Starting the fire: causes of PUD

There are two major causes of peptic ulcer disease (PUD): Helicobacter pylori bacteria and use of ASA (Aspirin®) and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Helicobacter pylori (H. pylori) bacteria are responsible for the majority of ulcers (about 50% to 70% of duodenal ulcers and 30% to 50% of gastric ulcers). It is estimated that the bacteria is found in the stomach of approximately one-half of the world’s population. The bacteria can spread into the protective mucus lining of the stomach and small intestine, causing damage. Not all people infected with these bacteria will actually develop ulcers.

Use of ASA (Aspirin®) and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can cause PUD. NSAIDs block natural chemicals called prostaglandins that can help repair damaged cells in the protective mucus layer. This makes the mucus layer weaker and less able to protect the delicate stomach and intestine lining. Using ASA and NSAIDs regularly for a long time (such as for arthritis pain) increases the risk of developing PUD. Since NSAIDs are painkillers, they can mask the discomfort of ulcers.

Smoking also contributes to PUD, poor ulcer healing, and ulcer complications (such as bleeding). It is not known exactly how this happens, but smoking is believed to block prostaglandins that can help repair damaged cells in the protective mucus layer. It may also make it easier for H. pylori to cause PUD. Excessive alcohol use can put people at higher risk for PUD.

Some people have certain risk factors that make them more vulnerable to peptic ulcers caused by NSAIDs. If you are taking an NSAID and have one of these risk factors, your doctor may recommend a stomach protective medication (e.g., misoprostol) or an acid-suppressing medication (e.g., esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole). These risk factors are:

  • being older than 50 years
  • a history of previous ulcers (including a family history)
  • using high doses of NSAIDs or multiple NSAIDs
  • using corticosteroids (for example, prednisone)
  • using blood thinners such as ASA or warfarin
  • blood clotting disorders (e.g., hemophilia)
  • chronic health problems with major organs (e.g., heart disease)
  • heavy cigarette smoking (more than 10 cigarettes per day)
  • H. pylori infection
  • poor general health

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