From the Guidelines
The most common causes of esophageal, gastric, and duodenal ulcers are Helicobacter pylori (H. pylori) bacterial infection and nonsteroidal anti-inflammatory drug (NSAID) use, with H. pylori being the primary cause of peptic ulcers, as stated in the most recent study 1.
Causes of Ulcers
The causes of ulcers vary based on their location in the digestive tract.
- Esophageal ulcers are primarily caused by gastroesophageal reflux disease (GERD), where stomach acid repeatedly flows back into the esophagus, damaging its lining.
- Gastric and duodenal ulcers, collectively known as peptic ulcers, are most commonly caused by H. pylori bacterial infection and NSAID use.
Risk Factors
Other contributing factors to peptic ulcers include:
- Excessive alcohol consumption
- Smoking
- Stress
- Certain medical conditions like Zollinger-Ellison syndrome, which causes excessive stomach acid production
Treatment and Prevention
Treatment typically involves:
- Antibiotics (amoxicillin, clarithromycin, metronidazole) combined with proton pump inhibitors (omeprazole, pantoprazole) for H. pylori eradication
- Acid-reducing medications alone for NSAID-induced ulcers Lifestyle modifications such as avoiding NSAIDs, alcohol, smoking, and spicy foods can help prevent recurrence, as supported by studies 1 and 1. Understanding these causes is essential because proper identification leads to appropriate treatment strategies that address the underlying issue rather than just managing symptoms.
From the FDA Drug Label
Sometimes H. pylori bacteria can cause duodenal ulcers. The infection needs to be treated to prevent the ulcers from coming back.
The most common cause of duodenal ulcers mentioned in the drug label is H. pylori bacteria.
- H. pylori infection is a direct cause of duodenal ulcers. No information is provided in the drug labels about the most common causes of esophageal and gastric ulcers. 2
From the Research
Causes of Peptic Ulcers
The most common causes of peptic ulcers are:
- Helicobacter pylori infection, which is associated with approximately 1 in 5 peptic ulcers 3
- Nonsteroidal anti-inflammatory drug (NSAID) use, which is responsible for most of the remaining peptic ulcers 3, 4, 5, 6, 7 Other causes of peptic ulcers include:
- Aspirin use 6, 7
- Hypersecretory states 7
- Crohn's disease 7
- Idiopathic ulcers, characterized by postprandial hypersecretion of acid and hypergastrinemia with accelerated gastric emptying 7
Interaction between H. pylori Infection and NSAID Use
The combination of H. pylori infection and NSAID use synergistically increases the risk of bleeding ulcers more than sixfold 3 Eradicating H. pylori in NSAID users reduces the likelihood of peptic ulcers by one-half 3, 6
Management of Peptic Ulcers
Patients with H. pylori-negative ulcers may require long-term management with acid-suppressing drugs, such as proton pump inhibitors 4, 5 The test-and-treat strategy for detecting H. pylori is appropriate in situations where the risk of gastric cancer is low based on age younger than 55 years and the absence of alarm symptoms 5