain factors make a person with an H. pylori infection more likely to get an ulcer. Some of these factors, not all of which are well understood, include:

• The use of certain medicines, such as aspirin, ibuprofen (Advil, Motrin), or other NSAIDs.
• Smoking.
• Excessive alcohol use.
• Prior history of ulcers.
• Physical stress caused by a severe illness or injury (such as a major trauma, the need to be on a ventilator to assist breathing, or surgery).

Most peptic ulcers that are not caused by an H. pylori infection are caused by the use of NSAIDs. NSAIDs may be prescribed to control pain or inflammation caused by long-term (chronic) diseases such as arthritis or headaches. When used for weeks or months, NSAIDs can damage the lining of the digestive tract, causing an ulcer or making an existing ulcer worse.

A rare cause of peptic ulcers is Zollinger-Ellison syndrome. In this condition, the stomach greatly overproduces acid, damaging the stomach lining.

Although there is no evidence to prove that emotional or mental stress causes ulcers, it does seem to make ulcers worse in some people. But the connection is still controversial. And there are no specific recommendations for using counseling or psychotherapy to treat peptic ulcers.

The symptoms of a peptic ulcer vary and, by themselves, are not a reliable way to tell whether you have an ulcer. Also, some people may not have symptoms.

The symptoms of an ulcer often can be confused with other abdominal conditions, such as dyspepsia or gastroesophageal reflux disease (GERD).

Common ulcer symptoms include:

• A burning, aching pain—or a pain that feels like hunger—between the navel and the breastbone. The pain sometimes extends to the back.
• Belly pain that can last from a few minutes to a few hours and usually goes away for a while after taking an antacid or acid reducer.
• Weeks of pain that comes and goes and may alternate with pain-free periods.
• Loss of appetite and weight loss.
• Bloating or nausea after eating.

Less common but more serious symptoms of ulcers include:

• Vomiting after meals.
• Vomiting blood and/or material that looks like coffee grounds.
• Black stools that look like tar, or stools that contain dark red blood.

Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the stomach (gastric ulcers) are similar, except for when pain occurs.

• Pain from a duodenal ulcer may occur several hours after eating (when the stomach is empty) and may improve after eating. Pain also may wake you frequently in the middle of the night.
• Pain from a gastric ulcer may occur shortly after eating (when food is still in the stomach).

Some ulcers do not cause symptoms. These are known as silent ulcers. Silent ulcers are more common in older adults, people who have diabetes, or people who use nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), or naproxen (Aleve).

Complications of an ulcer include bleeding, perforation, penetration, or obstruction of the digestive tract. Complications can happen in both silent ulcers and ulcers that cause symptoms.

In children, symptoms vary with age:

• Toddlers and young children may complain of general stomach pain.
• Teenagers may have symptoms more like those experienced by adults.

Many people who have peptic ulcers may not seek medical attention when their symptoms begin. Their symptoms, such as belly pain, may come and go for some time and may alternate with pain-free periods. Even without treatment, some ulcers will heal by themselves.

And even with treatment, some ulcers may come back. Certain factors such as cigarette smoking and continued use of nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of ulcer recurrence.

Sometimes ulcers can cause complications, such as bleeding, perforation, penetration, or obstruction. Complications are more common with stomach (gastric) ulcers than with upper intestinal (duodenal) ulcers.

Most peptic ulcers without complications heal, regardless of the cause. But an ulcer is likely to come back if you have an H. pylori infection that is not successfully treated. Recurring ulcers caused by reinfection with H. pylori are not common in the United States, except in areas that are overcrowded or have poor sanitation.

If you have a history of ulcers, taking NSAIDs regularly raise your chances of developing another ulcer. If you stop using these medicines, you can reduce your chances of getting another ulcer.¹

Risk factors you can control

The following factors can increase your chance of developing a peptic ulcer and may slow the healing of an ulcer if you already have one. You may be able to reduce the risk of developing an ulcer by controlling or eliminating these factors, which include:

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs) (such as aspirin).
• Cigarette smoking.
• Excessive use of alcohol.

Risk factors you cannot control

Some factors that you cannot control may increase your risk of developing an ulcer. These include:

• A Helicobacter pylori (H. pylori) infection, which is the most common cause of ulcers.
• Physical stress caused by a severe illness or injury (such as a major trauma, the need to be on a ventilator to assist breathing, or surgery).
• Excess secretion of stomach acid.
• A family history of ulcers.

What is not a risk factor

In the past, eating spicy foods or drinking caffeine or moderate amounts of alcohol were thought to increase your risk of developing an ulcer. This is no longer believed to be true. But although certain foods or certain beverages may not increase your risk of developing an ulcer, they may cause symptoms of heartburn or indigestion. You may need to avoid them if they bother you.

Although there is no evidence to prove that emotional or mental stress causes ulcers, it does seem to make ulcers worse in some people. But the connection is still controversial. And there are no specific recommendations for using counseling or psychotherapy to treat peptic ulcers.

If you have been diagnosed with a peptic ulcer, call 911 or other emergency services immediately if you have:

• Symptoms that could indicate a heart attack or shock.
• Sudden severe, continuous abdominal pain or vomiting.
• Frequent feelings of dizziness or lightheadedness, especially when moving from lying down to a seated or standing position.
• Blood in your vomit or something that looks like coffee grounds (partially digested blood) in your vomit.
• Stools that are black or that look like tar, or stools that contain dark red or maroon blood.

Call your doctor if you have been diagnosed with a peptic ulcer and:

• Your symptoms continue or become worse after 10 to 14 days of treatment.
• You begin to lose weight without trying.
• You are vomiting.
• You have new belly pain or belly pain that does not go away.
• You have pain or difficulty when swallowing.

Watchful Waiting

If you have been diagnosed with a peptic ulcer and medical treatment is not helping, call your doctor. Waiting until your symptoms get worse can be serious.

If you do not know if you have a peptic ulcer and you do not have any of the emergency symptoms listed above, you may try taking an antacid or nonprescription acid reducer and other home treatment, such as making changes to your diet.

• If your symptoms don't get better after 10 to 14 days, call your doctor.
• If your symptoms go away after taking antacids or acid reducers and trying home treatment but then symptoms come back, call your doctor.

Who To See

To evaluate your symptoms, see your:

• Family medicine doctor.
• Internist.
• General practitioner.
• Nurse practitioner.
• Physician assistant.
• Pediatrician (for children and teens).

If further testing or specialized treatment is needed, you may need to see someone who specializes in the treatment of diseases of the digestive tract (gastroenterologist).

If surgery is needed, your doctor may refer you to a general surgeon. But surgery is rarely needed to treat ulcers.

To prepare for your appointment, see the topic Making the Most of Your Appointment

The tests needed to diagnose peptic ulcer disease may depend on your symptoms and on a medical history and physical exam.

If you are a younger adult who is having ulcer symptoms for the first time, your doctor may begin treatment with medicines based only on your symptoms and the results of your medical history and physical exam. But it is becoming more common to test your blood, breath, or stool immediately for Helicobacter pylori (H. pylori) infection whenever someone has common ulcer symptoms.

If you are older than 55, you may require more testing because you may be at increased risk for stomach cancer. Although the risk of stomach cancer is small, it is important to distinguish between a gastric and duodenal ulcer. If you have a stomach ulcer, it will be tested for cancer. In rare cases, stomach ulcers contain cancer cells. Further testing is needed, especially for those people older than 55 who have:

• Ulcer symptoms for the first time.
• Ulcer symptoms that return before or after treatment is completed.
• A family history of stomach cancer.
• Additional symptoms that may point to a more serious problem, such as stomach cancer. These include:
  • Blood in the stool.
  • Weight loss of more than 10% of body weight.
  • Anemia.
  • Difficulty swallowing (dysphagia).
  • Jaundice.
  • Abdominal mass.
  • Anorexia.

Tests to diagnose peptic ulcer disease

When a person has symptoms of a peptic ulcer, the following tests may be used to look for the ulcer:

• Endoscopy.Endoscopy allows the doctor to look at the inside of the stomach and upper small intestine to see whether ulcers are present. It also allows the doctor to collect a tissue sample (biopsy) that can be tested for the presence of H. pylori bacteria or other problems (such as cancer) in the stomach.
• Upper gastrointestinal (UGI) series. An X-ray exam of the esophagus and stomach (upper GI series) may be used to diagnose peptic ulcer disease, although this test is being used less frequently.

A fecal occult blood test (FOBT) may be done to detect blood in the stool, which may be caused by a peptic ulcer or another serious problem, such as colon cancer. By itself, an FOBT cannot diagnose peptic ulcer disease, but it may show if an ulcer is bleeding.

A complete blood count (CBC) also may be done to look for anemia, which may be caused by a bleeding ulcer.

Tests for H. pylori infection

Many people are infected with H. pylori bacteria, but most of them will not have symptoms of peptic ulcer disease. Because of this, the American College of Gastroenterology advises testing for H. pylori infection for people who:²

• Have active peptic ulcer disease or a past history of a peptic ulcer.
• Are known to have or have a family history of a condition called gastric mucosa-associated lymphoid tissue (MALT) lymphoma, which is a type of stomach cancer.
• Have a new case of dyspepsia, are younger than 55, and do not have bleeding, weight loss, or other symptoms that may be caused by a more serious condition.

However, some doctors prefer to test for H. pylori infection in everyone who has common ulcer symptoms.

Your doctor may advise a screening for H. pylori before long-term NSAID use is begun. Screening and treatment for H. pylori infection has been shown to reduce the risk of ulcers for people starting long-term NSAID use.³ Anyone taking NSAIDs should discuss with his or her doctor the potential risks of long-term NSAID use.

Helicobacter pylori tests cannot diagnose peptic ulcer disease or other conditions that may cause symptoms similar to an ulcer. These tests can only determine whether H. pylori bacteria are present. The most common tests used to detect an infection with H. pylori bacteria include:

• Blood test for H. pylori antibodies. A blood test for H. pylori antibodies is a quick, easy, and inexpensive test to detect them. This blood test may make it possible to avoid having an upper endoscopy exam. But it cannot distinguish between a past or current infection with H. pylori bacteria, so it is not useful for determining whether an infection has been cured.
• Urea breath test. A urea breath test for H. pylori is very accurate. Unlike the blood test, it will detect only those H. pylori bacteria that are present at the time of the test. This makes it a good test for checking to see whether an H. pylori infection has been cured. The test is somewhat expensive.
• Stool antigen test. This test checks for antigens for H. pylori in the stool. It can be used to diagnose H. pylori bacteria as a cause of peptic ulcer disease and to see whether treatment has cured the infection.
• Biopsy of the stomach lining. During an upper endoscopy exam, a biopsy of the stomach lining will be collected to test for H. pylori bacteria. A biopsy is the most accurate way to test for H. pylori. It also allows the doctor to check for other possible causes of symptoms (such as cancer). A biopsy is expensive and requires an upper endoscopy exam, which is more invasive than other tests used to detect H. pylori.

Some people who have received therapy with medicines to treat an H. pylori infection need follow-up testing to ensure that the infection is cured.

• If you have been diagnosed with a peptic ulcer caused by infection with Helicobacter pylori (H. pylori) bacteria, you will need treatment with antibiotic medicines to kill the bacteria.
• If your ulcer is caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), stop using them. NSAIDs slow or prevent the healing of an ulcer.
• Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. These include H2 blockers and proton pump inhibitors (PPIs).
• Lifestyle changes, such as quitting smoking and not drinking too much alcohol, are important for helping ulcers heal. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
• Ulcers that do not respond to treatment may have developed complications or may actually be cancer. You may need an endoscopy so that your doctor can look at the inside of your stomach and your upper small intestine to check for H. pylori or can collect a tissue sample (biopsy) that can be tested for cancer. But sometimes when symptoms do not get better with treatment, they are caused by something else that may or may not be a serious problem. Make sure you talk with your doctor to get to the bottom of your symptoms.
• If an ulcer eats through the wall of the stomach or intestine into the abdominal cavity (perforation), or if your ulcer continues to bleed despite therapy, you may require surgery. But these complications are rare.

Most cases of peptic ulcer disease are caused by an infection with H. pylori bacteria or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease. If an H. pylori infection is present, antibiotics to cure the infection are used in combination with these medicines.

Because the medicines now used to treat peptic ulcer disease are so effective, surgery is rarely used to treat peptic ulcer disease. Surgery generally is reserved for people who develop a life-threatening complication of an ulcer, such as severe bleeding, perforation, or obstruction. In some cases, even these complications can be treated without surgery.

Initial treatment

Initial treatment of peptic ulcer disease depends on its cause.

• H. pylori infection. Treatment to eliminate Helicobacter pylori (H. pylori) bacteria usually involves combining two antibiotics with an acid reducer such as a proton pump inhibitor or sometimes a bismuth compound. Curing the infection speeds the healing of an ulcer and makes the ulcer less likely to recur. It is important to take all the medicine your doctor prescribes so that the bacteria are killed and do not come back. Do not stop taking the medicine just because you feel better. If the bacteria are not eliminated by the antibiotics, they may become even more difficult to kill later (resistant).
• NSAIDs. If at all possible, you will need to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs). If you must continue taking an NSAID, other medicines may be used to protect the stomach. For more information, see the Medications section of this topic.
• Hypersecretory condition. Acid reducers are most often used to treat an ulcer caused by a hypersecretory condition (a condition in which your stomach produces excessive acid). In addition, your doctor may want to conduct other tests to determine whether there is another cause for the ulcer.
• Unknown cause. If no cause can be found (idiopathic ulcer), your ulcer will usually be treated with an acid reducer. Long-term treatment depends on the severity of the ulcer and other factors, such as the size of the ulcer, whether you have had complications, and what other treatments have been used.

No matter what is causing your ulcer, it is important to stop taking NSAIDs and to quit smoking.

Ongoing treatment

If you feel that you need to continue to use nonsteroidal anti-inflammatory drugs (NSAIDs) after being diagnosed with a peptic ulcer, work with your doctor to find an alternative pain reliever. Use of NSAIDs can slow the healing of an ulcer or prevent it from healing altogether. If you must continue to use NSAIDs, your doctor may recommend that you take a prostaglandin analog, such as misoprostol, or a proton pump inhibitor. Misoprostol does not help ulcers heal, but it can help prevent ulcers from coming back.

If ulcer symptoms do not respond to treatment, follow up with your doctor to be sure Helicobacter pylori (H. pylori) bacteria have been identified and treated. Most peptic ulcers are caused by infection with H. pylori bacteria. Persistent infection will likely be treated with an alternate combination of medicines. Antibiotic treatment for H. pylori should be taken exactly according to your doctor's instructions for it to be effective.

Tests such as the urea breath test and a stool antigen test can determine whether an H. pylori infection has been cured. If you have a history of ulcer complications or a family history of stomach cancer, you may need an endoscopy so that your doctor can look at the inside of your stomach and upper small intestine to see whether an ulcer is present. An endoscopy can also be used to collect a tissue sample (biopsy) that can be tested for H. pylori or cancer. For more information on these tests, see the Exams and Tests section of this topic.

Treatment if the condition gets worse

Recurring ulcers caused by an infection with Helicobacter pylori (H. pylori) bacteria will likely be treated with a different combination of medicines.

Your doctor may conduct follow-up tests to determine whether an infection with H. pylori has continued or returned. Tests for H. pylori may include testing your breath or stool, as well as a biopsy of your stomach lining. For more information on these tests, see the Exams and Tests section of this topic.

If you have experienced significant complications from a peptic ulcer such as bleeding or obstruction, you may need an endoscopy, even if you have already had one. If your stomach or intestine has a perforation or your ulcer continues to bleed despite treatment, you may require surgery. But surgery is rarely used to treat an ulcer.

What To Think About

Risk of not treating ulcers

• Left untreated, many ulcers eventually heal. But ulcers often recur if the cause of the ulcer is not eliminated or treated. If ulcers keep coming back, you have an increased risk of developing a serious complication.
• If treatment for your ulcer does not work to heal the ulcer, your doctor will most likely suggest that you see a gastroenterologist. The gastroenterologist will do an endoscopy to look at your ulcer and to take a tissue sample (biopsy).

You can greatly reduce the chance that you will get a peptic ulcer if you:

• Don't start smoking. If you smoke, quit. Smokers are much more likely to develop ulcers than nonsmokers. For ways to quit smoking, see the topic Quitting Tobacco Use.
• Avoid taking certain medicines. Avoid taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) for longer than a few days at a time. If you are taking aspirin regularly for heart problems, ask your doctor about taking another medicine to help protect your stomach and intestines from ulcers.
• Drink alcoholic beverages only in moderation. Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Never drink alcohol on an empty stomach.

If you are being treated for a peptic ulcer, your doctor will likely prescribe medicines and encourage you to try some home treatment methods. To stop symptoms and help an ulcer heal, you can:

• Stop smoking.
• Try nonprescription medicines that reduce acid production. Make sure you tell your doctor about any medicines you are taking.
• Make changes to your diet, such as eating smaller, more frequent meals. These changes may improve your symptoms, but they will not help your ulcer heal.
• Drink alcohol only in moderation, or avoid drinking alcohol. Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Drinking too much alcohol may make an ulcer heal more slowly and may make your symptoms worse.

Many people who have mild symptoms that could be caused by a peptic ulcer first try home treatment for a short time without seeing a doctor. But if you have ulcer symptoms that do not improve after 10 to 14 days of home treatment, or if you have other symptoms such as weight loss, nausea after eating, or consistent pain, it is important to see your doctor to make certain you have an ulcer and not some other more serious illness. This is even more important if you are middle-aged or older, because the risk of developing cancer or other illnesses that cause symptoms similar to peptic ulcer disease increases with age.

Medicines are usually a very effective treatment for ulcers. The bland diets that in the past were part of ulcer treatment are no longer required. This means people with peptic ulcers do not have to drink lots of milk or avoid spicy foods.

Most peptic ulcers can be cured and prevented from returning by eliminating Helicobacter pylori (H. pylori) infections and avoiding use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Medicines are used to:

• Treat peptic ulcer disease by reducing the amount of acid produced by the stomach.
• Kill H. pylori bacteria when it is determined that they are infecting the stomach lining.
• Prevent NSAID-related peptic ulcer disease by helping protect the lining of the stomach and upper small intestine (duodenum) from injury caused by NSAIDs.

Medication Choices

Medicines to reduce acid production

Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.

• Proton pump inhibitors (PPIs) (for example, Prilosec, Prevacid, Aciphex, Protonix, Nexium) reduce the amount of acid produced by the stomach (and are more potent than H2 blockers).
• H2 blockers (for example, Tagamet, Zantac, Pepcid, Axid) also reduce the amount of acid produced by the stomach.
• Antacids neutralize stomach acid. They are not as strong as PPIs or H2 blockers.

Proton pump inhibitors may be taken with antibiotics if the ulcer is caused by an H. pylori infection.

Medicines to kill H. pylori bacteria

Doctors prescribe combination drug therapy to cure infection with H. pylori bacteria. Combination drug therapy usually includes at least two antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.

Medicines to prevent ulcers

Certain medicines are used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs. These medicines are called prostaglandin analogs (such as misoprostol). They are sometimes used to prevent NSAID ulcers.

What To Think About

Ulcers in the stomach (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).

For people who have peptic ulcer disease and are known to be infected with H. pylori, doctors recommend combination therapy that includes at least two antibiotics, an acid reducer (usually a proton pump inhibitor), and sometimes a bismuth compound. These combination regimens cure infections 80% to 90% of the time.^{4, 5} Successful treatment of the infection greatly reduces the chances that the ulcer will come back.

You can get some H2 blockers and PPIs without a prescription (over-the-counter or OTC). If you are using OTC acid reducers (such as Prilosec OTC or Pepcid AC) to help with your symptoms for more than 10 to 14 days at a time, or if your symptoms are very bad, it is important that you see your doctor.

Surgery is rarely needed to treat peptic ulcers. Very effective medicine treatments are available to help heal ulcers. Treatment of a Helicobacter pylori (H. pylori) infection prevents most ulcers from coming back.

Surgery is needed occasionally to treat:

• Ulcers that do not heal (intractable peptic ulcers) after extensive medicine therapy and self-care.
• Life-threatening complications of an ulcer, such as severe bleeding, perforation, or obstruction.

Surgery Choices

When surgery is done to treat an ulcer, it usually involves one or more of the following:

• Cutting one or more of the nerves to the stomach (vagotomy).
• Widening the opening of the bottom of the stomach (pyloroplasty).
• Removing part of the stomach (partial gastrectomy).

What To Think About

Because medicine for peptic ulcers works so well, surgery is rarely needed. If surgery is suggested, you may want to:

• Seek a second opinion and ask whether all medicine treatment options have been tried.
• Compare the cost of long-term medicine treatment to the one-time cost of surgery.
• Remember that no surgery can completely prevent ulcers from returning.
• Find a surgeon who has a lot of experience with this type of surgery.

Surgery may be needed for ulcers that are not healing because you are taking aspirin or NSAIDs. If you continue taking these medicines, surgery may not work well. Not taking these medicines is very important. Talk to your doctor about medicines you can take instead of aspirin or NSAIDs.

There is no other treatment available for uncomplicated peptic ulcers at this time.

Organization

• Gastroesophageal Reflux Disease (GERD)

Citations

1. Chey WD, Scheiman JM (2003). Peptic ulcer disease. In SL Friedman et al., eds., Current Diagnosis and Treatment in Gastroenterology, 2nd ed., pp. 323–340. New York: McGraw-Hill.

2. Chey WD, et al. (2007). American College of Gastroenterology guideline of the management of Helicobacter pylori infection. American Journal of Gastroenterology, 102(8): 1808–1825.

3. Chan KLF, et al. (2002). Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: A randomised trial. Lancet, 359(9300): 9–13.

4. Howden CW, Hunt RH (1998). Guidelines for the management of Helicobacter pylori infection. American Journal of Gastroenterology, 93(12): 2330–2338.

5. Laine L, et al. (1998). Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease: Results of three multicenter, double-blind, United States trials. American Journal of Gastroenterology, 93(11): 2106–2112.