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Starting the fire: causes of PUD

There are 2 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 95% of duodenal ulcers and 70% of gastric ulcers). It is estimated that the bacteria is found in the stomach of more than 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 65 years
  • a history of previous ulcers (including a family history)
  • using high doses of NSAIDs
  • using NSAIDs for prolonged periods of time
  • using corticosteroids (example.g., 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)
  • cigarette smoking
  • heavy alcohol consumption (i.e., more than 3 drinks a day for men or more than 2 drinks a day for women)
  • H. pylori infection
  • poor general health

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source:

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