Peptic Ulcers - Causes

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Highlights	Risk Factors	Lifestyle Changes
Introduction	Diagnosis	Resources
Causes	Treatment	References
Symptoms	Medications	References
Complications	Surgery

When H. pylori were first identified as the major cause of peptic ulcers, these bacteria were found in 90% of people with duodenal ulcers and in about 80% of people with gastric ulcers. As more people are being tested and treated for the bacteria, however, the rate of H. pylori- associated ulcers has declined. Currently, H. pylori are found in about 50% of people with peptic ulcer disease.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Long-term use of NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn) is the second most common cause of ulcers. NSAIDs also increase the risk for gastrointestinal (GI) bleeding. The risk of bleeding continues for as long as a patient takes these drugs and may last for about 1 year after stopping.

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Short courses of NSAIDs for temporary pain relief should not cause major problems, because the stomach has time to recover and repair any damage that has occurred.

Patients with NSAID-caused ulcers should stop taking these drugs. However, patients who require these medications on a long-term basis can reduce their risk of ulcers by taking drugs in the proton pump inhibitor (PPI) group, such as omeprazole (Prilosec). Famotidine (Pepcid -- an H2 blocker) may also offer some protection.

Other Causes

Certain drugs other than NSAIDs may aggravate ulcers. These include warfarin (Coumadin) -- an anticoagulant that increases the risk of bleeding, oral corticosteroids, some chemotherapy drugs, spironolactone, and niacin.

Bevacizumab, a drug used to treat colorectal cancer, may increase the risk of GI perforation. Although the benefits of bevacizumab outweigh the risks, GI perforation is very serious. If it occurs, patients must stop taking the drug.

Rarely, certain conditions may cause ulcers in the stomach or intestine, including:

Alcohol abuse
Bacterial or viral infections
Burns
Physical injury
Radiation treatments

Zollinger-Ellison Syndrome (ZES)

Zollinger-Ellison syndrome (ZES) is the least common major cause of peptic ulcer disease. In this condition, tumors in the pancreas and duodenum (called gastrinomas) produce excessive amounts of gastrin, a hormone that stimulates gastric acid secretion. These tumors are usually cancerous, so proper and prompt management of the disease is essential.