An ulcer occurs when part of the lining of the esophagus, intestine or stomach is eaten away by stomach acid and digestive juices. Normally, the lining is protected from stomach acids. However, sometimes this protection fails and ulcers can result.

The most common cause of duodenal ulcers is a type of bacteria called Helicobacter pylori (also known as H. pylori). These bacteria cause about two-thirds of ulcers.

Another common cause of ulcers is long-term use of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil) and naproxen (Aleve). Ulcers also occur more often in smokers or those who drink alcohol. Substances that increase the production of stomach acids (such as caffeine) can also increase the risk of ulcer occurrence.

Although stress does not cause ulcers, it can aggravate them. If you have a family history of ulcers, you may be more likely to get them. Ulcers are four times more common in men than in women, and generally occur between ages 40 and 50.

Some people don’t experience any symptoms. However, if you do have symptoms, the most common ones include:

• gnawing or burning upper abdominal pain,
• pain that may get better when you eat or take antacids,
• pain that gets worse before meals or a couple of hours after eating and
• pain that wakes you up at night.

You may have heard of a bleeding ulcer. Those symptoms can include:

• vomit containing bright red blood or digested blood that looks like coffee grounds and/or
• black, tarry bowel movements.

Your healthcare provider will take a medical history and examine you. He or she may also ask you to complete one or more of the following tests: (For details, see Words to Know.)

• Stool sample evaluation, in which part of your bowel movement is provided for analysis.
• Blood tests to determine if H. pylori is present.
• Upper GI X-ray (sometimes called a Barium X-ray).
• Upper Endoscopy (also called Upper GI Series or EGD).
• Biopsy.

A treatment plan is designed with the goals of pain relief, healing of the ulcer and prevention of complications. Treatment can also help prevent recurrences of the ulcer. Depending on your needs, your physician may prescribe:

• antibiotics if H. pylori is present,
• antacids,
• acid-reducers and/or
• sucralfate (see Words to Know).

Antibiotics are typically taken for 1 to 2 weeks, but some medications may be taken longer to reduce acid and prevent additional ulcers from forming.

Because antacids can have side effects with prolonged use, be sure to follow your physician’s directions and report any problems.

About 25% of patients with duodenal ulcers experience complications – so the good news is that 75% don’t. Potential complications include:

• Perforation (a hole in the wall of the duodenum).
• Obstruction (build-up of ulcer tissue that blocks movement of food).
• Hemorrhage (significant bleeding).

Each of the above complications, if they occur, require surgical repair.

There are many things you can do to help reduce the pain of ulcers and prevent new ones from forming. Most of these are lifestyle changes.

• Do not smoke – if you’d like to quit, ask your physician for recommendations on how to stop.
• Do not drink alcohol.
• Avoid (or limit) use of NSAIDs such as aspirin, ibuprofen (Advil) and naproxen (Aleve).
• Avoid coffee (caffeinated AND decaf), colas and other acidic foods that may bother your stomach.
• Get plenty of sleep and exercise.
• Reduce stress, perhaps through relaxation or biofeedback techniques.