What Is Peptic Ulcer Disease?

Peptic ulcer disease occurs when open sores, also known as ulcers, form in the stomach or small intestine, causing stomach pain, bloating, heartburn, and nausea. About one out of 12 Americans experience this uncomfortable condition. Recently, singer Bruce Springsteen announced he would be postponing all concerts for the rest of 2023 while undergoing medical treatment for peptic ulcer disease.

The term “peptic” is used to describe the stomach acid that causes irritation to the lining of the stomach and small intestine, resulting in ulcers of varying degrees of severity. According to Dr. Carolyn Newberry, gastroenterologist at NewYork-Presbyterian/Weill Cornell Medical Center and assistant professor of medicine at Weill Cornell Medicine, this condition arises when the protective mucus lining in the stomach or the upper part of the small intestine breaks down and can no longer provide protection against acidic digestive fluids.

“Everyone has acid in their stomach, which you need in order to properly digest food,” says Dr. Newberry. “However, there are also barriers protecting your stomach so that the stomach acid doesn’t cause damage. If you have risk factors that lead to a reduction in the barriers’ efficacy or an increase in stomach acid secretion, that can contribute to stomach acid irritation. Peptic ulcer disease occurs when there’s a mismatch between the amount of stomach acid that’s produced and the amount of protection you have against the stomach acid.”

Health Matters spoke with Dr. Newberry to learn more about peptic ulcer disease, including its symptoms and treatments.

What causes peptic ulcer disease?

Various risk factors can reduce the protective barrier against stomach acid. These include smoking, alcohol consumption, genetic factors, and certain medications, including corticosteroids. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium can also break down your stomach’s natural protection.

A change in stomach acid secretion because of certain bacterial infections can also put people at risk. One of the most common causes of peptic ulcers is Helicobacter pylori (H. pylori) bacteria. This is a common bacterium that can live in the stomach and affect the way stomach acid is secreted, but an H. pylori infection can be treated with antibiotics.

Stress can also be a risk factor because it can be associated with increased stomach acid secretion. So when people talk about worrying themselves into getting an ulcer, there actually is some truth to that.

What are the signs and symptoms of peptic ulcer disease?

Because H. pylori causes inflammation in the stomach, some people may experience abdominal pain or develop heartburn-like symptoms. You may develop a sour stomach or sometimes nausea. The symptoms can also be general, nonspecific digestive complaints. Many times, when people come to us with generalized gastrointestinal issues, we’ll check for H. pylori through a stool test, a breath test, or a biopsy obtained through an endoscopy.

Usually, significant peptic ulcer disease will cause symptoms, but sometimes people will have no symptoms and are only diagnosed with it when they have to undergo an endoscopy for another reason.

How is peptic ulcer disease diagnosed?

Peptic ulcer disease happens when you develop a breakdown of the mucus lining in the stomach or the first part of the small intestine, so this is usually diagnosed through an upper endoscopy. Sometimes you can see ulcers on other imaging tests of the digestive tract, such as a barium swallow, but an endoscopy should still be done to confirm the diagnosis.

Who is most at risk of developing peptic ulcer disease?

On top of the other risk factors we discussed, such as being a smoker or taking certain medications, this condition is more common in older adults. We experience changes in our secretion of stomach acid as we get older, and the protective factors in the stomach also get weaker as we age. People who are older, critically ill, and frail, while taking NSAIDs or steroids, are most at risk of developing ulcers that become so severe that a hole develops at the site of the ulcer and it becomes a surgical emergency.

It’s important to note that not everyone who takes NSAIDs will develop ulcers. But if you have, for instance, a history of smoking or steroid use, or an H. pylori infection, then also taking NSAIDs can increase your risk of developing peptic ulcer disease.

How is peptic ulcer disease typically treated?

The treatment is typically case by case depending on the specific cause of the ulcer. Treatment is usually a combination of acid-blocking medications known as proton pump inhibitors to reduce the amount of stomach acid that’s being secreted so that it’s not damaging the mucus lining, then reducing the risk factors associated with the development of the ulcer. If somebody is a smoker, that means quitting smoking. If somebody’s using a lot of NSAIDs or steroids, that means stopping those medications. And if they have an H. Pylori infection, that means treating it with antibiotics and then taking acid-blocking medications.

For most people, peptic ulcer disease is not serious, and recovery happens quickly. But there is a broad spectrum of severity, so it’s important to see a doctor if you have symptoms. If you have non-healing ulcers that aren’t treated or addressed, that can lead to cellular damage, which, in turn, could lead to stomach cancer. This is rare, but it’s still a good reminder to seek treatment as soon as possible and to be aware of your risk factors.

What lifestyle changes can you make to help prevent the development of peptic ulcers?

Not smoking and not using excessive amounts of the medications that increase your risk can help significantly. If you do have digestive symptoms, get tested for infections such as H. pylori. And this is easier said than done, but managing stress levels is incredibly important when it comes to prevention.

Carolyn Newberry, M.D., is a gastroenterologist and physician nutrition specialist at NewYork-Presbyterian/Weill Cornell Medical Center and an assistant professor of medicine at Weill Cornell Medicine. Dr. Newberry serves as the director of GI Nutrition within the Innovative Center for Health and Nutrition in Gastroenterology, a multidisciplinary weight-management and lifestyle program. Dr. Newberry’s primary clinical and research interests lie in defining the relationship between GI, nutrition, and obesity. She has published multiple review papers and original articles examining diet’s role in treating common gastrointestinal diseases, the link between malnutrition and gut pathology, and optimal therapy for obesity management.