Peptic Ulcers


A peptic ulcer is a sore in the lining of the stomach or duodenum (start of the small intestine). Ulcers can have a wide range of causes, including long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin as well as certain bacteria. Ulcers can also be caused by cancerous tumors in the pancreas or stomach. You may have heard that stress, spicy food, and alcohol also cause ulcers, but many doctors believe this is not the case. These factors may exacerbate existing ulcers, but they do not cause them on their own.

If you are experiencing abdominal discomfort, you might have peptic ulcers. Most patients experience a gnawing or dull ache in the abdomen, which occurs off and on for several days or weeks. This ache begins 2-3 hours after a meal or during the middle of the night, when the stomach is empty. Eating and antacid medications can both relieve this pain. You might also notice that you are losing weight unexpectedly, don’t have much of an appetite, are experiencing bloating or burping, or have nausea or vomiting. Some of these symptoms might be mild or may not even be present.

However, keep in mind that there are several emergency symptoms of ulcers that require you to seek medical attention right away:

  • Black or bloody stools
  • Bloody vomit or vomit that resembles coffee grounds
  • Sudden, persistent, and sharp stomach pain

Call us right away if you experience any of these symptoms. They can all be signs that your ulcer has gone through the stomach or duodenal wall, broken a blood vessel, or is blocking the path of food trying to leave the stomach.


We mentioned earlier that ulcers have many causes. Today, however, doctors believe that the majority of them are caused by a particular strain of bacteria: Helicobacter pylori (H. pylori). H. pylori is extremely common in the United States, infecting about 20% of people under 40 and approximately 50% of those over 60. Many people with these bacteria do not develop ulcers, and doctors have not yet determined why this is. Doctors also aren’t sure how people contract H. pylori, though theories include contamination in food or water as well as mouth-to-mouth contact (kissing).

Once you have been infected by H. pylori, assuming you experience symptoms, the infection will start to weaken the protective mucus coating of the stomach and duodenum. It’s able to survive in the harsh environment of the stomach by secreting enzymes that neutralize stomach acid. Thanks to its spiral shape, it’s able to burrow through the lining of the stomach. This itself irritates the lining, and exposure to stomach acid causes further irritation, leading to an ulcer.


If you are coming to us with the symptoms above, first, we will check to make sure you have ulcers. (Many of these symptoms can be caused by a wide range of stomach or liver diseases.) Usually Dr. Donepudi will order an upper GI series or an endoscopy to check for ulcers.

Once ulcers are found, the doctor must determine the cause of them. Ulcers caused by NSAIDs and those caused by H. pylori are treated differently. We will use blood, stool, breath, and tissue tests to determine if you are infected by H. pylori. Except for the stool test, all of this testing can be done during your initial appointment in our office.


Treating H. pylori ulcers requires a multi-pronged approach. It’s not enough to simply relieve ulcer symptoms or treat the bacteria. Most doctors recommend dual, triple, or quadruple therapy in order to properly treat the H. pylori infection and the ulcers.

There are numerous types of medications used to treat these ulcers. Whether you are undergoing dual, triple, or quadruple therapy, you’ll probably be taking some of the following medications:

  • Antibiotics: These are used to kill the bacteria. Common antibiotics prescribed for peptic ulcers include clarithromycin, tetracycline, metronidazole, and amoxicillin.
  • H2 Blockers: These are used to block the acid secretion, which helps reduce the pain associated with ulcers. H2 blockers commonly prescribed include famotidine, nizatidine, ranitidine, and cimetidine. 
  • Proton Pump Inhibitors: These block the production of the enzyme that in turn produces stomach acid, which can relieve stomach pain from ulcers. Common proton pump inhibitors prescribed include esomeprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole.
  • Stomach Lining Protector: This both protects the stomach lining from acid and kills the H. pylori bacteria. There is only one stomach lining protector commonly prescribed, bismuth subsalicylate. It’s a component of Pepto-Bismol.

Triple Therapy
This is the most common form of therapy, so we will explain it first. Usually, this form of therapy takes two weeks. You’ll take two forms of antibiotics to kill the bacteria as well as an acid suppressor or a stomach-lining shield. Over 90% of patients find that a two-week course of triple therapy reduces the symptoms of ulcers, kills the H. pylori bacteria, and keeps ulcers from coming back.

Dual Therapy
Dual therapy only requires patients to take an acid suppressor and antibiotic.

Quadruple Therapy
A patient undergoing quadruple therapy will take two antibiotics, an acid suppressor, and a stomach-lining shield. Treatment lasts for two weeks.


If you have or suspect that you have peptic ulcers, talk to Dr. Donepudi. She can recommend the right course of therapy and the exact mix of medications that will work for you. Even if you have already been diagnosed with ulcers, but have not been tested for H. pylori, talk to Dr. Donepudi. It takes time to change medical practice, and some doctors may not yet be testing for H. pylori. Make sure you know the cause of your ulcers before you consent to treatment. Call Dr. Donepudi today to make an appointment!

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