Understanding the Risk Factors for Peptic Ulcer Disease

What Causes Peptic Ulcers?

A peptic ulcer is a sore in the lining of the stomach or duodenum, the first part of the small intestine. The National Institute of Diabetes and Digestive and Kidney Diseases identifies infection with Helicobacter pylori, usually shortened to H. pylori, and the use of nonsteroidal anti-inflammatory drugs, or NSAIDs, as the two most common causes.

Those causes provide a useful starting point, but they do not explain every case. Some people exposed to H. pylori or NSAIDs never develop an ulcer. Conversely, an ulcer may occasionally be related to another medicine, infection, medical condition, injury, procedure, or severe illness. When an evaluation does not identify a cause, clinicians may describe the ulcer as idiopathic.

Risk assessment involves more than checking one item on a list. A clinician may consider infection status, the type and duration of NSAID use, other medicines, previous ulcer or bleeding history, age, smoking, and relevant health conditions. These details may help guide how peptic ulcers are diagnosed, but risk factors alone cannot confirm that an ulcer is present.

H. pylori increases the likelihood of an ulcer, although infection does not make ulcer disease inevitable. Possible routes of spread include contact with an infected person's vomit, stool, or saliva and food or water contaminated with those materials. The precise transmission process remains incompletely understood, so these possibilities do not mean ordinary contact will necessarily spread the bacterium.

NSAIDs include commonly used medicines such as aspirin, ibuprofen, and naproxen. They can make the stomach lining more prone to damage and ulcers. Risk varies among people and patterns of use, which is why a complete medication review matters. The broader peptic ulcer disease overview places these causes within the condition's symptoms, complications, and care.

Some relevant factors cannot be changed. They still matter because they help clinicians place potentially modifiable exposures, particularly NSAID treatment, into context. Their presence does not prove that an ulcer or complication will occur.

Older age. NIDDK reports that older adults are more likely to develop peptic ulcers. FDA NSAID labeling also identifies older age as a factor associated with NSAID-related GI bleeding, ulceration, or perforation. The evidence does not define one universal age cutoff for every patient.

A previous peptic ulcer or GI bleed. Prior history deserves particular attention when NSAIDs are used. FDA labeling states that NSAID users with a previous peptic ulcer or GI bleed had a greater than tenfold increase in GI bleeding risk compared with people without those factors. This estimate concerns bleeding among NSAID users, not the risk of developing any ulcer.

Other health considerations. FDA NSAID labeling includes poor general health, advanced liver disease, and bleeding disorders among factors associated with NSAID-related GI bleeding, ulceration, or perforation. These are medication-safety considerations rather than proof that each condition independently causes peptic ulcer disease.

If these factors apply to you, avoid changing medicines on your own. A clinician can review why a medicine was prescribed, how it is used, and which additional risks are present. That individualized review is more useful than treating age, medical history, or one medicine as a stand-alone answer.

The labels “modifiable” and “non-modifiable” are useful only when they do not oversimplify care. A prescribed medicine may be theoretically modifiable but medically necessary. A previous ulcer cannot be erased, yet knowing about it may affect how a clinician evaluates current NSAID exposure.

The goal is not to eliminate every theoretical risk without considering the consequences. It is to identify the factors that apply to you and discuss them with the appropriate clinician. The review should account for the reason for treatment, your complete medication list, infection status, prior history, and relevant health conditions.

H. pylori infection and NSAID use can occur in the same person. The American College of Gastroenterology recognizes H. pylori as an independent risk factor for NSAID-induced ulcers and ulcer bleeding. ACG guidance recommends testing people who are beginning chronic NSAID treatment.

This recommendation does not mean everyone who has ever taken ibuprofen requires testing. It applies to people beginning chronic NSAID therapy. Decisions in other circumstances depend on clinical context, including anticipated treatment duration, symptoms, age, prior ulcer or bleeding history, other medicines, and relevant medical conditions.

If testing identifies H. pylori, treatment decisions should be made with a healthcare professional. Addressing the infection does not remove every risk associated with continued NSAID exposure. Likewise, a negative test does not make prolonged or high-dose NSAID use risk-free.

A medication review should include nonprescription products because aspirin, ibuprofen, and naproxen are NSAIDs. Differently branded products may belong to the same medicine class. Bringing an accurate list of products and doses to an appointment can make the discussion clearer.

When an ulcer or infection is confirmed, the plan depends on the findings and why an NSAID is being used. The GastroDoxs page on peptic ulcer disease treatment describes clinician-directed care. Do not stop prescribed aspirin, an NSAID, or another medicine without guidance.

Not every peptic ulcer is explained by H. pylori or NSAIDs. NIDDK identifies several other causes as uncommon or rare. They may become more relevant when the usual explanations do not fit, but they should not be presented as equally likely alternatives.

Evaluating an unusual cause requires clinical context. A list of rare conditions cannot determine what caused an individual person's ulcer, and having another disease does not establish that it is responsible. Some ulcers remain idiopathic even after evaluation.

• Infections other than H. pylori: Certain other infections are included among uncommon causes.
• Corticosteroids or some antidepressants: NIDDK notes these particularly when they are combined with NSAIDs. FDA labeling also connects these combinations with NSAID-associated GI complications.
• Medicines used for low bone mass: These appear on NIDDK's list of less common or rare causes.
• Surgery or procedures involving the stomach or duodenum: Prior interventions may be relevant during an evaluation.
• Crohn disease: This is among the conditions that may rarely be associated with peptic ulcers.
• Cancer, injury, or impaired blood flow: These are uncommon but potentially important explanations involving the stomach or duodenum.
• Critical illness or severe chronic disease: These physical illnesses are distinct from ordinary emotional or workplace stress.
• Zollinger-Ellison syndrome: This rare condition is included among uncommon causes of peptic ulcer disease.
• Idiopathic ulcers: This term describes ulcers for which no cause is identified after evaluation.

• “Spicy food causes peptic ulcers.” NIDDK reports that diet and nutrition have not been shown to play an important role in causing, preventing, or treating peptic ulcers. Spicy food is not established as a cause.
• “Coffee causes ulcers.” The supplied evidence does not establish coffee as a cause. It should not be placed alongside H. pylori and NSAIDs as a proven common cause.
• “Every ulcer is caused by stress.” Ordinary emotional stress is not identified as one of the two most common causes. Critical illness is listed as a rare cause, but that is a different clinical circumstance.
• “Everyone with H. pylori develops an ulcer.” Infection increases the likelihood of peptic ulcer disease, but an ulcer is not inevitable.
• “Aspirin is safe to stop whenever ulcer risk is mentioned.” Do not stop prescribed aspirin or another medicine without guidance from the responsible clinician. The reason for treatment and consequences of stopping must be considered.
• “Only older adults develop ulcers.” Older age is a recognized risk factor, not the sole determinant. H. pylori, NSAID exposure, prior history, smoking, and other circumstances may be relevant.
• “A special diet can prevent or heal an ulcer.” NIDDK does not recommend a special ulcer diet and reports that nutrition has not been shown to play an important role in prevention or treatment.
• “Having a risk factor confirms an ulcer.” A risk factor indicates increased likelihood or provides clinical context; it does not diagnose peptic ulcer disease.