Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2003;68(10):2028-2029

What is an ulcer?

An ulcer is an opening in the lining of the stomach or in the duodenum (the first part of the small intestine). Ulcers cause a gnawing or burning pain in the stomach. However, most people who have stomach pain do not have an ulcer. Your doctor can do tests to decide if your stomach pain is caused by an ulcer.

Are ulcers serious?

Most people with ulcers just have stomach pain. Some people do not have any symptoms at all. But, ulcers may cause other health problems. Sometimes they bleed. If ulcers become too deep, they can break through the stomach wall. Ulcers also can block food from going through the intestines.

What causes ulcers?

Some people think ulcers are caused by stress or by eating food with too much acid in it, but this is not true. Most stomach ulcers are caused by infection with a bacteria called Helicobacter pylori (say: “hell-ee-ko-back-ter pie-lore-ee”), or H. pylori for short. Ulcers in people who do not have an H. pylori infection are usually related to heavy aspirin use, or heavy use of anti-inflammatory drugs such as ibuprofen (some brand names: Advil, Nuprin, Motrin). Acetaminophen (brand name: Tylenol) does not cause stomach ulcers.

How does my doctor know if I have H. pylori infection?

H. pylori infection can be diagnosed with a blood test. Your doctor might want you to get an x-ray or have an endoscopy (a thin tube with a tiny camera inside it that is passed down your throat and into your stomach) to see if you have an ulcer. A breath test is another way to find out if you have H. pylori infection.

How are ulcers treated?

Three kinds of medicines can be used to treat ulcers. All of them do a good job of healing ulcers. Your doctor can tell you which one is right for you. You should take the medicine just as your doctor tells you to.

The first kind of medicine reduces the amount of acid your stomach makes. This medicine can heal an ulcer in the duodenum in six to eight weeks. Ulcers in the stomach take a little longer to heal. You take these medicines for eight to 12 weeks if you have a stomach ulcer.

A second kind of medicine blocks the stomach's ability to make acid. This medicine helps heal an ulcer in the duodenum in four weeks. It helps heal stomach ulcers in six to eight weeks.

A third kind of medicine coats the ulcer. It protects the sore place from stomach acid, so it can heal. This kind of medicine takes eight to 12 weeks to heal an ulcer.

What if I have an ulcer and H. pylori infection?

The medicines described earlier heal ulcers whether you have H. pylori infection or not. But, if you have H. pylori infection too, your doctor also will treat the infection. H. pylori is hard to get rid of. No single medicine can cure this infection. The best way to cure H. pylori infection is to take several medicines at the same time.

To treat an H. pylori infection, your doctor will prescribe several medicines: one or two antibiotics plus bismuth (bismuth is commonly called Pepto-Bismol) or a medicine to block stomach acid production. This means taking a large number of pills every day. Some combinations that use fewer drugs also might help. Tritec is a pill that combines bismuth and a drug to reduce acid in the stomach. It is used with an antibiotic. Helidac is another medicine that combines bismuth and two antibiotics. Your doctor will tell you which medicines you should take.

Do the medicines cause side effects?

Because you have to take so many medicines at the same time, you may have some side effects. Minor side effects of H. pylori medicines include a black color on your tongue, black stools, diarrhea, nausea, and headaches. Some of the medicines leave a bad taste in your mouth. These side effects are usually minor and go away on their own.

You can cure H. pylori infection only if you take the medicines just the way your doctor tells you. If you forget to take some of your medicines or stop taking them because of side effects, the infection will not be cured. You may get another ulcer in the future. Let your doctor know right away if you have side effects with your medicines or if you have any questions about how to take them. Your doctor may suggest something to make the side effects better, or may give you different medicines.

What else can I do?

If certain foods bother you, do not eat them. You may heal faster if you do not smoke or use aspirin or ibuprofen. Acetaminophen will not hurt your stomach.

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