Peptic ulcer disease (PUD) refers to the presence of one or more defects, or breaks, in the lining of the stomach or the first part of the small intestine, called the duodenum.  These ulcers can be superficial, or they can extend deep into the tissue wall.  While some PUD patients will experience no symptoms, the majority will present with abdominal pain.  Pain associated with a peptic ulcer is often burning, gnawing, or hunger-like in nature, but it can also be vague and crampy.  It can be felt anywhere from the mid abdomen up to the chest, with most patients reporting pain in the upper abdomen just below the breast bone.  The pain may worsen when your stomach is empty or at night, and it may be relieved by eating certain foods or by taking an acid-reducing medication.   While pain is the most common symptom, PUD can also cause indigestion, nausea or vomiting, unexplained weight loss, changes in appetite, anemia, vomiting blood (which may appear red or black), or blood in stools (which may appear as dark blood or black, tarry stools).

The most common peptic ulcer complication is bleeding.  It can be microscopic, causing low blood counts (anemia), or overt, causing visible blood in the vomit or stool.  A less common complication is perforation, where the ulcer extends completely through the wall of the stomach or duodenum.  Both of these complications can be life-threatening, and ulcer perforation may require emergency surgery.

What Causes Peptic Ulcer Disease?

Most peptic ulcers are caused by one of two factors:  infection with Helicobacter pylori (H. pylori) bacteria or chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs).  Other contributors include acid hypersecretory diseases, cigarette smoking, alcohol consumption, steroid use, and severe stress.

H. pylori Infection

H. pylori is a bacterium that causes inflammation in the stomach (gastritis) or the duodenum (duodenitis). If this inflammation progresses, it can lead to peptic ulcers, and in rare cases, it can lead to cancer. Infection with H. pylori is very common, present in over 50% of the world’s population.  It is acquired from the environment, from such sources as contaminated food and drinking water.  It is important to note that while H. pylori is the leading cause of stomach cancers worldwide, not all people infected with H. pylori will develop ulcers, and only very few will develop cancer.  Because of the risks associated with infection, it is important to diagnose and treat H. pylori infection, even if a patient has no symptoms.  There are numerous tests which can diagnose H. pylori infection, the simplest of which is a breath test.  Dr. Treyzon offers a rapid breath test in the office, which takes approximately 15 minutes to complete and gives instant, definitive results.  Once H. pylori is detected, it can be successfully eradicated with a short course of antibiotics.  Dr. Treyzon can then repeat your breath test to confirm that the treatment was a success.  If you have gastrointestinal symptoms, a family history of stomach cancer, or any of the risk factors listed above, ask Dr. Treyzon about a breath test to rule out H. pylori infection at your next office visit.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used painkillers in the world, with an estimated over 30 billion doses consumed in the United States each year.  This is a class of medications which are commonly used for the treatment of pain and inflammation, many of which are available over-the-counter at drugstores.  Some well-known examples are aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), indomethacin (Indocin), Mobic, diclofenac, Toradol, and Celebrex.  Notably, acetaminophen (Tylenol) is not an NSAID and is not associated with risk for peptic ulcer disease.  Research is still being done to better understand the association, but it is known that risk of NSAID-associated peptic ulcer complications is higher in those who take NSAIDs chronically, those who take both aspirin and other NSAIDs, the elderly, those who take corticosteroids or blood thinning medications (such as Plavix, Coumadin, Xarelto, Pradaxa, or Eliquis), those who take the osteoporosis medication Fosamax, and those who take SSRI medications (antidepressants such as Prozac, Zoloft, Celexa, or Lexapro).  Be sure to include any NSAIDs that you are taking when you review your medications with Dr. Treyzon.

Author Natalie Bransky Assistant to Dr. Treyzon

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