What causes ulcers and can they make you tired? Discover the connection between peptic ulcers, bleeding ulcers, and symptoms like bloating, heartburn, nausea, and pain. Get the facts on the serious medical conditions that can lead to ulcers and find out when to seek emergency care.

The Surprising Impact of Ulcers on Fatigue

Peptic ulcers, a common digestive disorder, can have a significant impact on an individual’s energy levels and overall well-being. These sores that develop in the lining of the stomach or small intestine can cause a range of symptoms, including pain, nausea, vomiting, and bloating, all of which can contribute to feelings of fatigue and exhaustion.

Understanding the Causes of Peptic Ulcers

Peptic ulcers are typically caused by one of two main factors: an infection with the Helicobacter pylori (H. pylori) bacteria or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin. The stomach produces powerful acids that are necessary for digestion, but in some cases, the body produces too much acid, leading to damage and ulceration of the digestive tract’s protective lining.

The Dangers of Bleeding Ulcers

In some cases, peptic ulcers can start to bleed, a condition known as a bleeding ulcer. Severe bleeding, or hemorrhaging, from an ulcer can be a life-threatening medical emergency and requires immediate attention. Symptoms of a bleeding ulcer include dark, sticky stools, vomiting that looks like coffee grounds, and feelings of lightheadedness or fainting.

The Link Between Ulcers and Anemia

A slow-bleeding ulcer can gradually lead to anemia, a condition where the body does not have enough red blood cells and hemoglobin, which means the organs cannot get enough oxygen. Anemia can make a person feel tired or short of breath and cause the skin to appear paler than usual.

Uncommon Causes of Peptic Ulcers

While H. pylori infections and NSAID use are the most common causes of peptic ulcers, there are some less common conditions that can also lead to the development of these sores. Zollinger-Ellison syndrome, a rare disorder that causes tumors in the stomach, duodenum, or pancreas, can lead to the overproduction of stomach acid and the formation of peptic ulcers.

Seeking Medical Attention for Ulcers

Anyone experiencing symptoms of a peptic ulcer, such as upper abdominal pain, nausea, vomiting, or bloating, should seek medical attention. Prompt diagnosis and treatment are crucial, as leaving an ulcer untreated can lead to serious complications, including rapid blood loss and even death.

Do ulcers always cause fatigue?

No, ulcers do not always cause fatigue. While some people with ulcers may experience feelings of tiredness or exhaustion, this is not a universal symptom. Factors such as the severity of the ulcer, the presence of bleeding, and any underlying conditions like anemia can all contribute to feelings of fatigue in individuals with peptic ulcers.

Can ulcers lead to anemia?

Yes, a slow-bleeding ulcer can gradually cause anemia, a condition where the body does not have enough red blood cells and hemoglobin. Anemia can make a person feel tired or short of breath and cause the skin to appear paler than usual. Prompt treatment of bleeding ulcers is essential to prevent the development of anemia.

How do I know if my ulcer is bleeding?

Symptoms of a bleeding ulcer include dark, sticky stools, vomiting that looks like coffee grounds, and feelings of lightheadedness or fainting. If you experience any of these symptoms, it is important to seek emergency medical care, as a severe bleeding ulcer can be life-threatening if left untreated.

What are the risk factors for developing peptic ulcers?

The two main risk factors for developing peptic ulcers are infection with the H. pylori bacteria and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin. Less common causes include Zollinger-Ellison syndrome, a rare disorder that causes tumors in the stomach, duodenum, or pancreas, as well as other factors like alcohol, infections, and certain medications or diseases.

When should I seek medical attention for an ulcer?

If you are experiencing any symptoms of a peptic ulcer, such as upper abdominal pain, nausea, vomiting, or bloating, it is important to seek medical attention. Prompt diagnosis and treatment are crucial, as leaving an ulcer untreated can lead to serious complications, including rapid blood loss and even death.

Can ulcers be cured?

Yes, with the correct treatment, peptic ulcers can be cured. Treatment typically involves a combination of medications to reduce stomach acid production and eradicate any H. pylori infection. In some cases, surgery may be necessary to treat severe or recurring ulcers. The key is to seek medical attention and follow the prescribed treatment plan to ensure a full recovery.

What causes it and is it serious?

The term “ulcer” means a sore that does not heal quickly. If an ulcer develops at the site of a blood vessel, it can cause bleeding. Excessive ulcer bleeding is a medical emergency.

Often, when people refer to an ulcer, they mean peptic ulcers, which develop in the digestive tract. The term “peptic” means it is related to acid.

Peptic ulcers may occur in the stomach, the small intestine just below the stomach, or the esophagus (food pipe) above the stomach.

Sometimes, peptic ulcers can bleed. Doctors refer to these as bleeding ulcers. Severe bleeding, known as hemorrhaging, can be life threatening. Minor bleeding in an ulcer is typically not as serious and may go unnoticed. However, it still requires treatment.

Some of the key facts about bleeding ulcers include:

• Symptoms vary in severity. Notably, there is pain in the upper abdomen or stomach.
• Infections and some medications can cause bleeding ulcers.
• Using the correct treatment, doctors can cure bleeding ulcers.
• Diagnosis and treatment of bleeding ulcers typically involve an endoscopy.

Peptic ulcers can be difficult to diagnose because some people never display symptoms. Those who do experience symptoms often find them quite noticeable. Symptoms include:

• pain in the upper abdomen, which may get worse after eating or when the stomach is empty
• nausea, vomiting, or both
• feeling full or bloated

If a peptic ulcer begins bleeding, a person may notice:

• stools that are dark and sticky
• stools that are dark red in color
• vomit that looks similar to coffee grounds or that has blood in it
• fainting or feeling lightheaded

A person with any of these symptoms should seek emergency medical care. A severe bleeding ulcer left untreated can cause rapid blood loss and even death.

Anemia

A slow-bleeding ulcer may gradually cause anemia. Anemia means the body does not have enough red blood cells and hemoglobin, which means the body’s organs cannot get enough oxygen.

Anemia can make a person feel tired or short of breath. It can also cause skin to appear paler than is typical.

The stomach produces powerful acids that are necessary for digestion. These acids do not typically damage the digestive tract because of its protective mucous lining.

However, in some cases, the body produces too much stomach acid, and the mucous lining becomes damaged or worn down. When this happens, the acid may damage the lining of the digestive tract and cause an ulcer.

Most peptic ulcers have clear causes. Certain factors can increase a person’s risk of developing them.

NSAIDs

Taking certain pain relief medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) at high doses or for extended periods can cause peptic or bleeding ulcers. This is because NSAIDs block a particular chemical in the body that helps protect the stomach lining from acids.

The most common NSAIDs are:

• ibuprofen
• naproxen
• aspirin

NSAIDs can also decrease the blood’s clotting ability, which can make ulcers more likely to bleed.

H. pylori infection

Helicobacter pylori (H. pylori) is a type of bacteria that can infect the stomach. It attacks the stomach’s mucous lining, allowing acid to penetrate and damage the tissues. It is a common cause of peptic ulcers, affecting around 30–40% of people in the United States.

Experts do not know for sure how people contract H. pylori. However, some believe it comes from contaminated food and water.

H. pylori may also spread from person to person. Being diligent about hand washing and doing what you can to avoid consuming contaminated food and beverages (such as foods kept in unsanitary conditions or dirty water) are the only known ways to avoid the infection.

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome (ZES) is an uncommon condition that causes tumors in the stomach, duodenum, or pancreas. These tumors cause the stomach to produce more acid than it needs, leading to peptic ulcers. The tumors caused by ZES may or may not be cancerous.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, ZES is rare, occurring in only 0.5 to 3 out of every 1 million people.

Symptoms of ZES may be similar to those of peptic ulcers, such as dull or burning pain in the belly, and digestive problems such as diarrhea, nausea, decreased appetite, bloating, and burping. Experts believe it causes less than 1% of all peptic ulcers.

Ulcers with other causes

According to a study from 2012, H. pylori and NSAIDs are the most prevalent causes of peptic ulcers. However, a newer review in the Asian Pacific Journal of Cancer Prevention states that ulcers without H. pylori infection or NSAID involvement are increasing.

The study, which took place in Thailand, suggests that other factors such as alcohol, other infections, medications, or diseases including stomach and intestinal cancer, may be to blame.

Quickly treating peptic ulcers, especially bleeding peptic ulcers, is the best way to avoid complications. If a person does not seek treatment for the ulcers, certain conditions can arise, such as:

• Severe internal bleeding: This can lead to hemorrhaging and is a medical emergency.
• Perforation: This is when the lining of the stomach splits open. This rare and severe complication can lead to stomach bacteria infecting the lining of the abdomen. This is called peritonitis.
• Gastric outlet obstruction: This is when a scarred or swollen stomach ulcer stops food from getting into the digestive system.

People with symptoms of a peptic ulcer may undergo a test known as an upper endoscopy. A doctor passes a lighted, flexible tube with a camera through the mouth and into the stomach. In some cases, it is possible to treat a bleeding ulcer during the endoscopy.

Doctors often treat peptic ulcers with medications that block or reduce stomach acid. These medicines include:

• Proton pump inhibitors: Examples include dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex).
• h3 blockers: Examples include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid).

People who take NSAIDs and have a peptic ulcer may need to stop taking NSAIDs temporarily.

If a doctor diagnoses a person with an H.pylori infection, they will prescribe antibiotics and other medicines to kill the bacteria. H. pylori can be difficult to kill, so to ensure that the treatment is successful, a person must take all medicines as prescribed, even if they feel better.

After a person receives treatment for H. pylori, they should follow up with a healthcare professional for testing to make sure the infection is gone. H. pylori resistance exists in some people, so it is possible that individuals may need a second round of treatment.

It is not always possible to completely prevent peptic ulcers, especially in the cases of an H. pylori infection or another genetic condition. There are, however, certain risk factors that can make the development of an ulcer more likely, or that can exacerbate an ulcer until symptoms such as bleeding occur.

Some of these risk factors include:

• older age
• smoking
• heavy alcohol consumption
• past heavy alcohol consumption
• obesity
• certain chronic conditions

For many years, people thought peptic ulcers were caused by stress or spicy foods. The American College of Gastroenterology says that these factors do not cause peptic ulcers, although they may aggravate an ulcer that is already present.

A person living with ulcers does not typically need to follow a special diet. However, taking medications as prescribed is key.

An ulcer refers to any type of wound, internal or external, which does not heal correctly. A person can develop ulcers in many parts of the body. However, the most common area is in and around the digestive tract. Doctors call this type of ulcer a peptic ulcer.

Sometimes, peptic ulcers can bleed. However, this is not always a cause for concern and may not always cause noticeable symptoms.

With the correct treatment, a peptic ulcer — even one that causes minor bleeding — can heal, and most people recover completely. They may need to avoid taking NSAIDs temporarily, and many people need a follow-up endoscopy to ensure the ulcer is gone.

Even though minor bleeding from peptic ulcers is not life threatening, a person should talk with a doctor if they believe they have symptoms. This is because, over time, minor bleeding can become severe and can cause a medical emergency.

Peptic ulcers: Symptoms, causes, and treatments

A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. It can occur in the lining of the stomach, duodenum, or lower part of the esophagus. The symptoms can include indigestion-like pain, nausea, and weight loss.

Globally, researchers estimate that around 8.09% had at least one peptic ulcer in 2019, which marked a 25% increase from 1990. The same study reported that cases in the United States had decreased since the first half of the 20th century. They started to increase again between 1990 and 2019.

A peptic ulcer can affect several areas of the digestive tract. Therefore it goes by different names, including:

• gastric ulcer in the stomach
• duodenal ulcer in the duodenum (the first part of the small intestine)

Potential causes of peptic ulcers include Helicobacter pylori (H. pylori) bacteria infections and the long-term use of non-steroidal anti-inflammatory drugs.

This article reviews peptic ulcers and their symptoms, causes, diagnosis, treatment, and more.

Learn more about gastric and duodenal ulcers.

Peptic ulcers may not cause any noticeable symptoms, or they may cause mild discomfort. Others may experience a dull, burning pain in their stomach.

Other symptoms can include:

• difficulty swallowing food
• nausea
• vomiting
• feeling bloated or full
• black, sticky stool (if bleeding)

In some cases, ulcers can cause severe signs and symptoms and bleeding. Signs the ulcer is bleeding include:

• vomiting blood
• black and tarry stools, or stools with dark red blood
• nausea and vomiting that is especially persistent and severe

These symptoms indicate a medical emergency. The patient should see a doctor immediately or call 911.

Peptic ulcers occur due to several potential causes, but the two most common include:

• H. pylori bacteria
• long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)

How do

H. pylori cause ulcers?

Although many people naturally carry H. pylori bacteria, it is not clear why these bacteria only cause ulcers in some people.

H. pylori spread through food and water. They live in the mucus that coats the lining of the stomach and duodenum, and they produce urease, an enzyme that neutralizes stomach acid by making it less acidic.

To compensate for this, the stomach produces more acid, and this irritates the stomach lining. The bacteria also weaken the defense system of the stomach and cause inflammation.

Patients with peptic ulcers caused by H. pylori need antibiotic treatment to remove the bacterium from the stomach and prevent them from returning.

How do nonsteroidal anti-inflammatory drugs cause ulcers?

NSAIDS are a type of medication used often for headaches, period pains, and other pains. They can also help reduce fever and inflammation. Examples include aspirin and ibuprofen. Many NSAIDs are available without a prescription.

They lower the stomach’s ability to make a protective layer of mucus. This makes it more susceptible to damage by stomach acid. NSAIDs can also affect the flow of blood to the stomach, reducing the body’s ability to repair cells.

Other causes of peptic ulcers

Other potential causes of peptic ulcers include:

• Genetics: Many individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may be contributing.
• Smoking: People who regularly smoke tobacco may be more likely to develop peptic ulcers when compared with non-smokers, but the exact way smoking influences peptic ulcers is unclear.
• Alcohol consumption: Drinking alcohol can irritate the stomach lining and increase acidity.
• Corticosteroid use: People on large or chronic doses of corticosteroids are also at greater risk, according to research.
• Stress: Studies regarding the increased risk of ulcers due to stress are conflicting, but one study found that psychological stress may increase the incidence of peptic ulcers in a way that cannot be explained by other factors such as NSAID use or an H. pylori infection.

A person’s description of symptoms will often cause a doctor to suspect a peptic ulcer during a routine exam.

Tests that can confirm a diagnosis include:

• a blood test to check for H. pylori, though a positive test does not always mean there is an active infection
• a breath test, which uses a radioactive carbon atom to detect H. pylori
• a stool antigen test to detect H. pylori in the feces
• an upper gastrointestinal (GI) X-ray to identify ulcers

The most common tool doctors use for diagnosis is EsophagoGastroDuodenoscopy or upper endoscopy. It involves inserting a tube through the mouth to look for the presence of an ulcer in the stomach and upper intestine.

If the test detects an ulcer, the doctor may take a biopsy (a small sample of tissue) for examination under a microscope. A biopsy can test for H. pylori and look for evidence of cancer. A person may need to repeat an endoscopy a few months later to determine whether the ulcer is healing.

Dietary changes may help a person find some relief during treatment for peptic ulcers.

A person should avoid foods and flavorings that may cause the stomach to produce acids. This can vary for some people, but common causes include chili powder, garlic, black pepper, and caffeine.

Alcohol has the same effect on the stomach so a person should avoid it as well.

A person’s diet should also contain foods that provide large portions of vitamin A and fiber, which dissolves easily. These can include:

Sources of soluble fiber:

• oats
• apples
• oranges
• carrots
• psyllium husk
• legumes
• flax seeds
• nuts
• barley

Sources of vitamin A:

• liver
• broccoli
• kale
• spinach
• sweet potatoes
• collard greens

A balanced diet filled with fruits and vegetables and lacking in intense spices and flavors may help a person feel better.

However, it is important to note that diet alone cannot treat or prevent peptic ulcers so additional treatment may be necessary.

A person may not be able to prevent all ulcers from forming.

A person can limit their use of NSAIDs to help prevent new ulcers from forming. People with chronic pain conditions should talk with their doctor about alternatives to NSAIDs that may be safer for their stomachs.

Another step to help prevent ulcers is to make sure to finish a full antibiotic regimen. A person should see their doctor for a follow-up to ensure the bacteria is under control.

Peptic ulcers can sometimes lead to complications that often require additional treatment. The three most common complications include:

• internal bleeding
• bowel obstruction
• peritonitis, which is when the ulcer bores a hole through the wall of the stomach or small intestine

Peptic ulcers can recur. Having the first ulcer increases the risk of developing another one later.

The following sections help answer some frequently asked questions about peptic ulcers.

How common are peptic ulcers?

Peptic ulcers affect about 8% of the world population. Though they decreased in the later 20th century, they have since started to increase in frequency again in the U.S.

What is the difference between peptic ulcers, GERD, and gastritis

Peptic ulcers are holes or lesions that form due to too much acid. GERD, which stands for gastroesophageal reflux disease, occurs when a person’s stomach acid repeatedly backs up into the esophagus. Gastritis is a group of conditions that cause inflammation in the stomach. While all of these conditions affect the stomach, they are not the same and require different treatments.

Do peptic ulcers go away?

If the cause of the peptic ulcer is NSAID use, stopping the medication should help the ulcer clear. However, a bacterial infection requires treatment with antibiotics. A person should see their doctor for a proper diagnosis to determine the best course of treatment.