Peptic Ulcer Disease

A peptic ulcer is a sore on the lining of the stomach or duodenum, the beginning of the small intestine. Sometimes, a peptic ulcer may develop just above the stomach in the esophagus , the tube that connects the mouth to the stomach. A peptic ulcer in the stomach is called a gastric ulcer. One that occurs in the duodenum is called a duodenal ulcer. People can have both gastric and duodenal ulcers at the same time. They can also develop peptic ulcers more than once in their lifetime. Peptic ulcers are not caused by stress or eating spicy food, but both can make ulcer symptoms worse. Smoking and drinking alcohol also can worsen ulcers and prevent healing.


  • Helicobacter pylori (H. pylori): H. pylori is a type of bacteria that may cause infection. Experts are not certain how H. pylori is transmitted, although they think it may be spread through contaminated food or water. People may pick up the bacterium from food that has not been washed well or cooked properly or from drinking water that has come from an unclean source. Studies suggest that having contact with the stool or vomit of an infected person can spread H. pylori infection. H. pylori has been found in the saliva of some infected people, which means infection can be spread through direct contact with saliva. The bacterium causes Peptic Ulcers by damaging the mucous coating that protects the stomach and duodenum. Damage to the mucous coating allows powerful stomach acid to get through to the sensitive lining beneath. Together, the stomach acid and H. pylori irritate the lining of the stomach or duodenum and cause an Ulcer. Most people infected with H. pylori never develop Ulcers. Why the bacterium causes Ulcers in some people and not in others is not known. Most likely, development of Ulcers depends on characteristics of the infected person; the type of H. pylori present; and factors researchers have yet to discover.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as aspirin and ibuprofen, are another common cause. When used for weeks or months, NSAIDs can irritate or damage the lining of the stomach and digestive tract, causing an Ulcer or making an existing ulcer worse. Experts believe that NSAIDs may interfere with prostaglandins, which help to regulate the protective lining of the stomach. NSAID Ulcers and their complications can be prevented by not taking NSAIDs or by only taking them occasionally and in small doses. If you have to use NSAIDs, Dr. Ranvir SinghDr. Stephen RashbaumDr. Nitin J. Parikh, Dr. Long B. NguyenTammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; may advise you to take an NSAID that is less likely to cause ulcers.


Typical SymptomsPain DescriptionEmergency SymptomsAlarm Symptoms
Nausea & vomitingPain when the stomach is empty,
briefly relieved by eating
Sharp, sudden, persistent,
and severe stomach pain
Poor appetite with
Weight loss
Pain comes and goes for
several days or weeks
Bloody or black stoolsPerforation
Bloating or BurpingPain lasts for minutes
to hours
Bloody vomit or vomit that
looks like coffee grounds

Testing for Peptic Ulcers

If you have Peptic Ulcer symptoms, Dr. Ranvir Singh, Dr. Stephen Rashbaum, Dr. Nitin J. Parikh, and Dr. Long B. Nguyen will first ask about use of over-the-counter and prescription medications. Patients who are taking an NSAID are asked to stop, reduce the dose, or switch to another medication. Second, tests may be performed to check for H. pylori bacteria. These tests are important because H. pylori-induced Ulcers are treated differently than ulcers caused by NSAIDs.

  • Blood tests: A blood sample is taken and tested for H. pylori antibodies. Antibodies are substances the body produces to fight invading harmful substances—called antigens—such as the H. pylori bacterium.
  • Urea breath test: You swallow a capsule, liquid, or pudding that contains urea “labeled” with a special carbon atom. After a few minutes, you breathe into a container, exhaling carbon dioxide. If the carbon atom is found in the exhaled breath, H. pylori is present, as this bacterium contains large amounts of urease, a chemical that breaks urea down into carbon dioxide and ammonia.
  • Stool antigen test: You provide a stool sample, which is tested for H. pylori antigens.

It is generally recommended that these tests be run if you first experience Peptic Ulcer symptoms around age 50. Often performed as outpatient procedures, both procedures are painless and allow them to look inside your stomach and duodenum.


Peptic Ulcers caused by H. pylori are treated with Antibiotics that kill the bacteria, reduce stomach acid, and protect the stomach and duodenal lining. Medicines that reduce stomach acid include Proton Pump Inhibitors (PPIs) and Histamine Receptor Blockers (H2 blockers). Both acid-reducing medicines help relieve Peptic Ulcer pain after a few weeks and promote Ulcer healing. While PPIs cannot kill H. pylori, research shows they do help fight the H. pylori infection. Research also shows that after 4 weeks of treatment, patients taking PPIs had earlier pain relief and better healing rates than those taking H2 blockers.

  • Proton Pump Inhibitors (PPIs): suppress acid production by halting the mechanism that pumps acid into the stomach.
  • Histamine Receptor Blockers (H2 blockers): work by blocking histamine, which stimulates acid secretion.

Your physician will prescribe antibiotics or other medication according to your symptoms and individual profile. Although antibiotics can cure 80 to 90 percent of Ulcers caused by H. pylori, eliminating the bacteria can be difficult. You must take all medicines exactly as prescribed, even when the Peptic Ulcer pain is gone. If infection is still present, ulcers could recur or, less commonly, stomach cancer could develop. Thus, you may need to take more than one round of medication to kill the H. pylori bacteria.

Board-Certified physicians Dr. Ranvir SinghDr. Stephen RashbaumDr. Nitin J. ParikhDr. Long B. Nguyen, Dr. Ruth Montalvo, and providers Tammi D’Elena, PA-C and Vanessa T. Bridgeman, MSN, APRN, FNP-BC; care for patients in the North Atlanta, GA; area including Johns Creek, GA, Cumming, GA, Lawrenceville, GA,  Alpharetta, GA, and Dawsonville, GA. The in-house endoscopy suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems, abdominal pain, or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.

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Dr. Ranvir Singh, Dr. Stephen Rashbaum, Dr. Long Nguyen, Dr. Nitin Parikh, Dr. Ruth Montalvo, Tammi D’Elena, PA-C, and Vanessa Bridgeman, MSN, FNP-BC

For clinical questions, please contact our office: 770-227-2222

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