The term “ulcer” means a sore that does not heal quickly. Ulcers can occur almost anywhere on the body, typically resulting from injuries, illnesses, or infections. They can be short-lived or ongoing.

Often, when people refer to an ulcer, they mean peptic ulcers, which develop in the digestive tract. The term “peptic” means it is related to acid.

Peptic ulcers may occur in the stomach, the small intestine just below the stomach, or the esophagus (food pipe) above the stomach.

Sometimes, peptic ulcers can bleed. Doctors refer to these as bleeding ulcers. Severe bleeding, known as hemorrhaging, can be life threatening. Minor bleeding in an ulcer is typically not as serious and may go unnoticed. However, it still requires treatment.

Some of the key facts about bleeding ulcers include:

  • Symptoms vary in severity. Notably, there is pain in the upper abdomen or stomach.
  • Infections and some medications can cause bleeding ulcers.
  • Using the correct treatment, doctors can cure bleeding ulcers.
  • Diagnosis and treatment of bleeding ulcers typically involve an endoscopy.

Peptic ulcers can be difficult to diagnose because some people never display symptoms. Those who do experience symptoms often find them quite noticeable. Symptoms include:

  • pain in the upper abdomen, which may get worse after eating or when the stomach is empty
  • nausea, vomiting, or both
  • feeling full or bloated

If a peptic ulcer begins bleeding, a person may notice:

  • stools that are dark and sticky
  • stools that are dark red in color
  • vomit that looks similar to coffee grounds or that has blood in it
  • fainting or feeling lightheaded

A person with any of these symptoms should seek emergency medical care. A severe bleeding ulcer left untreated can cause rapid blood loss and even death.

Anemia

A slow-bleeding ulcer may gradually cause anemia. Anemia means the body does not have enough red blood cells and hemoglobin, which means the body’s organs cannot get enough oxygen.

Anemia can make a person feel tired or short of breath. It can also cause skin to appear paler than is typical.

The stomach produces powerful acids that are necessary for digestion. These acids do not typically damage the digestive tract because of its protective mucous lining.

However, in some cases, the body produces too much stomach acid, and the mucous lining becomes damaged or worn down. When this happens, the acid may damage the lining of the digestive tract and cause an ulcer.

Most peptic ulcers have clear causes. Certain factors can increase a person’s risk of developing them.

NSAIDs

Taking certain pain relief medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) at high doses or for extended periods can cause peptic or bleeding ulcers. This is because NSAIDs block a particular chemical in the body that helps protect the stomach lining from acids.

The most common NSAIDs are:

NSAIDs can also decrease the blood’s clotting ability, which can make ulcers more likely to bleed.

H. pylori infection

Helicobacter pylori (H. pylori) is a type of bacteria that can infect the stomach. It attacks the stomach’s mucous lining, allowing acid to penetrate and damage the tissues. It is a common cause of peptic ulcers, affecting around 30–40% of people in the United States.

Experts do not know for sure how people contract H. pylori. However, some believe it comes from contaminated food and water.

H. pylori may also spread from person to person. Being diligent about hand washing and doing what you can to avoid consuming contaminated food and beverages (such as foods kept in unsanitary conditions or dirty water) are the only known ways to avoid the infection.

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome (ZES) is an uncommon condition that causes tumors in the stomach, duodenum, or pancreas. These tumors cause the stomach to produce more acid than it needs, leading to peptic ulcers. The tumors caused by ZES may or may not be cancerous.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, ZES is rare, occurring in only 0.5 to 3 out of every 1 million people.

Symptoms of ZES may be similar to those of peptic ulcers, such as dull or burning pain in the belly, and digestive problems such as diarrhea, nausea, decreased appetite, bloating, and burping. Experts believe it causes less than 1% of all peptic ulcers.

Ulcers with other causes

According to a study from 2012, H. pylori and NSAIDs are the most prevalent causes of peptic ulcers. However, a newer review in the Asian Pacific Journal of Cancer Prevention states that ulcers without H. pylori infection or NSAID involvement are increasing.

The study, which took place in Thailand, suggests that other factors such as alcohol, other infections, medications, or diseases including stomach and intestinal cancer, may be to blame.

Quickly treating peptic ulcers, especially bleeding peptic ulcers, is the best way to avoid complications. If a person does not seek treatment for the ulcers, certain conditions can arise, such as:

  • Severe internal bleeding: This can lead to hemorrhaging and is a medical emergency.
  • Perforation: This is when the lining of the stomach splits open. This rare and severe complication can lead to stomach bacteria infecting the lining of the abdomen. This is called peritonitis.
  • Gastric outlet obstruction: This is when a scarred or swollen stomach ulcer stops food from getting into the digestive system.

People with symptoms of a peptic ulcer may undergo a test known as an upper endoscopy. A doctor passes a lighted, flexible tube with a camera through the mouth and into the stomach. In some cases, it is possible to treat a bleeding ulcer during the endoscopy.

Doctors often treat peptic ulcers with medications that block or reduce stomach acid. These medicines include:

People who take NSAIDs and have a peptic ulcer may need to stop taking NSAIDs temporarily.

If a doctor diagnoses a person with an H.pylori infection, they will prescribe antibiotics and other medicines to kill the bacteria. H. pylori can be difficult to kill, so to ensure that the treatment is successful, a person must take all medicines as prescribed, even if they feel better.

After a person receives treatment for H. pylori, they should follow up with a healthcare professional for testing to make sure the infection is gone. H. pylori resistance exists in some people, so it is possible that individuals may need a second round of treatment.

It is not always possible to completely prevent peptic ulcers, especially in the cases of an H. pylori infection or another genetic condition. There are, however, certain risk factors that can make the development of an ulcer more likely, or that can exacerbate an ulcer until symptoms such as bleeding occur.

Some of these risk factors include:

  • older age
  • smoking
  • heavy alcohol consumption
  • past heavy alcohol consumption
  • obesity
  • certain chronic conditions

For many years, people thought peptic ulcers were caused by stress or spicy foods. The American College of Gastroenterology says that these factors do not cause peptic ulcers, although they may aggravate an ulcer that is already present.

A person living with ulcers does not typically need to follow a special diet. However, taking medications as prescribed is key.

An ulcer refers to any type of wound, internal or external, which does not heal correctly. A person can develop ulcers in many parts of the body. However, the most common area is in and around the digestive tract. Doctors call this type of ulcer a peptic ulcer.

Sometimes, peptic ulcers can bleed. However, this is not always a cause for concern and may not always cause noticeable symptoms.

With the correct treatment, a peptic ulcer — even one that causes minor bleeding — can heal, and most people recover completely. They may need to avoid taking NSAIDs temporarily, and many people need a follow-up endoscopy to ensure the ulcer is gone.

Even though minor bleeding from peptic ulcers is not life threatening, a person should talk with a doctor if they believe they have symptoms. This is because, over time, minor bleeding can become severe and can cause a medical emergency.