6 Common Risk Factors for Developing Ulcers

Stomach ulcer

In the United States, more than six million Americans are diagnosed with ulcers, otherwise known as peptic ulcer disease (PUD), each year. Ulcers are the formation of painful, open sores, which develop in the lining of the stomach or at the first section of the small intestine, called the duodenum. Ulcers can have severe health consequences if left untreated. However, by knowing the risk factors that lead to ulcers, you can learn ways to minimize your chances of developing peptic ulcer disease.

Below are the most common risk factors for developing peptic ulcer disease.

H. pylori Infection

Helicobacter pylori (H. pylori) is a type of bacterial infection found in the digestive tract that has been closely associated with developing ulcers. According to the American College of Gastroenterology, it is estimated that 30-40 percent of the U.S. population is infected with H. pylori, but most do not even know it.

This unawareness is because the infection often remains dormant, or quiet, without any symptoms. Over time, H. pylori bacteria can damage the lining of the stomach and duodenum, exposing it to acid and digestive juices, which increases the risk of developing an ulcer. If a person is found to have H. pylori present in the digestive tract, antibiotics can be prescribed to treat the infection. Unfortunately, most infections are silent, so many people do not learn they are infected until they develop an ulcer.

It isn’t that clear yet as to how H. pylori is spread, but intake of contaminated food or water and close contact with an infected person are believed to be the means of transmission. Therefore, it is crucial for food handlers at home and in restaurants to practice good hygiene. Proper hand washing is still the best way to prevent the spread of H.pylori if you have been diagnosed.

Long-Term Use of NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain and inflammation associated with a variety of conditions. When NSAIDs are taken on a daily basis they can damage the mucosal lining of the stomach or duodenum because they inhibit the production of prostaglandin, a substance that protects and keeps the stomach lining healthy. Without prostaglandin, the stomach lining is exposed to the harmful effects of stomach acids. According to the American Journal of Gastroenterology, as many as 25 percent of chronic NSAID users will develop an ulcer. The risk increases when NSAID use is combined with H. pylori infection.

Gastroesophageal Reflux Disease (GERD)

GERD is a condition where stomach contents back up to the esophagus. When this occurs, the acidic stomach juices can cause severe irritation in both the esophagus and upper stomach. Over time, the acid can break down the lining of the esophagus and cause ulcers.

Personal History of Tobacco Use

As if smoking wasn’t bad enough already, it can increase the risk of developing ulcers.

While smoking is not found to increase acid production, it has been found to increase the risk of H. pylori infection. The harmful chemicals in cigarettes reduce the protective factors in the stomach and provide an environment conducive for H. pylori to flourish. Smoking also affects the circulation to the digestive lining, which can delay healing and cause ulcers to recur.

Stressful Lifestyle

Stress is often associated with ulcers. It does not directly cause peptic ulcer disease, but it is considered a contributing factor. In a recent study, it was determined that stress really does have a role in ulcers. It is thought that through possible mechanisms of increased acid, increased bad habit coping skills (smoking), and poor sleep hygiene all makes stress a risk factor.

Personal or Family History of Ulcers

Anyone who has previously been diagnosed with an ulcer is at increased risk for developing another one in the future. Studies have also shown that if you have a family history of ulcers your chances could be increased to develop one yourself.

Although peptic ulcer disease is very common, you can lower your chances of ending up with an ulcer by taking some simple precautions. I always tell my patients to do what they probably have been told their whole lives: Wash your hands, don’t smoke, and don’t stress out so much. Then, all you have to do is keep the NSAID use down and treat any GERD if it starts. Remember, if you have any symptoms of an ulcer, talk to your doctor as soon as possible.


Cryer B, Mahaffey KW, Gastrointestinal ulcers, role of aspirin, and clinical outcomes: pathobiology, diagnosis, and treatment. Multidiscip Healthc. 2014.

Levenstein S.Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastro Hep. 2015.

Peptic Ulcer Disease, American College of Gastroenterology. 2016.

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