Peptic Ulcer Disease
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.
What Causes Ulcers?
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori).
Factors that can increase your risk for ulcers include:
Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of Midol, and others), and many others available by prescription; even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.
Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)
Excessive drinking of alcohol
Smoking or chewing tobacco
Radiation treatment to the area
What Are the Symptoms of an Ulcer?
An ulcer may or may not have symptoms. When symptoms occur, they may include:
A gnawing or burning pain in the middle or upper stomach between meals or at night
Nausea or vomiting
In severe cases, symptoms can include:
Dark or black stool (due to bleeding)
Vomiting blood (that can look like “coffee-grounds”)
Severe pain in the mid to upper abdomen
How Serious Is an Ulcer?
Though ulcers often heal on their own, you shouldn’t ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:
Perforation (a hole through the wall of the stomach)
Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine
Taking NSAIDs can lead to an ulcer without any warning. The risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.
Who Is More Likely to Get Ulcers?
You may be more likely to develop ulcers if you:
Are infected with the H. pylori bacterium
Take NSAIDs such as aspirin, ibuprofen, or naproxen
Have a family history of ulcers
Have another illness such as liver, kidney, or lung disease
Drink alcohol regularly
Are age 50 or older
How Are Ulcers Diagnosed?
Your doctor may suspect you have an ulcer just by talking with you about your symptoms. However, to confirm the diagnosis one of several tests should be taken. First, your doctor may ask you to take an acid-blocking medication, such as those used to treat heartburn, for a short period of time to see if symptoms improve.
If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe or recurring symptoms of ulcers.
Doctors sometimes treat for ulcers without confirming the diagnosis using endoscopy.
How Are Ulcers Treated?
If not properly treated, ulcers can lead to serious health problems. There are several ways in which ulcers can be treated, including making lifestyle changes, taking medication, and/or undergoing surgery.
Lifestyle Changes to Treat an Ulcer
To treat an ulcer, first eliminate substances that can be causing the ulcers. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they need to be stopped.
Ulcer medications can include:
Proton pump inhibitors (PPI). Proton pump medications reduce acid levels and allow the ulcer to heal. They include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), and omeprazole/sodium bicarbonate (Zegerid).
Antibiotics . If you have H. pylori infection, then antibiotics are also used. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Bismuth is also part of some treatment regimens.
Upper endoscopy . Some bleeding ulcers can be treated through an endoscope.
Surgery. Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach, or if there is serious bleeding that can’t be controlled with an endoscope.
How Can I Prevent Ulcers?
To reduce the risk of developing ulcers:
Don’t overuse aspirin and/or NSAIDs.
If you have symptoms of an ulcer, contact your health care provider.