When There's No Clear Cause: Why Am I Getting Ulcers for No Reason?

An estimated 4 million Americans are treated for peptic ulcers each year. For many, the cause is a bacterial infection or NSAID use, but for those asking, 'Why am I getting ulcers for no reason?', the underlying culprit can be much more complex.

Quick Summary

Investigating ulcers without obvious culprits like H. pylori or NSAIDs often involves exploring underlying health conditions, rare syndromes, genetic factors, and advanced diagnostic testing. These less common causes require medical expertise to identify and treat effectively.

Key Points

• Hidden Causes: Ulcers can stem from rare conditions or autoimmune diseases, even when H. pylori and NSAIDs are ruled out.

• Zollinger-Ellison Syndrome: A rare but possible cause, where tumors lead to excessive stomach acid production.

• Genetic Factors: Some individuals have a moderate genetic predisposition to developing peptic ulcers, independent of H. pylori status.

• Comprehensive Testing: A thorough medical investigation, including endoscopy and advanced lab work, is crucial for diagnosing unexplained ulcers.

• Lifestyle Exacerbates, Doesn't Cause: Stress and diet don't directly cause ulcers but can worsen symptoms and hinder healing.

• Older Patients at Higher Risk: Patients with non-H. pylori, non-NSAID ulcers tend to be older and have other health issues.

The Usual Suspects: H. pylori and NSAIDs

When most people think of ulcers, they think of the two most common causes: infection with Helicobacter pylori bacteria and the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. These two factors account for the vast majority of cases. H. pylori can weaken the protective lining of the stomach and duodenum, while NSAIDs can directly irritate and damage it. A thorough medical evaluation always starts by testing for these common culprits to guide the most direct treatment. However, if these tests come back negative, a patient may be left with the frustrating question: "Why am I getting ulcers for no reason?" The reality is that there are other, albeit less common, reasons for ulcer development that warrant further investigation.

Beyond the Obvious: Uncovering Less Common Ulcer Causes

As the prevalence of H. pylori infections has declined in developed countries, the number of ulcers from other causes has become more apparent. Identifying these causes often requires a deeper diagnostic dive.

• Hypersecretory States and Endocrine Disorders: A rare but well-documented cause is Zollinger-Ellison syndrome (ZES). In ZES, one or more tumors (gastrinomas) form, typically in the pancreas or duodenum, and release excessive amounts of the hormone gastrin. This overproduction of gastrin leads to extremely high levels of stomach acid, which overwhelms the stomach's protective mucus and leads to severe ulcers. Multiple endocrine neoplasia type 1 (MEN-1) is another rare condition that can cause this syndrome.

• Chronic and Autoimmune Conditions: Certain autoimmune and chronic inflammatory diseases can manifest as ulcers in the gastrointestinal tract. These include Crohn's disease, an inflammatory bowel disease that can affect any part of the digestive tract, and celiac disease, which can cause sores and damage in the small intestine. Other conditions like Behçet's disease, which causes inflammation of blood vessels, can also cause recurring ulcers.

• Genetic Predisposition: For some, the tendency to develop ulcers may be written in their genes. Research has shown that genetic factors play a moderate role in an individual's susceptibility to peptic ulcers, independently of their H. pylori status. Recent studies have identified specific genetic markers linked to the condition, shedding light on potential underlying biological differences that make some people more vulnerable.

• Severe Physiological Stress: While emotional stress doesn't directly cause ulcers, severe physiological stress can. This can occur in patients with life-threatening illnesses, major trauma, extensive burns, or those in intensive care units. These stressful conditions can cause changes in the body's pH balance, increasing stomach acid and predisposing the lining to damage.

• Medications Beyond NSAIDs: While NSAIDs are the most common drug-related cause, other medications can also increase ulcer risk. These include some selective serotonin reuptake inhibitors (SSRIs), anticoagulants (blood thinners), and certain medications used to treat osteoporosis. It is crucial to have a detailed discussion with your doctor about all medications you are taking.

Comparing Common vs. Less Common Ulcer Causes

Feature	Common Ulcers (H. pylori or NSAID-related)	Less Common Ulcers (Other causes)
Primary Culprit	Bacterial infection or regular, high-dose use of NSAIDs.	Varied, including rare syndromes, chronic diseases, or genetic factors.
Diagnostic Approach	Initial testing for H. pylori (breath or stool test); review of medication history.	Extensive investigation, potentially including imaging, specific blood tests, and endoscopy with biopsies.
Patient Profile	Can affect a wide range of people, with increased risk for older individuals or those on long-term NSAIDs.	Often older, may have significant comorbidities or related symptoms from a systemic disease.
Treatment Focus	Antibiotics to eradicate H. pylori and/or discontinuing NSAIDs, combined with acid-suppressing medication.	Treating the underlying condition (e.g., ZES, Crohn's), combined with potent acid-suppressing medication.
Risk of Recurrence	Lower risk if H. pylori is successfully eradicated.	Potentially higher risk of recurrence, especially if the underlying cause is chronic.

The Diagnostic Journey for Unexplained Ulcers

For a person with an unexplained ulcer, the diagnostic process involves more than just a standard H. pylori test. A doctor will likely recommend a comprehensive evaluation, which may include:

• Upper Endoscopy: A thin, flexible tube with a camera is passed down the throat into the stomach and duodenum. This allows the gastroenterologist to visually inspect the ulcer and take biopsies to check for rare infections or cancer.
• Repeat H. pylori Testing: In some cases, a previous test may have been a false negative, so repeat testing, perhaps via biopsy during endoscopy, is prudent.
• Blood and Other Lab Tests: These may be ordered to check for specific conditions like ZES, autoimmune markers, or nutritional deficiencies associated with ulcers.
• Review of All Medications: The doctor will re-evaluate all prescription, over-the-counter, and even herbal supplements that could be contributing factors.

What to Do If You Suspect an Unexplained Ulcer

If you are experiencing symptoms like burning abdominal pain, nausea, bloating, or unexplained weight loss, it is vital to consult a healthcare provider. For those who have already been checked for the most common causes, it is essential to continue working with your doctor to explore the less obvious possibilities. Do not ignore your symptoms, as untreated ulcers can lead to serious complications, including bleeding and perforation.

Conclusion: Don't Dismiss Your Symptoms

While the search for a cause can be frustrating, the feeling of getting ulcers "for no reason" is a medical symptom that requires attention. A significant number of ulcers fall outside the textbook definition of H. pylori or NSAID-related cases. By undergoing a thorough medical evaluation, you and your doctor can work to identify and treat the underlying cause, providing relief and preventing serious complications. Persistence and patience are key on the road to diagnosis and recovery. Yale Medicine offers additional resources on peptic ulcers and their treatment.

Frequently Asked Questions

Can stress really cause an ulcer?

No, stress does not directly cause ulcers, but it can worsen symptoms and delay healing by increasing stomach acid. In rare cases, severe physiological stress, such as in ICU patients, can lead to stress ulcers.

What tests are used to find the cause of an ulcer?

Tests include H. pylori breath or stool tests, upper endoscopy with biopsies, and blood tests to check for specific rare syndromes or autoimmune conditions.

Is it possible for an ulcer to have no cause at all?

While the cause is often eventually found, some ulcers are considered idiopathic, meaning no specific cause can be identified. However, it is crucial to rule out all possibilities with a doctor first.

Can diet cause an ulcer?

Spicy or acidic foods do not cause ulcers. However, they can irritate an existing ulcer and exacerbate symptoms for some people, so avoiding them may offer symptomatic relief.

How are ulcers with an unknown cause treated?

Treatment often involves powerful acid-suppressing medication, such as proton pump inhibitors (PPIs), to allow the ulcer to heal. If an underlying condition is found, treatment will also target that specific issue.

When should I see a doctor for my ulcer symptoms?

You should see a doctor for persistent abdominal pain. Seek immediate medical attention for severe pain, bloody vomit, or black, tarry stools, as these can indicate a serious complication.

Are ulcers that aren't caused by H. pylori or NSAIDs more serious?

Ulcers from less common causes may be associated with a higher risk of complications and recurrence, especially in older patients with underlying health issues. A proper diagnosis is essential.