Peptic Ulcers - Causes

When H. pylori was first identified as the major cause of peptic ulcers, it was found in 90% of people with duodenal ulcers and in about 80% of people with gastric ulcers. As more people are being tested and treated for the bacteria, however, the rate of H. pylori associated ulcers has declined. For example, a 2001 study suggested that about half of ulcers are not caused by H. pylori. Instead, they tend to be due to regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin and other common pain relievers. Genetic factors, or, rarely, Crohn's disease or Zollinger-Ellison syndrome also cause ulcers.

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of ulcers and the rate of NSAID-caused ulcers is increasing. About 20 million people take prescription NSAIDs regularly, and over 25 billion tablets of over-the-counter brands are sold each year in America. The most common NSAIDs are aspirin, ibuprofen (Advil), and naproxen (Aleve, Naprosyn), although many others are available. Patients who have an ulcer caused by NSAIDs should stop taking these drugs.

NSAIDs definitely increase the risk for ulcers and gastrointestinal bleeding. The risk for bleeding is continuous for as long as a patient is on these drugs and may even persist for about a year after taking them. Taking short courses of NSAIDs for temporary pain relief should not cause major problems because the stomach has time to recover and repair any damage that has occurred.

Specific NSAIDs pose greater or lesser risks for ulcers and bleeding. No NSAIDs, however, even over-the-counter brands, should be used long-term except under a doctor's direction.

Ulcer Risk by Specific NSAIDs
Lowest Risk	Medium Risk	Highest Risk
Nabumetone (Relafen) Etodolac (Lodine) Salsalate Sulindac (Clinoril)	Aspirin. Even low-dose aspirin (81 mg) used to protect the heart may pose some risk (although lower than standard doses). Ibuprofen (Motrin, Advil, Nuprin, Rufen) Naproxen (Aleve, Naprosyn, Naprelan, Anaprox) Diclofenac (Voltaren) Tolmetin (Tolectin) NOTE: Drugs within the medium risk group vary in risk. For example, studies show that use of naproxen is twice as likely as ibuprofen to be associated with hospitalization from GI bleeding.	Flurbiprofen (Ansaid) Piroxicam (Feldene) Fenoprofen Indomethacin (Indocin) Meclofenamate (Meclomen) Ketoprofen (Actron, Orudis KT) NOTE: Ketoprofen is often considered a medium-risk drug, but one study reported that taking the drug even one week at low doses causes significant GI injury.