Causes and Risk Factors of Peptic Ulcer Disease

In This Article
Table of Contents

You may be surprised to learn the usual causes of peptic ulcers are infection with a bacterium called Helicobacter pylori or long-term use of pain relievers. In the past, it was believed stress, diet, or having too much stomach acid (hydrochloric acid and pepsin) caused peptic ulcers, and these inaccurate beliefs still circulate. But Dr. Barry Marshall and Dr. J. Robin Warren were awarded the 2005 Nobel Prize in Medicine for their discovery of bacterial cause.

Common Causes

About 75% of the cases of peptic ulcers in the U.S. are caused by an infection by the Helicobacter pylori bacterium. Having this bacteria growing in your stomach increases your risk of developing an ulcer. It can damage the mucus coating that protects the tissues lining the stomach and duodenum. This allows stomach acid to come into contact with the lining, causing inflammation and ulcers. The bacteria also stimulate gastric cells to grow in the lining of the duodenum, secreting acid and pepsin.

In the U.S., 30 to 40% of the population is infected with H. pylori, but most never develop an ulcer. The bacteria can be spread via saliva, food, water, or eating utensils. It is often acquired in childhood, without any symptoms.


Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is another common cause of peptic ulcers, raising your risk 20 times that of non-users. These include over-the-counter products containing aspirin, ibuprofen, and naproxen sodium. Prescription NSAIDs are also used to treat several arthritic conditions.

NSAIDs can make the stomach's defense mechanisms fail in a couple of different ways. They can make the stomach vulnerable to the harmful effects of acid and pepsin by interfering with the stomach's ability to produce mucus and bicarbonate. This natural bicarbonate normally neutralizes digestive fluids and breaks them down into less harmful substances. They can affect cell repair (by inhibiting the COX-1 receptors) and blood flow to the stomach, which normally helps protect the stomach.

Both having H. pylori infection and taking NSAIDs at the same time can increase the risk of developing a peptic ulcer to 60 times the usual rate. Other risk factors for NSAID-induced peptic ulcers include:

  • Age 70 or over
  • Female
  • Taking more than two types of NSAIDs
  • Taking NSAIDs regularly for a long time
  • Previous peptic ulcer
  • Two or more medical conditions
  • Taking corticosteroids or medicines to increase your bone mass
  • Drinking alcohol or smoking

Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome is a rare condition that can cause peptic ulcers. In this condition, you have one or more tumors in your pancreas and duodenum that produce a large amount of gastrin hormone. This leads to large amounts of acid in the duodenum and upper intestine.


About 20% of people with peptic ulcer disease have a family history of duodenal ulcers. Researchers have found some genetic basis for susceptibility to H. pylori infection. This genetic research is still very early, but in the future, it might show those at greater risk.

Lifestyle Risk Factors

Studies show that cigarette smoking can increase your chance of getting an ulcer, especially if you are infected with H. pylori. Smoking also slows the healing of existing ulcers and contributes to ulcer recurrence.

While a link hasn't been found between alcohol consumption and peptic ulcers, ulcers are more common in people who have cirrhosis of the liver, a disease often linked to heavy alcohol consumption. Drinking alcohol can increase discomfort when you have an ulcer.

Spicy foods, caffeine, and acidic juices do not cause peptic ulcers, and a bland diet is no longer recommended for people with ulcers. However, you may find there are things that aggravate your symptoms and you can choose to avoid them while your ulcer is being treated and healing.

Emotional stress is no longer thought to be a cause of ulcers, but people who are experiencing emotional stress often report increased pain of existing ulcers.

A Word From Verywell

The discovery of the true causes of most peptic ulcers has reduced the stigma that it is primarily caused by stress or diet. While you may still need lifestyle adjustments to relieve symptoms, effective treatments can mean being cured rather than having to manage peptic ulcer disease for the rest of your life.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Testerman TL, Morris J. Beyond the stomach: an updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol. 2014;20(36):12781-808. doi:10.3748/wjg.v20.i36.12781

  2. Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005-12.

  3. Epelboym I, Mazeh H. Zollinger-Ellison syndrome: classical considerations and current controversies. Oncologist. 2014;19(1):44-50. doi:10.1634/theoncologist.2013-0369

  4. Lim YJ. Genetic susceptibility of gastroduodenal disease in ethnic and regional diversity. Gut Liver. 2014;8(6):575-6. doi:10.5009/gnl14313

  5. Li L, Chan R, Lu L, et al. Cigarette smoking and gastrointestinal diseases: The causal relationship and underlying molecular mechanisms (Review)International Journal of Molecular Medicine. 2014;34(2):372-380. doi:10.3892/ijmm.2014.1786

  6. Bang CS, Baik GH, Kim JH, et al. Peptic ulcer disease in liver cirrhosis and chronic hepatitis: impact of portal hypertension. Scand J Gastroenterol. 2014;49(9):1051-7. doi:10.3109/00365521.2014.923501

  7. American College of Gastroenterology. Peptic Ulcer Disease.

Additional Reading