In 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. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Gastric and duodenal ulcers are types of peptic ulcer. The main distinction is that they affect different parts of the digestive tract. A person could have both at the same time. Some causes of peptic ulcers include an excess of stomach acid, bacterial infection, and certain medications.
In this article, we look at what gastric and duodenal ulcers are and how a doctor diagnoses them. We also explore their causes and treatments, along with associated symptoms and risk factors.
Gastric and duodenal ulcers are peptic ulcers, which are open sores in the lining of the digestive tract.
Gastric ulcers form in the lining of the stomach.
Duodenal ulcers develop in the lining of the duodenum, which is the upper part of the small intestine.
Many people with peptic ulcers rely on medical treatment to relieve their symptoms. Peptic ulcers sometimes heal on their own, but they can recur if a person does not receive treatment.
Symptoms of gastric and duodenal ulcers are generally similar. The most common complaint is a burning pain in the stomach.
Duodenal ulcers may also cause abdominal pain a few hours after eating.
This pain tends to respond well to medications or foods that reduce stomach acid, but as the effects of these wear off, the pain usually returns.
Abdominal pain from a duodenal ulcer may be worse when the stomach is empty, for example, between meals, at night, or first thing in the morning.
Other common symptoms of peptic ulcers include:
Some people with these ulcers develop intolerances for specific foods. These foods may make a person feel sick, or they may make ulcer-related symptoms worse.
Less common and more severe symptoms include:
- feeling lightheaded
- weight loss
- blood in the stool
- vomiting blood
- trouble breathing
Some people with peptic ulcers have no symptoms. A doctor may only discover the ulcer when checking for a different digestive disorder.
Anyone with symptoms of peptic ulcers should see a doctor. If symptoms are severe, seek urgent medical attention.
Peptic ulcers result from damage or erosion to the protective lining of the digestive tract.
The following issues can play a role:
- having too much acid in the stomach or digestive tract
- digestive imbalances
- problems with the lining that makes it more susceptible to damage
Bacterial infections and certain medications can also lead to peptic ulcers.
A person has a higher risk of developing a peptic ulcer if they have an overgrowth of Helicobacter pylori (H. pylori) bacteria in the digestive tract. This type of bacterial infection is common.
While an H. pylori infection does not cause symptoms in most people, it sometimes irritates the lining of the digestive tract, which can lead to peptic ulcers.
Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage or irritate the lining and increase the risk of peptic ulcers.
NSAIDS include many other-the-counter pain relievers, such as ibuprofen (Advil), naproxen (Aleve), and aspirin.
A person’s genetics and lifestyle can also increase the risk of developing a peptic ulcer.
If close family members have peptic ulcers, a person may be more likely to develop them. Smoking tobacco products can also increase a person’s risk.
Other risk factors include:
- being over the age of 70
- having a history of gastric or duodenal ulcers
- recently experiencing serious physical trauma
Beyond NSAIDs, other medications can also increase a person’s risk of developing peptic ulcers, including:
- selective serotonin reuptake inhibitors, or SSRIs
Doctors no longer think that alcohol, spicy foods, or rich foods cause ulcers. However, consuming them may make symptoms worse or slow the healing process.
The role of stress in the development of ulcers is uncertain. Some doctors believe that stress is a direct risk factor, while others do not.
In one small study, psychological stress increased the risk of developing peptic ulcers. However, the researchers believed that the link was partly indirect, that stress led to other risk behaviors, such as taking NSAIDs and smoking.
Symptoms of peptic ulcers can be similar to those of other conditions, such as gallstones or gastroesophageal reflux disease, which is commonly called GERD. Receiving a correct diagnosis is essential.
A doctor may begin by asking about a person’s medical history and current medications. They will also ask about symptoms and the location of any pain.
A variety of tests can help confirm a diagnosis. The doctor may test the blood, stool, or breath to check for signs of H. pylori infection.
The doctor may also perform an endoscopy to look for ulcers. This involves inserting a thin tube with an attached camera down a person’s throat and into the stomach and upper small intestine.
In some cases, a doctor may also recommend a barium swallow test. This involves swallowing a liquid that contains barium. The barium helps the doctor see the intestinal tract more clearly on an X-ray of the abdomen.
For most people, treatment will involve taking medications that either reduce the amount of acid in the stomach or protect the lining of the stomach and duodenum.
These medications may fall into the following categories:
- proton pump inhibitors (PPIs), including omeprazole, pantoprazole, and lansoprazole
- H2-receptor antagonists, including famotidine, and cimetidine
- protectants, such as sucralfate
- antacids, such as calcium carbonate and sodium bicarbonate
If an H. pylori infection is responsible for the ulcers, a doctor may prescribe antibiotics to kill the bacteria. They may also prescribe medications that help suppress excess stomach acid, such as PPIs.
If other medications, such as NSAIDs, have caused the ulcers, the doctor may prescribe a PPI or review the need for the drug.
Some doctors also recommend reducing or better managing levels of stress.
Untreated ulcers can cause complications.
Rarely, peptic ulcers can lead to a perforation, or hole, in the wall of the stomach or intestine.
A perforation can put a person at serious risk of infection in the abdominal cavity. The medical name for this infection is peritonitis.
If a person with peptic ulcers experiences sudden abdominal pain that grows worse, they should see a doctor immediately.
Also, inflammation from ulcers can block a portion of the digestive tract. This obstruction can cause a person to:
- feel full after eating little or no food
- regularly vomit
- lose weight or become malnourished
If the bleeding is severe, a person may see blood in vomit or stools. Anyone with symptoms of severe internal bleeding should seek immediate medical attention.
It may not be possible to prevent a peptic ulcer. However, reducing risk, for example by quitting tobacco use and eating a healthful diet, may help.
People who use NSAIDs or other medications that can cause peptic ulcers should talk to a doctor about managing their ulcer-related risk.
A doctor may recommend taking:
- medications with meals
- lower dosages
- an alternate medication
- acid-reducing drugs
The medical community is not entirely certain how H. Pylori spreads. People should protect themselves by cooking foods thoroughly and frequently washing the hands with soap and water.
Gastric and duodenal ulcers are both types of peptic ulcer. They can cause pain and other symptoms in the digestive tract.
Treatment usually involves addressing the underlying cause and taking appropriate medication, including medicine to reduce stomach acid.
If left untreated, these ulcers can cause serious complications.