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Ulcer pain worse at night: Peptic Ulcer Disease (PUD)

Peptic Ulcer Disease (PUD)


A peptic ulcer is a sore in the lining of the stomach or first part of the small intestine called the duodenum. When an individual has chronic peptic ulcers, it is known as peptic ulcer disease (PUD). A healthy digestive tract is coated with a layer of mucus that protects against acid deterioration. If the mucus decreases or the acid increases, an ulcer can result. Some ulcers may be associated with infection from a bacterium called Helicobacter Pylori (H. pylori).

H. pylori can live in the mucus layer and often causes no problems, but sometimes the bacterium can cause inflammation in the stomach lining and slowly produce an ulcer. H. pylori can be transmitted through food, water, and close human contact.

Another cause of PUD is long-term use of anti-inflammatory medicines like aspirin and ibuprofen. And contrary to popular belief, while stress and spicy foods can aggravate ulcers, they do not cause them. If untreated, peptic ulcers may get worse and cause more serious problems.

Symptoms of PUD

Burning stomach pain is the most common symptom of peptic ulcers and may come and go for a few days or weeks. Pain is more bothersome when the stomach is empty and usually recedes after the patient eats. The burning sensation may become worse at night and is almost always worse on an empty stomach. Sometimes, peptic ulcer disease has more severe symptoms.

  • Nausea
  • Vomiting of blood—Blood may appear red or black
  • Unexplained weight loss
  • Loss of appetite
  • Dark blood in the stools or tar-like stools

Risk Factors for PUD

  • Alcohol—Alcohol can wear away the mucus lining of the stomach and gut, and it also increases the amount of stomach acid that is produced.
  • Smoking—Smoking can increase the risk of peptic ulcers for those who are infected with H. pylori.
  • Long-term use of pain relievers and/or nonsteroidal anti-inflammatory drugs (NSAIDs).

Tests to Diagnose PUD

  • H. pylori test- Doctors can test for the presence of H. pylori in the system by a blood sample, stool sample or a breath test. It can also be diagnosed by obtaining a sample of tissue during endoscopy.
  • Endoscopy- an endoscopy is a test that uses a hollow tube with a lens attached. The scope can view the throat, stomach and small intestine and detect an ulcer.
  • Biopsy- if an ulcer is found, a small tissue sample will be removed and examined
  • X-ray- Swallowing barium (a white liquid) before the x-ray helps doctors see details of the esophagus, stomach, and small intestine as well as view the ulcer

Treatments for PUD

Depending on the cause of the peptic ulcer, treatments will vary.

  • Antibiotics—antibiotics can kill the bacterium H. pylori in the digestive system. A two-week treatment should be sufficient, and then antacid medication may be prescribed to control stomach acid.
  • Proton pump inhibitors—these medications reduce stomach acid by blocking the action of cells that produce acid. Examples of brand-name proton pump inhibitors are Prilosec, Prevacid, Aciphex, Nexium and Protonix.
  • h3 blockers—these medications reduce stomach acid, reduce pain and bring healing. Brand-name products are Zantac, Pepcid, Tagamet, and Axid.
  • Antacids—these medications neutralize stomach acid. Side effects can include constipation or diarrhea. Antacids relieve symptoms but do not always produce healing.

If medication does not heal a peptic ulcer, this may be an indication of another issue.

  • An infection other than H. pylori
  • Zollinger-Ellison syndrome—extreme overproduction of gastric acid
  • Stomach cancer
  • Crohn’s disease

Lifestyle Changes to Treat PUD

Along with medication, these lifestyle changes may be helpful in assisting to control the pain of peptic ulcer disease.

  • Wise diet choices—eating plenty of fresh fruits, vegetables and whole grains may promote healing. Processed foods, fried foods and junk food will make it harder to heal.
  • Change your pain reliever—because PUD can be aggravated by using certain pain relievers, talk to your doctor about a different option.
  • Stop smoking—Smoking can affect the mucus lining of the stomach and produce more stomach acid.
  • Avoid alcohol—Alcohol can wear away the mucus layer of the stomach and intestine.
  • Manage stress—Use exercise, mediation, relaxation techniques and recreation to reduce stress and reduce stomach acid production.

Ulcers | Cedars-Sinai





An ulcer occurs when part of the lining of the stomach or intestines becomes deeply eroded. This typically happens in the stomach (gastric ulcer) or the in the duodenum (duodenal ulcer), which is located at the lower end of the stomach and the beginning of the small intestine. Ulcers range from quite small to an inch or more in size.


Symptoms vary depending on where the ulcer is and how old the patient is. Many patients, especially older ones, may have no symptoms. When symptoms do occur, they tend to come back again and again.

Stomach (or peptic) ulcers may produce few or no symptoms, or they may cause burning, gnawing pain in the upper middle part of the abdomen that is relieved by eating or taking an antacid. Stomach ulcers often are not consistent. For example, eating sometimes will make the pain worse rather than better with certain types of ulcers, such as pyloric channel ulcers, which are often associated with bloating, nausea and vomiting, symptoms of a blockage caused by swelling (edema) and scarring.

Duodenal ulcers tend to cause consistent pain. A patient may feel no pain when he or she awakens, but by midmorning it is present. The pain can be relieved by eating, but it usually returns two to three hours later. Pain that wakes a patient at night is common for duodenal ulcers.

Causes and Risk Factors 

At one time ulcers were believed to be the result of too much stomach acid. It is now known that the main factors that lead to ulcers are the bacteria H. pylori and non-steroidal anti-inflammatory drugs (NSAIDS). These disturb the normal defense and repair processes of the mucosal linings, making them more vulnerable to attack from stomach acid.

How H. pylori causes ulcers is not entirely clear. One theory is that the organism causes ammonia to be created so that it can survive in the stomach’s acid. The ammonia may then erode the mucous barrier that protects the cells of the digestive tract. Other poisons and enzymes from the bacteria may also be a cause, and proteins produced by the body in response to inflammation may play a role.

NSAIDs tend to cause inflammation of the GI tract lining. Weak acids themselves, NSAIDS cause a number of changes within the stomach, including reduced flow of blood to the stomach, less mucus production, and less cell repair and reproduction. All of these tend to break down the process of defense and repair that keeps the mucosa healthy.


A doctor usually bases a diagnosis of peptic ulcer on the patient’s history. A physician will want to rule out the presence of stomach cancer, which can have similar symptoms. This is especially true in patients who are older, have lost weight, have severe symptoms or do not respond to treatment.

The diagnosis can be confirmed through a variety of studies, such as:

  • Endoscopy, which uses a camera attached to the end of a flexible tube to allow the doctor to see inside the body. This can reliably detect swelling and irritation (inflammation) of the esophagus and esophageal ulcers as well as H. pylori infection.
  • Barium swallow
  • Cytology (examination under a microscope of cells from the affected area)
  • Multiple biopsies
  • X-rays or CT scans to identify ulcers that have caused holes in the stomach or intestines


In the past, ulcers were treated by trying to neutralize or decrease the amount of acid in the stomach. Current treatment focuses on eliminating H. pylori through antibiotics. Antibiotic treatment should be given to all ulcer patients who have been diagnosed with H. pylori, even if they have no symptoms or are being treated to reduce stomach acid. Antibiotic treatment is especially important for patients who have had complications in the past. Antibiotics to treat H. pylori are evolving, and a combination of antibiotics is usually prescribed.

The symptoms of an ulcer can be relieved by taking antacids, which can also help prevent the symptoms from coming back and help promote healing of the ulcer. Antacids must be taken five to seven times a day and can interfere with the body’s ability to absorb other drugs. The two general types of antacids are:

  • Ones that the body can absorb, such as baking soda. These are quick and effective but may have side effects when taken on a regular basis
  • Ones that interact with stomach acid to create salts that are not absorbed by the body and are excreted

While there is currently no evidence that changing the diet helps an ulcer heal faster or prevents its return, a doctor may suggest that any food that causes distress be eliminated. These may include fruit juices, spicy foods and fatty foods.

Alcohol tends to increase the acid in the stomach, and ulcer patients are usually advised to restrict their drinking of alcohol. Persons who smoke are at a higher risk of developing ulcers and complications. Smoking also slows the healing process and makes the return of ulcers more likely.

Although surgical treatment is being prescribed less often, surgery may be necessary if complications do not respond to medical therapy, symptoms are severe or there is a suspicion that the ulcer may be cancerous.

More than 60% of people have a return of their ulcers a year after traditional treatment has ended. Fewer than 10% of people have a recurrence of ulcers after anti-H. pylori therapy. The use of non-steroidal anti-inflammatory drugs might also affect recurrence of ulcers.


Certain complications can also result from peptic ulcers, including:

  • Bleeding
  • A hole in the wall of the stomach or duodenum. This causes intense, ongoing pain that may be felt in locations other than the abdomen. The pain may change with shifts in body position.
  • A hole into the peritoneal cavity, which surrounds the organs of the abdomen. This causes sudden, intense pain that spreads quickly throughout the abdomen and is worse with movement.
  • A blockage. The outlet of the stomach may become blocked as a result of scarring, muscle spasms or inflammation related to an ulcer. This causes repeated, high volume vomiting, usually at the end of the day. There may also be a feeling of bloating after eating and a loss of appetite. Dehydration and weight loss are risks if vomiting continues.

Treatment of complications varies. For example:

  • Bleeding may be stopped using a variety of minimally invasive techniques.
  • Acid-suppressing drugs may be given intravenously and continued until the condition stabilizes.
  • Emergency surgery may be necessary if the patient gets worse even with treatment and blood transfusions and if their pulse rate and blood pressure are not stable.

Persons who have H. pylori-related ulcers may be at higher risk for certain forms of cancer and lymphoma.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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symptoms, causes, treatment, diet

A stomach ulcer is one of the most common diseases of the gastrointestinal tract. This is a chronic pathology in which defects occur in the gastric mucosa. With untimely treatment or its complete absence, it can cause a person’s disability or even death.

Gastric and duodenal ulcers affect people aged 20 to 65 years. Men from 25 to 40 years old get sick 5-6 times more often than women, for the reason that male sex hormones indirectly increase the acidity and aggressiveness of gastric juice, and female ones decrease it.

Structure of the human stomach

The stomach is an organ of the digestive system in which food accumulates, and under the action of gastric juice, it undergoes primary digestion with the formation of a mushy mixture.

The stomach is mostly located in the upper left region of the abdominal cavity. The stomach does not have a specific shape and size, since they depend on the degree of its filling, the state of its muscular wall (contracted or relaxed) and age. The capacity of the organ is about 3 liters, 21-25 cm long.

The stomach has two main functions:

  • Secretory . Excretion of gastric juice, which contains the necessary components for the initial stages of digestion and the formation of chyme (food lump). Approximately 2 liters of gastric juice are secreted per day. With a disorder of the secretory function of the stomach, a person’s acidity increases, i.e. the release of hydrochloric acid increases, or the acidity decreases, accompanied by a decrease in the release of hydrochloric acid.
  • Motor . The muscular layer of the stomach contracts, resulting in mixing of food with gastric juice, primary digestion and promotion through the duodenum.

Violations of the motility of the stomach due to a violation of the tone of its muscular wall leads to a violation of digestion and the evacuation of gastric contents into the intestine. This is manifested by various dyspeptic disorders (nausea, vomiting, bloating, heartburn, and others).

Mechanism of stomach ulcer formation

A gastric ulcer is a defect in the gastric mucosa, rarely less than 1 cm (sometimes submucosal), surrounded by an inflammatory zone.

The most common cause of gastric and duodenal ulcers is Helicobacter pylori infection. Various factors lead to an imbalance between protective factors (gastric mucus, gastritis, secretin, bicarbonates, gastric muco-epithelial barrier and others) of the gastric mucosa and aggression factors (Helicobacter Pylori, hydrochloric acid and pepsin).

Under the influence of treatment, the defect is overgrown with connective tissue (a scar is formed). The area on which the scar has formed does not have a functional ability (secretory function).

Causes of pathology development

The bacterium Helicobacter Pylori (the causative agent of ulcers) – has a destructive effect on the cells of the gastric mucosa, destroys local protective factors. As a result, a defect such as an ulcer is formed. Infection with a bacterium through the saliva of an infected person (non-observance of personal hygiene rules, use of unwashed dishes after an infected person).

Increased acidity – develops as a result of increased release of hydrochloric acid, which has a corrosive effect on the gastric mucosa, followed by the formation of a defect.

What affects the formation of stomach ulcers?

  • Neuro-emotional overstrain leads to increased secretion of gastric juice (hydrochloric acid).
  • Genetic predisposition to stomach ulcers.
  • Smoking, alcohol consumption, coffee consumption in large quantities, nicotine and ethyl alcohol stimulate the formation of gastric juice, thereby increasing acidity.
  • The presence of a pre-ulcerative condition: chronic gastritis, chronic inflammation of the gastric mucosa.
  • Disturbed diet: dry food, long breaks between meals lead to a violation of the secretion of gastric juice.
  • Abuse of sour, spicy and coarse foods.
  • Long-term use of drugs that have a destructive effect on the gastric mucosa.

Symptoms of gastric ulcer

  • Painful sensations . Ulcer pain can be annoying day and night. Most often, pain in pathology manifests itself during hunger. It is localized in the upper abdomen, may decrease or increase immediately, or after a while after eating, depending on the location of the ulcer.

Unpleasant signs of a stomach ulcer can be so pronounced that nausea or even vomiting appears, which intensifies in the morning and disappears after eating. The ulcer manifests itself more often in the autumn-spring periods.

  • Feeling of heaviness in the stomach . A person often begins to reduce portions of food, since the absorption of even a small amount of food that falls on the inflamed areas of the gastric mucosa and ulcers can cause these unpleasant sensations.
  • Bad breath, tongue coating . Frequent companions of any inflammatory diseases of the upper gastrointestinal tract, including gastritis (inflammation of the stomach), against which ulcers most often appear.

Diagnosis of gastric ulcer

Diagnosis of a typical stomach ulcer is quite simple, carried out by a general practitioner or gastroenterologist. Upon examination, the doctor determines the general condition of the patient, finds out complaints, the nature and characteristics of the course of the disease, and during palpation specifies the boundaries of the painful zones and their nature.

To form an accurate picture of the patient’s health status, the doctor may prescribe a complete blood count and instrumental examination. Most often, this is an endoscopic examination (EGDS).

The procedure is safe, lasts a few minutes, accompanied by unpleasant, but quite tolerable sensations. Allows you to examine the upper sections of the gastrointestinal tract, to establish the presence and nature of inflammatory and erosive-ulcerative processes, as well as the appearance of neoplasms.

Treatment of gastric ulcer

A peptic ulcer is treated by a therapist or gastroenterologist. It aims to relieve symptoms, heal ulcers, and eliminate the cause of the disease through diet, lifestyle changes, and medication.

Medical therapy

To get rid of Helicobacter pylori infection, the doctor prescribes antibiotics, and to reduce the acidity of gastric juice, acid-lowering drugs, etc. If a stomach ulcer is caused by taking painkillers (NSAIDs) or other medications that can provoke the development of an ulcer, then the doctor selects other drugs for the patient that do not have an ulcer-forming effect.

First, the pain is relieved with painkillers. Drugs are taken only if there is discomfort in the stomach. Enterosorbents are also prescribed, which neutralize the negative effects of toxins. In addition, the patient needs to drink a course of vitamins.


It is important for stomach ulcers not to aggravate the symptoms with the help of bad habits. You need to stop smoking and drinking alcohol. And also watch your diet. With a stomach ulcer, a special diet should be prescribed.

It involves a full meal, divided into 5-6 meals a day. The use of strong irritants of gastric secretion (ketchups, hot spices), coarse foods and dishes is limited. Food is prepared mostly pureed, steamed or boiled in water, fish and coarse meats are served in pieces. Very cold and hot dishes are excluded from the diet. The intake of table salt is limited.

The appearance of an excess amount of hydrochloric acid in the stomach leads to the fact that pain occurs, the patient is tormented by heartburn. Water is needed, which has an alkalizing effect – when it is used, the harmful effects of hydrochloric acid are neutralized.

The opposite problem is low acidity. In this case, little gastric juice is produced. Bottom line: food is poorly digested, there is a feeling of fullness in the stomach.

Alkaline mineral waters speed up the processing of food and promote its rapid movement through the gastrointestinal tract.

Gastric ulcer prevention

With a healthy lifestyle, proper nutrition, careful attitude to your health, the likelihood of a stomach ulcer is extremely low. As we have already found out, sleep and nutrition disorders, an overly active lifestyle, as well as non-compliance with personal hygiene rules lead to the development of stomach ulcers.

If relatives had peptic ulcer disease, then regardless of complaints, endoscopy is recommended with the determination of gastric acidity, clarifying biopsies to determine H. Pylori infection and histological examination of suspicious areas at least once every 2 years.

You also need to adhere to a healthy lifestyle: give up bad habits, be physically active, sleep at least 7 hours at night. Avoid stressful situations, learn to perceive them correctly.

Regularly visit a doctor as part of a medical examination and eliminate foci of chronic infection. Starting from the age of 25, every two years, undergo a planned comprehensive endoscopic examination – endoscopy with the definition of H. Pylori.

Where to get the diagnosis and treatment of gastric ulcer in Krasnoyarsk?

The private medical clinic “Medunion” on Nikitin works for you. We are engaged in the prevention, diagnosis and treatment of stomach ulcers. Our experts will conduct a comprehensive examination on the latest devices, in sterile clean rooms.

To make an appointment, fill out the online feedback form indicated on the website, or call and clarify the information at the clinic’s phone number 201-03-03.

Peptic ulcer of the stomach and duodenum – MOSITALMED

Peptic ulcer of the stomach and duodenum 12 is a disease in which an ulcerative defect of the mucous membrane is formed. The disease is observed when the balance between the factors of aggression and protection of the mucous membrane is disturbed. As a result, under the influence of provoking factors, the submucosal and muscle layers are affected, and after healing, cicatricial changes remain. The peak incidence occurs in the autumn-spring period.

Treatment of gastric and duodenal ulcers is carried out on an outpatient basis and in a hospital. The clinic “MOSITALMED” has an inpatient department equipped with comfortable wards, operating rooms and manipulation rooms with everything necessary to provide both planned and emergency medical care.

Causes of gastric ulcer

The appearance of an ulcer defect of the gastric mucosa occurs when exposed to a number of causes, including:

  • Helicobacter pylori infection;
  • taking non-steroidal anti-inflammatory drugs, antibiotics and glucocorticoids;
  • abdominal trauma;
  • nerve strain;
  • alcohol abuse;
  • excessive consumption of coffee;
  • smoking;
  • unbalanced diet with insufficient content of vitamins and excessive consumption of rough, hot, salty and sweet foods;
  • hereditary predisposition

Symptoms of peptic ulcer of the stomach and duodenum

The main symptom of peptic ulcer of the stomach and duodenum is pain.

Duodenal ulcer is characterized by pain on an empty stomach and 2-3 hours after eating in the epigastric region or right hypochondrium. Their intensity decreases after eating and taking antacids and increases at night.

An ulcer in the stomach presents with pain half an hour after eating and is accompanied by heartburn, nausea and vomiting, which brings relief. It is localized in the upper abdomen and intensifies after a heavy meal and physical activity.

Perforation of the ulcer is manifested by acute, unbearable, dagger pain in the projection of the stomach. It can mimic heart disease, leading to misdiagnosis, worsening of the condition and prognosis of the disease. This form of the disease is treated only by surgical intervention by stitching the wound.

Treatment of peptic ulcer of the stomach and duodenum

Treatment of peptic ulcer of the stomach and duodenum includes diet, drug therapy and physiotherapy. If Helicobacter pylori infection is confirmed, a course of antibiotic therapy is prescribed.

To restore the acid-base balance, antacids and drugs that have an enveloping and protective effect on the mucous membrane of the stomach and duodenum are used. In order to monitor the effectiveness of therapy, endoscopic examinations are carried out with an interval of 2 weeks.

Diet for gastric and duodenal ulcers involves the exclusion of fried, salty, smoked, pickled and sweet. It is allowed to eat lean meats and fish, soy and dairy products. Meals should be fractional, up to 6 times a day. The diet can be supplemented with medicinal mineral waters. They should be low-mineralized, with a minimum amount of carbon dioxide or without it at all, with a neutral, alkaline or slightly acidic reaction.

Physiotherapeutic procedures are used to improve blood flow, accelerate mucosal regeneration, relieve inflammation and pain. At the peak of the disease exacerbation, patients are usually prescribed microwave therapy, sinusoidal currents, diadynamic currents, ultrasound, magnetotherapy, galvanization, electrophoresis with prescribed drugs.