Cause

The two most common causes of peptic ulcers are:

• Infection withHelicobacter pylori(H. pylori) bacteria. Although many people are infected with H. pylori bacteria, only a few get ulcers.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). 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 makes too much 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.

Symptoms

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 that usually goes away for a while after you take 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 you eat (when the stomach is empty) and may improve after you eat. Pain also may wake you in the middle of the night.
• Pain from a gastric ulcer may occur shortly after you eat (when food is still in your stomach).

Some ulcers don't cause symptoms. These are known as silent ulcers. Silent ulcers are more common in:

• Older adults.
• People who have diabetes.
• People who use nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).

In children, symptoms vary with age:

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

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