Peptic Ulcers

Peptic ulcer disease occurs when open sores, or ulcers, form in the stomach or first part of the small intestine. Many cases of peptic ulcer disease develop because a bacterial infection eats away the protective lining of the digestive system. People who frequently take pain relievers are more likely to develop ulcers.

Causes #

People used to think that stress or certain foods could cause ulcers. But researchers haven’t found any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:

• Helicobacter pylori (H. pylori) bacteria.

• Pain-relieving NSAID medications.

H. pylori bacteria #

H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms. Researchers believe people can transmit H. pylori from person to person, especially during childhood.

The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue.

However, for most people the presence of H. pylori doesn’t have a negative impact. Only 10% to 15% of people with H. pylori end up developing ulcers.

Pain relievers #

Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form:

• Aspirin (even those with a special coating).

• Naproxen.

• Ibuprofen.

• Prescription NSAIDs

Rare causes #

Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:

• Being seriously ill from various infections or diseases.

• Having surgery.

• Taking other medications, such as steroids.

• Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.

Symptoms #

Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:

• Gnawing or burning pain in your middle or upper stomach between meals or at night.

• Pain that temporarily disappears if you eat something or take an antacid.

• Bloating.

• Heartburn.

• Nausea or vomiting.

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding).

• Vomiting.

• Weight loss.

• Severe pain in your mid- to upper abdomen.

Diagnosis #

Endoscopy #

If you have severe symptoms, your provider may recommend an upper endoscopy to determine if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through your throat and into your stomach to look for abnormalities.

H. Pylori tests #

Tests for H. pylori are now widely used, and your provider will tailor treatment to reduce your symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your provider can also look for it with a blood or stool test, or by taking a sample during an upper endoscopy.

Imaging tests #

Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the imaging machines.

Treatment #

For most people, doctors treat ulcers with medications, including:

• Proton pump inhibitors (PPI): These drugs reduce acid, which allows the ulcer to heal.

• Histamine receptor blockers (H2 blockers): These drugs also reduce acid production and include Tagamet, Pepcid, Zantac and Axid.

• Antibiotics: These medications kill bacteria. Doctors use them to treat H. pylori.

• Protective medications: Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. Doctors commonly recommend Carafate or Pepto-Bismol

Prevention #

• Talk to your doctor about alternatives to NSAID medications (like acetaminophen) to relieve pain.

• Discuss protective measures with your doctor, if you can’t stop taking an NSAID.

• Opt for the lowest effective dose of NSAID and take it with a meal.

• Quit smoking.

• Drink alcohol in moderation, if at all.