Medically reviewed by Graham Rogers, M.D. — Written by Valencia Higuera — Updated on April 13, 2020
- Overview
- Causes
- Symptoms
- Diagnosis
- Treatment
- Complications
- Outlook
- Prevention
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WITHDRAWAL OF RANITIDINEIn April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.
Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They’re usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
There are three types of peptic ulcers:
- gastric ulcers: ulcers that develop inside the stomach
- esophageal ulcers: ulcers that develop inside the esophagus
- duodenal ulcers: ulcers that develop in the upper section of the small intestines, called the duodenum
Different factors can cause the lining of the stomach, the esophagus, and the small intestine to break down. These include:
- Helicobacter pylori (H. pylori), a type of bacteria that can cause a stomach infection and inflammation
- frequent use of aspirin (Bayer), ibuprofen (Advil), and other anti-inflammatory drugs (risk associated with this behavior increases in women and people over the age of 60)
- smoking
- drinking too much alcohol
- radiation therapy
- stomach cancer
The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can range from mild to severe. In some cases, the pain may wake you up at night. Small peptic ulcers may not produce any symptoms in the early phases.
Other common signs of a peptic ulcer include:
Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy and upper gastrointestinal (GI) series.
Upper endoscopy
In this procedure, your doctor inserts a long tube with a camera down your throat and into your stomach and small intestine to examine the area for ulcers. This instrument also allows your doctor to remove tissue samples for examination.
Not all cases require an upper endoscopy. However, this procedure is recommended for people with a higher risk of stomach cancer. This includes people over the age of 45, as well as people who experience:
- anemia
- weight loss
- gastrointestinal bleeding
- difficulty swallowing
Upper GI
If you don’t have difficulty swallowing and have a low risk of stomach cancer, your doctor may recommend an upper GI test instead. For this procedure, you’ll drink a thick liquid called barium (barium swallow). Then a technician will take an X-ray of your stomach, esophagus, and small intestine. The liquid will make it possible for your doctor to view and treat the ulcer.
Because H. pylori is a cause of peptic ulcers, your doctor will also run a test to check for this infection in your stomach.
Treatment will depend on the underlying cause of your ulcer. If tests show that you have an H. pylori infection, your doctor will prescribe a combination of medication. You’ll have to take the medications for up to two weeks. The medications include antibiotics to help kill infections and proton pump inhibitors(PPIs) to help reduce stomach acid.
You may experience minor side effects like diarrhea or an upset stomach from antibiotic regimens. If these side effects cause significant discomfort or don’t get better over time, talk to your doctor.
If your doctor determines that you don’t have an H. pylori infection, they may recommend a prescription or over-the-counter PPI (such as Prilosec or Prevacid) for up to eight weeks to reduce stomach acid and help your ulcer heal.
Acid blockers like famotidine (Pepcid) can also reduce stomach acid and ulcer pain. These medications are available as a prescription and also over the counter in lower doses.
Your doctor may also prescribe sucralfate (Carafate) which will coat your stomach and reduce symptoms of peptic ulcers.
Shop for acid blockers.
Untreated ulcers can become worse over time. They can lead to other more serious health complications such as:
- Perforation: A hole develops in the lining of the stomach or small intestine and causes an infection. A sign of a perforated ulcer is sudden, severe abdominal pain.
- Internal bleeding: Bleeding ulcers can result in significant blood loss and thus require hospitalization. Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools.
- Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. Signs of scar tissue include vomiting and weight loss.
All three complications are serious and may require surgery. Seek urgent medical attention if you experience the following symptoms:
- sudden, sharp abdominal pain
- fainting, excessive sweating, or confusion, as these may be signs of shock
- blood in vomit or stool
- abdomen that’s hard to the touch
- abdominal pain that worsens with movement but improves with lying completely still
With proper treatment, most peptic ulcers heal. However, you may not heal if you stop taking your medication early or continue to use tobacco, alcohol, and nonsteroidal pain relievers during treatment. Your doctor will schedule a follow-up appointment after your initial treatment to evaluate your recovery.
Some ulcers, called refractory ulcers, don’t heal with treatment. If your ulcer doesn’t heal with the initial treatment, this can indicate:
- an excessive production of stomach acid
- presence of bacteria other than H. pylori in the stomach
- another disease, such as stomach cancer or Crohn’s disease
Your doctor may offer a different method of treatment or run additional tests to rule out stomach cancer and other gastrointestinal diseases.
Certain lifestyle choices and habits can reduce your risk of developing peptic ulcers. These include:
- not drinking more than two alcoholic beverages a day
- not mixing alcohol with medication
- washing your hands frequently to avoid infections
- limiting your use of ibuprofen, aspirin, and naproxen (Aleve)
Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco use and eating a balanced diet rich in fruits, vegetables, and whole grains will help you prevent developing a peptic ulcer.
Last medically reviewed on August 23, 2017
Duodenal ulcers are a common cause of abdominal pain. Once treated, they usually get better in a matter of weeks.
A duodenal ulcer is a sore that forms in the lining of the duodenum. Your duodenum is the first part of your small intestine, the part of your digestive system that food travels through straight after it leaves your stomach.
You can get an ulcer in your stomach as well as in your duodenum. Stomach ulcers and duodenal ulcers are both types of peptic ulcers. If you have either of these, you have what's called 'peptic ulcer disease'.
Causes of duodenal ulcers
Your stomach makes a strong acid that kills germs and helps you digest food. To protect themselves against this acid, cells of the stomach and duodenum make a barrier from mucus. If this barrier is damaged, an ulcer can form.
The main cause of this damage is infection with bacteria called Helicobacter pylori, or H. pylori. The bacteria can cause the lining of your duodenum to become inflamed and an ulcer can form.
Some medications can also cause a duodenal ulcer, particularly anti-inflammatory drugs such as ibuprofen and aspirin. Rarely, other medicines or medical conditions might cause an ulcer.
It's possible that you are more likely to get a duodenal ulcer if you smoke, drink a lot of alcohol or you are stressed, but these things are less important than infection with H. pylori.
Symptoms of a duodenal ulcer
If you have a duodenal ulcer, you might:
- have pain in the stomach or abdomen (this might come and go and is relieved by eating or taking an antacid)
- have indigestion
- feel very full and bloated after eating
- feel like you might vomit (nauseous)
- lose weight
Very occasionally, an ulcer can cause serious complications. Go to the emergency department if:
- you have a sharp pain in your stomach that doesn't go away
- your vomit or stools (poo) look bloody or a black colour
If you are concerned about symptoms, you can use healthdirect's online Symptom Checker to get advice on the next appropriate healthcare steps and when to seek medical attention.
Diagnosis of a duodenal ulcer
To diagnose a duodenal ulcer, your doctor will talk to you and examine you. They will probably also run some tests, which could include:
- a gastroscopy (also called an endoscopy), where a specialist uses a thin, flexible tube with a camera on the end to look inside your stomach and duodenum
- a blood test, stool sample, or breath test to find out if you have a H. pylori in your system
If you have a gastroscopy, the surgeon might take a sample of tissue (a biopsy) to test for H. pylori.
Treatment for a duodenal ulcer
If your ulcer is caused by H pylori, the usual treatment is 'triple therapy'. This involves taking 2 antibiotics to kill the bacteria, and a medicine to reduce the amount of acid made by your stomach.
If you don't have an H. pylori infection, and you have been using anti-inflammatory drugs, you will need to stop taking them (if possible) and to start taking a drug to reduce acid production by your stomach.
Taking antacids, drinking less alcohol, and quitting smoking if you smoke may also help.