Causes

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Depending on their location, peptic ulcers have different names:

Gastric ulcer. This is a peptic ulcer that occurs in your stomach.
Duodenal ulcer. This type of peptic ulcer develops in the first part of the small intestine (duodenum).
Esophageal ulcer. An esophageal ulcer is usually located in the lower section of your esophagus. It's often associated with chronic gastroesophageal reflux disease (GERD).

The culprit in most cases
Although stress and spicy foods were once thought to be the main causes of peptic ulcers, doctors now know that the cause of most ulcers is the corkscrew-shaped bacterium Helicobacter pylori (H. pylori).

H. pylori lives and multiplies within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of your stomach or duodenum, producing an ulcer.

H. pylori is a common gastrointestinal infection. In the United States, one in five people younger than 30 and half the people older than 60 are infected. Although it's not clear exactly how H. pylori spreads, it may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

H. pylori is the most common, but not the only, cause of peptic ulcers. Besides H. pylori, other causes of peptic ulcers, or factors that may aggravate them, include:

Regular use of pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. These medications, which are available both by prescription and over-the-counter, include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve), ketoprofen and others. To help avoid digestive upset, take NSAIDs with meals. If you have been diagnosed with an ulcer, make sure your doctor knows this when prescribing any pain reliever. Other medications that contain NSAIDs are Alka-Seltzer and bismuth subsalicylate (Pepto-Bismol, others). Unfortunately, some people take these medications for symptoms of peptic ulcer, but they can make the condition worse. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax and others).

NSAIDs inhibit production of an enzyme (cyclooxygenase) that produces prostaglandins. These hormone-like substances help protect your stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining, causing bleeding and ulcers.

Smoking. Nicotine in tobacco increases the volume and concentration of stomach acid, increasing your risk of an ulcer. Smoking may also slow healing during ulcer treatment.

Excessive alcohol consumption. Alcohol can irritate and erode the mucous lining of your stomach and increases the amount of stomach acid that's produced. It's uncertain, however, whether this alone can progress into an ulcer or if it just aggravates the symptoms of an existing ulcer.

Stress. Although stress per se isn't a cause of peptic ulcers, it's a contributing factor. Stress may aggravate symptoms of peptic ulcers and, in some cases, delay healing. You may undergo stress for a number of reasons — an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury.