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Peptic Ulcer Disease
and H. pylori
National Digestive Diseases Information Clearinghouse
What is a peptic ulcer? Ulcer
A peptic ulcer is a sore on the inner lining of
the stomach or duodenum—the first part of
the small intestine. Less commonly, a peptic
ulcer may develop just above the stomach in
the esophagus—the organ that connects the
mouth to the stomach. Esophagus
What causes peptic ulcer Stomach
disease? Pancreas
Causes of peptic ulcer disease include
Duodenum
• an infection with the bacteria
Helicobacter pylori (H. pylori) Small
• long-term use of nonsteroidal anti- intestine
inflammatory drugs (NSAIDs), such as
aspirin and ibuprofen
• rarely, cancerous or noncancerous A peptic ulcer is a sore on the inner lining of the
tumors in the stomach, duodenum, or stomach or duodenum.
pancreas
What are H. pylori? Who is more likely to
H. pylori are spiral-shaped bacteria that can develop an H. pylori-induced
cause peptic ulcer disease by damaging the peptic ulcer?
mucous coating that protects the lining of A person who has contracted an H. pylori
H. pylori infection is more likely to develop an
the stomach and duodenum. Once
have damaged the mucous coating, powerful H. pylori-induced peptic ulcer. Researchers
stomach acid can get through to the sensitive are not certain how H. pylori infection
lining. Together, the stomach acid and spreads, although they think that
H. pylori irritate the lining of the stomach or contaminated food, water, or eating utensils
duodenum and cause a peptic ulcer. may spread the infection. Researchers have
found H. pylori in the saliva of some infected
people, which suggests that infection could
spread through direct contact with saliva or
1
other bodily fluids. Most people contract Seek Immediate Care
H. pylori infection during childhood, and it A person who has any of the following
remains dormant for years. Adults rarely symptoms should call a health care
contract H. pylori. provider right away:
What are the signs and • difficulty breathing
symptoms of peptic ulcer • dizziness or feeling faint
disease? • red blood in the stool or black stools
A dull or burning pain in the stomach • red blood in vomit or vomit that
is the most common symptom of peptic looks like coffee grounds
ulcer disease. A person can feel this pain • sharp, sudden, persistent, and severe
anywhere between the navel and the stomach pain
breastbone. The pain usually
• occurs when a person’s stomach is These symptoms could be signs of peptic
empty—such as between meals or ulcer disease complications.
during the night
• lessens briefly after eating food or
taking antacids What are the complications
• lasts for minutes to hours of peptic ulcer disease?
• comes and goes for several days, weeks, Complications of peptic ulcer disease include
or months • internal bleeding—when gastric acid or
Other, less common symptoms include a peptic ulcer breaks a blood vessel
• bloating • obstruction—when a peptic ulcer blocks
• burping the path of food trying to leave the
stomach
• changes in appetite • perforation—when a peptic ulcer grows
• nausea deeper and breaks completely through
• vomiting the stomach or duodenal wall
• weight loss • peritonitis—when infection or
inflammation develops in the
peritoneum, or lining of the
abdominal cavity
1
Momtaz H, Souod N, Dabri H, Sarshar M. Study of
Helicobacter pylori genotype status in saliva, dental
plaques, stool and gastric biopsy samples. World
Journal of Gastroenterology. 2012;18(17):2105–2111.
2 Peptic Ulcer Disease and H. pylori
How is peptic ulcer disease The breath test and stool test detect
diagnosed? H. pylori more accurately than the blood
test, so some health care providers prefer
A health care provider diagnoses peptic ulcer to use one of these two tests. Testing is
disease based on important because health care providers
• a medical history treat H. pylori-induced peptic ulcer disease
• a physical exam differently from peptic ulcer disease caused
by NSAIDs.
• lab tests Read more in Peptic Ulcer Disease and
• upper gastrointestinal (GI) endoscopy NSAIDs at www.digestive.niddk.nih.gov.
• upper GI series Blood test. A blood test involves drawing a
• computerized tomography (CT) scan sample of a patient’s blood at a health care
provider’s office or a commercial facility
Medical History and sending the sample to a lab for analysis.
Taking a medical history may help a health The blood test can show the presence of
care provider determine the cause of a peptic H. pylori.
ulcer. If a patient has peptic ulcer disease Urea breath test. For a breath test, the
symptoms, the health care provider will ask patient swallows a special liquid that
about the patient’s use of over-the-counter contains urea—a waste product the body
and prescription NSAIDs. produces as it breaks down protein. If
Physical am H. pylori are present, the bacteria will
A physical exam may help the health care convert the urea into carbon dioxide. A
provider diagnose the cause of peptic ulcer nurse or technician will take samples of a
disease. During a physical exam, a health patient’s breath at a health care provider’s
care provider usually office or a commercial facility and send the
samples to a lab to measure the level of
• checks for abdominal bloating carbon dioxide.
• listens to sounds within the abdomen Stool test. A stool test is the analysis of a
using a stethoscope sample of stool. The health care provider
• taps on the abdomen checking for will give the patient a container to take
tenderness or pain home for catching and storing the stool.
The patient returns the sample to the health
a ests care provider or a commercial facility, and
A health care provider will look to see if it is sent to a lab for analysis. Stool tests can
H. pylori are present using one of three show the presence of H. pylori.
simple tests:
• blood test
• urea breath test
• stool test
3 Peptic Ulcer Disease and H. pylori
pper astrointestinal pper astrointestinal Series
ndoscopy Upper GI series is an x-ray exam that
Upper GI endoscopy is a procedure that uses provides a look at the shape of the upper GI
an endoscope—a small, flexible camera with tract to help diagnose peptic ulcer disease.
a light—to see the upper GI tract. A health An x-ray technician performs this test at
care provider performs the test at a hospital a hospital or an outpatient center, and a
or an outpatient center. The health care radiologist—a health care provider who
provider carefully feeds the endoscope down specializes in medical imaging—interprets
the patient’s esophagus and into the stomach the images. This test does not require
and duodenum. The small camera built into anesthesia. A patient should not eat or drink
the endoscope transmits a video image to a before the procedure, as directed by his or
monitor, allowing close examination of the her health care provider. Patients should
GI lining. A health care provider may give a ask their health care provider about how to
patient a liquid anesthetic to gargle or may prepare for an upper GI series.
spray anesthetic on the back of the patient’s During the procedure, the patient will
throat before inserting the endoscope. A stand or sit in front of an x-ray machine and
health care provider will place an intravenous drink barium, a chalky liquid that coats the
(IV) needle in a vein in the arm to administer esophagus, stomach, and small intestine so
sedation. Sedatives help patients stay relaxed the radiologist and health care provider can
and comfortable. The test may show signs see the shape of these organs more clearly on
of inflammation or erosions in the stomach the x rays.
lining.
The health care provider can pass tiny tools A patient may experience bloating and
through the endoscope to nausea for a short time after the test. For
several days afterward, barium liquid in
• take photos of the peptic ulcer. the GI tract causes white or light-colored
• obtain a biopsy of the lining of the stools. A health care provider will give the
stomach or small intestine. A biopsy patient specific instructions about eating and
is a procedure that involves taking a drinking after the test.
small piece of tissue for examination Read more in Upper GI Series at www.
with a microscope by a pathologist—a digestive.niddk.nih.gov.
health care provider who specializes in Computeried omography Scan
examining tissues to diagnose diseases.
The patient will not feel the biopsy. The Computerized tomography scans use
H. pylori. a combination of x rays and computer
test can show the presence of
• inject medications that help the blood technology to create images. For a CT scan,
clot. a nurse or technician may give the patient
a solution to drink and an injection of a
• stop any bleeding with an electrical special dye, called contrast medium. CT
probe or special medications. scans require the patient to lie on a table that
Read more in Upper GI Endoscopy at www. slides into a tunnel-shaped device that takes
digestive.niddk.nih.gov. the x rays. An x-ray technician performs
the procedure in an outpatient center or
a hospital, and a radiologist interprets
the images. The patient does not need
4 Peptic Ulcer Disease and H. pylori
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