What Causes Ulcers?

For a long time, ulcers were thought to be due to stress or excess amounts of stomach acid. Not so - find out the real causes.

Medically Reviewed
aspirin tablets and microscopic biomes that can cause ulcers
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Everyday Health: Ulcers are a common reason behind chronic stomach pain. Can you explain what causes ulcers and how they impact digestion?

Mark Babyatsky, MD (mssm.edu)

Most ulcers are caused by a bacterium known as Helicobacter pylori or the use of aspirin or nonsteroidal anti — inflammatory drugs. Helicobacter is mostly acquired in childhood and much less common in developed nations than in those with less well — developed sanitary conditions. Baby aspirin alone does not cause ulcers but higher doses and many other over — the — counter pain relievers can lead to ulcers, particularly at high doses and if used daily. Ulcers can affect appetite and cause nausea, vomiting, or bleeding into the digestive tract.

Kenneth Brown, MD (kennethbrownmd.com)

Peptic ulcer disease, commonly called ulcers, is very common and affects more than 4 million people each year in the U.S. Ulcers are sores or eroded areas that form in the lining of the stomach or duodenum (small bowel). Left untreated, ulcers can cause significant problems, including significant pain and severe bleeding. Fortunately, most people who develop ulcers can be easily treated.

People with ulcers can have a wide variety of symptoms. Some people may experience no symptoms at all, or in rare instances can develop life — threatening complications, such as bleeding. Some of the more common symptoms may include abdominal pain, burning, nausea, bloating, fatigue, or black stools.The two most common causes of ulcers are Helicobacter pylori (H. pylori) and non steroidal anti — inflammatory drugs (NSAIDS).

H. pylori is a bacteria which causes ulcers by disrupting the protective mucous layer that lines the intestines. When the mucus layer is disrupted, it triggers the release of certain enzymes and toxins that injure the cells of the stomach or duodenum causing small sores. Once a small sore develops, the tissue becomes more vulnerable to damage from digestive juices and has the potential to develop into an ulcer.

The most common NSAIDS are ibuprofen and aspirin. These types of drugs are taken to decrease inflammation. Inflammation is caused by a natural chemical in the body called prostaglandins. NSAIDS work by inhibiting the body's production of prostaglandins. However, certain prostaglandins are important in protecting the stomach lining from the corrosive effects of stomach acid, as well as playing a role in maintaining the natural, healthy condition of the stomach lining. By disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding.

Elisa Faybush, MD (bannerhealth.com)

The majority of peptic ulcers are caused by a bacterial infection of the stomach called Helicobacter pylori. This infection is often asymptomatic and can be acquired in childhood. The other cause of ulcers is the regular use of aspirin and anti — inflammatory medicines. There is no evidence that stress causes ulcers. Symptoms of ulcers can include upper abdominal pain, nausea and vomiting, and black, tarry stools (a sign of a bleeding ulcer).

Lisa Ganjhu, DO (wehealnewyork.org)

A gastric ulcer is a sore or scar in the stomach. Taking high — dose aspirin and nonsteroidal antinflammatory drugs like Motrin or Advil usually cause ulcer in the stomach. Ulcers can also be caused by an infection, called H. pylori. Common symptoms of gastric ulcers include weight loss, poor appetite, bloating, burping, vomiting, and sometimes vomiting blood.

Brett Lashner, MD (clevelandclinic.org)

Ulcers of the stomach and duodenum used to be very common, but are now becoming much less common. We used to think that acid caused ulcers and our treatment paradigm was "no acid, no ulcers." Yes, eliminating acid allowed ulcers to heal, but they came right back after treatment was stopped. We now know that ulcers are principally related to two causes, Helicobacter pylori infection and non — steroidal anti — inflammatory drug (NSAID) use. By eradicating H. pylori with antibiotics, we can eliminate ulcer disease for good. This discovery, that a chronic disease can be cured with antibiotic therapy, led to the awarding of the Nobel Prize in Medicine to Drs. Marshall and Warren in 2005. Interestingly, rates of H. pylori infection are falling, accounting for the lower rates of ulcer disease. Of course, stopping NSAIDs will cure NSAID — induced ulcers. Neither ulcers nor antacid therapy, like proton — pump inhibitors, impact on digesting very much. Digestion occurs more efficiently in the presence of acid, but occurs very well indeed when acid is suppressed.

Andrew Sable, MD (gastrohealth.com)

Most commonly ulcers occur in either the stomach or duodenum (first part of the small intestine). Symptoms usually manifest as pain or burning in your mid to upper abdomen just below the center of your chest. For years it was thought that stress was a major factor in the formation of ulcers. While severe stress experienced form medical illness may increase the risk of ulcer formation, more commonly medication such as NSAIDs (non — steroidal anti — inflammatory medications), the bacteria H. pylori, and smoking are the major risk factors. With the advent of PPIs (proton pump inhibitors) and the understanding of H. pylori, ulcers can usually be treated medically before they affect digestion. On a rare occasion, they may cause obstruction of the stomach, severe bleeding, or perforation of the intestine which may require surgery. In general though, the long term impact on digestion in minimal.

Albert Snow, ND (holisticgastroenterology.com)

First off, let's not buy into the myth that ulcers are caused by a bacteria called H. pylori. Just not true. Ulcers are caused by the prior use of a medication that destroyed your mucosal lining, thus leaving your stomach tissue exposed to your own digestive acids, which then eat a hole right through the flesh. This is also true of ulcerative colitis. Ulcers don't impact digestion, but in this scenario digestion impacts the ulcer (creating it).

William Chey, MD (med.umich.edu)

For many years, ulcers were thought to be due to stress or excess amounts of stomach acid. As it turns out, the most common causes of gastic (stomach) and duodenal (first part of the small intestine) ulcers are a specific type of bacteria called Helicobacter pylori and medications, most notably, nonsteroidal anti — inflammatory drugs (NSAIDs) and aspirin. Any person found to have an ulcer should be tested for H. pylori infection and asked about the use of these medications. H. pylori can be tested for using a breath test, by stool testing, or by checking for the bacteria in biopsy specimens from the stomach. This organism is usually treated with a combination of 3 to 4 antibiotics for 10 to 14 days. Curing the infection leads to healing of the ulcer and significantly reduces the likelihood of getting recurrent ulcers. Ulcers related to the use of NSAIDs or aspirin are typically healed with drugs that potently suppress the production of stomach acid called the proton pump inhibitors (PPIs). If a person can discontinue their NSAID or aspirin, a 10 — to 12 — week course of PPI therapy is sufficient to heal the ulcer. If a person needs to stay on an NSAID or aspirin, PPI therapy should be continued to reduce the risk of developing another ulcer.

Jacqueline Wolf, MD (drjacquelinewolf.com)

Stomach and duodenal ulcers are usually due to one of two causes: the bacterium Helicobacter pylori or nonsteroidal anti — inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen. An ulcer, regardless of the cause, can cause abdominal pain, bleeding, or even cause a hole (perforation). An ulcer is maintained by an acid environment in the stomach and pepsin, which is produced in the stomach. Chronic infection with H. pylori causes an increase in acid. There is also a change in some of the cells in the duodenum that is created by the acid change called gastric metaplasia. Additionally the bacteria create an active immune response that could contribute to ulcer formation/inflammation and they appear to decrease the response of protective factors in the lining of the stomach and duodenum. Smoking also increases ulcer formation. NSAIDs, by their effect on prostaglandins, can increase stomach acid, decrease the substances that protect the lining like bicarbonate and glutathione, and can allow the hydrogen ions to diffuse (go) backwards into the stomach lining and decrease the rate of blood flow to the stomach lining.