A peptic ulcer is an area of damage to the tissues lining the stomach, esophagus, or duodenum (the first part of the small intestine). Over 25 million Americans will have a peptic ulcer at some point in their lifetime. People of all ages can suffer from ulcers. Men and women are equally affected.

Peptic ulcers were formerly thought to be caused by lifestyle stress, coffee consumption, or spicy foods. Now it is clear that about 90% of peptic ulcers are caused by a bacterial infection that can usually be cured.

The bacterium Helicobacter pylori (H. pylori) was established as the leading cause of peptic ulcers in the early 1980s. It was also found to cause gastritis (inflammation of the stomach lining)

H. pylori is a spiral-shaped bacterium that can live and grow on the lining tissues of the stomach. Some people can be infected with H. pylori and never develop an ulcer or show any symptoms of the infection. In other people, the organism may persist for years before any symptoms develop.

It remains unclear why some people develop symptoms of the infection and others do not. It is also not clear exactly how H. pylori is transmitted from person to person. In the United States, H. pylori infection is more common among the elderly, African-Americans, Hispanics, and in those living under lower socioeconomic conditions.

Ulcers related to H. pylori infection are commonly treated now with a one- to two-week course of an antibiotic. The antibiotic is usually given along with a bismuth preparation (such as Pepto-Bismol) or one of the proton pump inhibitors that decrease acid output by the stomach. Omeprazole (Prilosec) and lansoprazole (Prevacid) are common proton pump inhibitors. If antibiotics are not administered, up to 80% of ulcers recur, in contrast to about 6% when the H. pylori infection is treated with an antibiotic.

Tests for H. pylori infection include upper endoscopy, in which a lighted optical scope is used to examine the esophagus, stomach, and duodenum. With endoscopy, the diagnosis of an ulcer can be confirmed and biopsy material removed and examined for the presence of H. pylori.

Noninvasive tests cannot determine if an ulcer is present but may be used to diagnose H. pylori infection. These include blood tests to identify antibodies to H. pylori and a the urea breath test (UTB). For the urea breath test, an oral preparation of urea containing radiolabeled carbon is given. H. pylori in the stomach metabolize the urea, and the resulting radioactive carbon is absorbed into the blood stream and ultimately exhaled. The exhaled breath is tested for radioactive carbon, indicating the H. pylori infection.

There are other causes of peptic ulcer that are unrelated to H. pylori infection, but these are less common. In particular, the chronic use of non steroidal antiinflammatory drugs (NSAIDs) and cigarette smoking can be causes of both ulcer formation and failure of treatment.