Causes and Risk Factors of Peptic Ulcer Disease

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You may be surprised to learn that infection with a bacterium called Helicobacter pylori and long-term use of pain relievers are causes of peptic ulcers. 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 Drs. Barry Marshall and J. Robin Warren were awarded the 2005 Nobel Prize in Medicine for their discovery of a bacterial cause of peptic ulcer disease.

Common Causes

About 75% of the cases of peptic ulcers in the U.S. are caused by a Helicobacter pylori (H. pylori) bacterium infection. NSAID use and a rare medical condition can also cause a peptic ulcer.

H. Pylori Infection

Having this bacteria growing in your stomach 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, and eating utensils. It is often acquired in childhood without any symptoms.

NSAIDs

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 also affect cell repair (by inhibiting the COX-1 receptors) and blood flow to the stomach, which normally help protect it.

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. Those who have it have one or more tumors in the pancreas and duodenum that produce a large amount of gastrin hormone. This leads to large amounts of acid in the duodenum and upper intestine.

Genetics

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 it 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.

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