Apeptic ulceris the term used for a sore that occurs in the mucosal lining of the stomach,small intestine, oresophagus. When the ulcer is in the stomach it might also be called a gastric ulcer. Ulcers in the first part of the small intestine (duodenum) may be called a duodenal ulcer.
The most common cause of a peptic ulcer is a type of bacteria calledHelicobacter pylori (H. pylori).A second, less common cause of peptic ulcers that’s steadily increasing in importance is the use ofnon-steroidal anti-inflammatory medications (NSAIDs)such asaspirin, ibuprofen, and naproxen.
Using over-the-counter NSAIDs for the occasional headache or achy back won’t typically cause a peptic ulcer. Rather, peptic ulcer disease is something that can occur with longer-term use of NSAIDs, especially at high doses, such as forchronic painassociated witharthritisor other inflammatory conditions.
People who have any concerns about the use of NSAIDs and how thedigestive systemwill be affected should speak to a healthcare provider.
Why NSAIDs Can Cause Ulcers
Normally, the stomach has three protections against gastric acid:
NSAIDs slow the production of protective mucus in the stomach and change its structure.
The suppression of the body’s natural defenses against gastric acids can lead to inflammation in the stomach lining. Over time, this can cause the rupture of a capillary blood vessel, causing bleeding and the development of an open, ulcerative sore in the mucosal lining.
Symptoms
A peptic ulcer may cause symptoms in the digestive tract, but some people have no symptoms at all.
The most common symptom is upper abdominal pain (where the stomach is located) that can feel dull or burning. The pain can range in severity, with some experiencing mild discomfort and others having severe pain. Most of the time the pain will occur after a meal but for some people, it might also occur at night. It could go on for anywhere from a few minutes to a few hours.
Other symptoms are less common but can include bloating, burping, gas, nausea, vomiting, loss of appetite, weight loss, feeling sick to your stomach, and feeling full after even a small meal.
In rare cases, people with peptic ulcers may see blood in their stool or have stools that are black because they contain blood. Blood coming from one or more peptic ulcers could also be visible in vomit.
Call your healthcare provider right away if you notice blood in your stool or vomit. This can be a sign of excessive bleeding or other serious problems.
Diagnosis
When the symptoms of a peptic ulcer are present, a healthcare provider may order several tests to determine the cause and confirm the diagnosis.
In people who are receiving NSAIDs for chronic pain, a healthcare provider may already have a high suspicion that the medication is the cause of, or is contributing to, peptic ulcer disease. Because it is the most common cause of peptic ulcers, infection withH. pyloriis normally ruled out through the use of a breath test, blood test, or stool test.
Tests may be done to look for ulcers in the inside of the upper digestive tract. These include:
Risk Factors
All NSAIDs have the potential to causeindigestion,gastric bleeding, and ulcers. However, some people are more susceptible to developing peptic ulcer disease than others.
While studies suggest that as much as 25% of people who use NSAIDs long-term will develop an ulcer, only a small percentage of those will go on to developserious complications.
Treatment
NSAID-induced ulcers usually heal once the NSAID is stopped. Treatment may be recommended to speed up the healing process. In other cases, surgery may be needed.
Medications
Treating ulcers with any over-the-counter medication should always be based on the advice of medical providers.
Over-the-counter options include:
Prescription medications that might be recommended include:
The larger problem for people experiencing peptic ulcer disease as a result of therapy with NSAIDs is how to manage pain when those medications are discontinued. In the case of chronic pain, this may require the help of a team of specialists, including a pain management healthcare provider.
A class of medications calledCOX-inhibitorsmight be used to control pain for some people. COX-inhibitors have been shown to work for pain relief and are associated with fewer digestive side effects than other types of NSAIDs. These drugs have also been shown to have cardiovascular side effects, however, so it’s usually recommended that they be used at the lowest effective dose.
Lifestyle
Some lifestyle changes that may be recommended in order to help heal peptic ulcers include:
Foods and Drinks to Avoid With an Ulcer (and What to Have Instead)
Surgery
In some cases,surgery for a peptic ulcermay be needed. This is more often the case when there are complications as a result of the ulcer, such as:
Peptic Ulcer Disease Treatment
Prevention
Obviously, avoiding long-term/high-dose use of NSAIDs, or not using these medications altogether, can help protect you from peptic ulcers.
If you have to take an NSAID due to a condition you are trying to manage, your healthcare provider may prescribe you one of the medications used to treat peptic ulcers in order to prevent one from occurring in the first place.
Some think that spicy food and everyday stress cause ulcers, but that has been disproven.The above lifestyle changes can, however, help reduce your risk.
A Word From Verywell
Most people who take NSAIDs will not experience peptic ulcer disease.However, people who have chronic pain and who are receiving high doses of these medications should be aware of the possibility.
In some cases, it might be appropriate to ask a healthcare provider if there are ways to prevent ulcers and if those measures should be put into place while receiving high doses of NSAIDs. Because untreated ulcers can lead to complications, it’s important to get a diagnosis and receive treatment right away if an ulcer is suspected.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fashner J, Gitu AC.Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection.Am Fam Physician. 2015 Feb 15;91(4):236-42.National Institute of Diabetes and Digestive and Kidney Diseases.Peptic ulcers (stomach ulcers).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514. doi:10.1053/j.gastro.2017.10.049Lanza, FL, Chan, FKL, Quigley, E.Practice Parameters Committee of the American College of Gastroenterology Guidelines for Prevention of NSAID-Related Ulcer Complications.American Journal of Gastroenterology. 2009;104(3):728-738.Begg M, Tarhuni M, N Fotso M, et al.Comparing the safety and efficacy of proton pump inhibitors and histamine-2 receptor antagonists in the management of patients with peptic ulcer disease: a systematic review.Cureus. 2023;15(8):e44341. Published 2023 Aug 29. doi:10.7759/cureus.44341Healthlink BC.Bismuth Subsalicylate - Oral.For the International NSAID Consensus Group, Scarpignato C, Lanas A, et al.Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis – an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks.BMC Med. 2015;13(1):55. doi:10.1186/s12916-015-0285-8Lee CW, Sarosi GA.Emergency ulcer surgery.Surgical Clinics of North America. 2011;91(5):1001-1013. doi:10.1016/j.suc.2011.06.008Cleveland Clinic.Can stress give you an ulcer?Drina M.Peptic ulcer disease and non-steroidal anti-inflammatory drugs.Aust Prescr. 2017;40(3):91-93. doi:10.18773/austprescr.2017.037Additional ReadingLanza, F, Chan F, Quigley E, et al.Guidelines for prevention of NSAID-related ulcer complications.Amer J Gastroenterol.2009;104:728-38. doi:10.1038/ajg.2009.115Larkai EN, Smith JL, Lidsky MD, et al.Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.Am J Gastroenterol. 1987;82:1153–1158.National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Symptoms & Causes of Peptic Ulcers (Stomach Ulcers). National Institutes of Health.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fashner J, Gitu AC.Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection.Am Fam Physician. 2015 Feb 15;91(4):236-42.National Institute of Diabetes and Digestive and Kidney Diseases.Peptic ulcers (stomach ulcers).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514. doi:10.1053/j.gastro.2017.10.049Lanza, FL, Chan, FKL, Quigley, E.Practice Parameters Committee of the American College of Gastroenterology Guidelines for Prevention of NSAID-Related Ulcer Complications.American Journal of Gastroenterology. 2009;104(3):728-738.Begg M, Tarhuni M, N Fotso M, et al.Comparing the safety and efficacy of proton pump inhibitors and histamine-2 receptor antagonists in the management of patients with peptic ulcer disease: a systematic review.Cureus. 2023;15(8):e44341. Published 2023 Aug 29. doi:10.7759/cureus.44341Healthlink BC.Bismuth Subsalicylate - Oral.For the International NSAID Consensus Group, Scarpignato C, Lanas A, et al.Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis – an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks.BMC Med. 2015;13(1):55. doi:10.1186/s12916-015-0285-8Lee CW, Sarosi GA.Emergency ulcer surgery.Surgical Clinics of North America. 2011;91(5):1001-1013. doi:10.1016/j.suc.2011.06.008Cleveland Clinic.Can stress give you an ulcer?Drina M.Peptic ulcer disease and non-steroidal anti-inflammatory drugs.Aust Prescr. 2017;40(3):91-93. doi:10.18773/austprescr.2017.037Additional ReadingLanza, F, Chan F, Quigley E, et al.Guidelines for prevention of NSAID-related ulcer complications.Amer J Gastroenterol.2009;104:728-38. doi:10.1038/ajg.2009.115Larkai EN, Smith JL, Lidsky MD, et al.Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.Am J Gastroenterol. 1987;82:1153–1158.National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Symptoms & Causes of Peptic Ulcers (Stomach Ulcers). National Institutes of Health.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fashner J, Gitu AC.Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection.Am Fam Physician. 2015 Feb 15;91(4):236-42.National Institute of Diabetes and Digestive and Kidney Diseases.Peptic ulcers (stomach ulcers).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514. doi:10.1053/j.gastro.2017.10.049Lanza, FL, Chan, FKL, Quigley, E.Practice Parameters Committee of the American College of Gastroenterology Guidelines for Prevention of NSAID-Related Ulcer Complications.American Journal of Gastroenterology. 2009;104(3):728-738.Begg M, Tarhuni M, N Fotso M, et al.Comparing the safety and efficacy of proton pump inhibitors and histamine-2 receptor antagonists in the management of patients with peptic ulcer disease: a systematic review.Cureus. 2023;15(8):e44341. Published 2023 Aug 29. doi:10.7759/cureus.44341Healthlink BC.Bismuth Subsalicylate - Oral.For the International NSAID Consensus Group, Scarpignato C, Lanas A, et al.Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis – an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks.BMC Med. 2015;13(1):55. doi:10.1186/s12916-015-0285-8Lee CW, Sarosi GA.Emergency ulcer surgery.Surgical Clinics of North America. 2011;91(5):1001-1013. doi:10.1016/j.suc.2011.06.008Cleveland Clinic.Can stress give you an ulcer?Drina M.Peptic ulcer disease and non-steroidal anti-inflammatory drugs.Aust Prescr. 2017;40(3):91-93. doi:10.18773/austprescr.2017.037
Fashner J, Gitu AC.Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection.Am Fam Physician. 2015 Feb 15;91(4):236-42.
National Institute of Diabetes and Digestive and Kidney Diseases.Peptic ulcers (stomach ulcers).
Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514. doi:10.1053/j.gastro.2017.10.049
Lanza, FL, Chan, FKL, Quigley, E.Practice Parameters Committee of the American College of Gastroenterology Guidelines for Prevention of NSAID-Related Ulcer Complications.American Journal of Gastroenterology. 2009;104(3):728-738.
Begg M, Tarhuni M, N Fotso M, et al.Comparing the safety and efficacy of proton pump inhibitors and histamine-2 receptor antagonists in the management of patients with peptic ulcer disease: a systematic review.Cureus. 2023;15(8):e44341. Published 2023 Aug 29. doi:10.7759/cureus.44341
Healthlink BC.Bismuth Subsalicylate - Oral.
For the International NSAID Consensus Group, Scarpignato C, Lanas A, et al.Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis – an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks.BMC Med. 2015;13(1):55. doi:10.1186/s12916-015-0285-8
Lee CW, Sarosi GA.Emergency ulcer surgery.Surgical Clinics of North America. 2011;91(5):1001-1013. doi:10.1016/j.suc.2011.06.008
Cleveland Clinic.Can stress give you an ulcer?
Drina M.Peptic ulcer disease and non-steroidal anti-inflammatory drugs.Aust Prescr. 2017;40(3):91-93. doi:10.18773/austprescr.2017.037
Lanza, F, Chan F, Quigley E, et al.Guidelines for prevention of NSAID-related ulcer complications.Amer J Gastroenterol.2009;104:728-38. doi:10.1038/ajg.2009.115Larkai EN, Smith JL, Lidsky MD, et al.Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.Am J Gastroenterol. 1987;82:1153–1158.National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Symptoms & Causes of Peptic Ulcers (Stomach Ulcers). National Institutes of Health.
Lanza, F, Chan F, Quigley E, et al.Guidelines for prevention of NSAID-related ulcer complications.Amer J Gastroenterol.2009;104:728-38. doi:10.1038/ajg.2009.115
Larkai EN, Smith JL, Lidsky MD, et al.Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.Am J Gastroenterol. 1987;82:1153–1158.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Symptoms & Causes of Peptic Ulcers (Stomach Ulcers). National Institutes of Health.
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