Stomach Ulcers

What Causes Stomach Ulcers?

In order to deal properly with stomach ulcers we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow stomach ulcers to develop?"

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Accurate diagnosis of the factors behind stomach ulcers consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to stomach ulcers.  Here are seven possibilities:
  • Stress
  • Heartburn
  • Atrophic Gastritis
  • Cigarette Smoke Damage
  • Hyperparathyroidism
  • Helicobacter Pylori Infection
  • Gastritis

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
occasional unexplained vomiting
meal-induced pain for under a week
cysts in breasts
abdominal pain reduced by eating
craving for salt
disturbed sleep
slight afternoon/evening fatigue
occasional rotten egg burps
very angry/hostile disposition
sexual abuse during childhood
eating during sleep hours
some difficulty waking up
... and more than 90 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of stomach ulcers:
Cause Probability Status
Helicobacter Pylori Infection 98% Confirm
Hyperparathyroidism 26% Unlikely
Stress 17% Unlikely
Heartburn 1% Ruled out
Cigarette Smoke Damage 1% Ruled out
Gastritis 0% Ruled out
Atrophic Gastritis 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate digestive problems, The Analyst™ will ask further questions including this one:
Have you had Peptic Ulcers, also known as Stomach Ulcers or Gastric Ulcers?
Possible responses:
→ Never had one / don't know
→ Probably/minor episode now resolved
→ Major episode now resolved
→ Current minor problem
→ Current major problem
Based on your response to this question, which may indicate either history of stomach ulcers or stomach ulcers, The Analyst™ will consider possibilities such as:
Helicobacter Pylori Infection

The average person's lifetime chance of suffering from a peptic ulcer is 5-10%, but this rises to 10-20% in those who are Helicobacter pylori positive.  H. Pylori infection usually persists for many years, leading to ulcer disease in 10-15% of those infected.  H. pylori is found in more than 80% of patients with gastric and duodenal ulcers.


Patients with hyperparathyroidism may be more likely to develop peptic ulcers, high blood pressure, and pancreatitis.

Cigarette Smoke Damage

Smoking is associated with the development, delayed healing and recurrence of peptic ulcers, as well as resistance to treatment.


Severe inflammation of the stomach lining (gastritis) can result in ulceration.

Heartburn / GERD / Acid Reflux

There is a relatively high prevalence of GERD amongst patients with duodenal or gastric ulcers.  Persistent dyspepsia/heartburn symptoms after eradication of H. pylori and ulcer resolution might suggest the treatment of GERD as a separate entity. [Am J Gastroenterol 2000;95: pp.101-5]


In general the duodenum isn't as well protected with mucus as is the stomach and is more prone to ulcers.  A deficiency of pancreatic juices to neutralize the acid chyme from the stomach, or stress causing sympathetic inhibition of enzyme secretion can lead to duodenal ulcer formation.

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