Peptic ulcers are open sores that develop as a result of the caustic effects of acid and pepsin on the inside lining of the esophagus (the hollow tube that carries food from the throat to the stomach), the stomach, or the duodenum (the upper portion of the small intestine).
The most common symptom of a peptic ulcer is abdominal pain. Peptic ulcers that occur in the stomach are named gastric ulcers, whereas ulcers found in the duodenum are referred to as duodenal ulcers.
Peptic ulcers can be minor (they only go through the first or the second layers of the stomach), or they can be considered a medical emergency (when they go through every layer of the stomach or duodenum lining, causing major internal bleeding).
Peptic ulcers occur when the lining of the stomach or duodenum is broken down by the digestive acids that help the body digest food. When the lining is broken down, the stomach and duodenum are more susceptible to infection. The most common cause is an infection with a bacterium called Helicobacter pylori; long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) is another common cause.
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus, stomach, or small intestine. The acid can create a painful open sore that may bleed. The digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you can develop an ulcer.
Common causes include:
NSAIDs Over-the counter and prescription pain relievers called NSAIDs can cause inflammation and damage to the lining of the stomach and small intestines. The lining of the stomach protects itself from gastric acid with a layer of mucus, the production of which is stimulated by certain prostaglandins. NSAIDs block the production of these prostaglandins. These pain relievers include aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others)
Other risk factors include:
Caffeine and coffee, commonly thought to cause or exacerbate ulcers, have not been found to affect ulcers to any significant extent. And, it's a myth that spicy foods or stress can cause peptic ulcers.
Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:
A doctor should be consulted if signs and symptoms persist. Over-the-counter antacids and acid blockers often temporarily relieve the gnawing pain, but the relief is short-lived. If pain persists, a doctor should be consulted.
Other less common signs and symptoms of Gastric Ulcers may include:
Although symptoms can suggest the presence of an ulcer, certain tests can be used to detect and confirm the diagnosis.
The most definitive test is direct examination of the upper digestive system by endoscopy. During endoscopy, a doctor passes a hollow tube equipped with a lens down the throat and into the esophagus, stomach, and small intestine to look for the presence of ulcers.
If an ulcer is detected, small tissue samples (biopsy) may be removed for examination in a lab. A biopsy can also identify the presence of H. pylori in the stomach lining. A series of X-rays of the upper digestive system, sometimes called a barium swallow or upper gastrointestinal series, creates images of the esophagus, stomach, and small intestine. During the X-ray, the patient swallows a white liquid (containing barium) that coats the digestive tract and makes an ulcer more visible.
A doctor may recommend tests to determine whether the H pylori bacterium is present in the body. The type of testing recommended depends on each patient’s unique situation, but may include:
Left untreated, peptic ulcers can result in severe complications. Gastrointestinal bleeding is the most common complication and occurs when the ulcer erodes one of the blood vessels in the stomach Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require immediate intervention. Severe blood loss may cause black or bloody vomit or black or bloody stools. Other complications include:
Treatment for peptic ulcers depends on the cause. Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. Treatments can include:
Antibiotics to kill Heliobacter Pylori: Doctors typically recommend antibiotics for two weeks, as well as additional medications to reduce stomach acid. When H. pylori infection is present, the most effective treatments are combinations of two antibiotics (e.g. Clarithromycin, Amoxicillin, Tetracycline, Metronidazole) and one proton pump inhibitor (PPI).
Medications that block acid production and promote healing: Proton pump inhibitors reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium), and pantoprazole (Protonix).
Medications to reduce acid production: Acid blockers—also called histamine (H-2) blockers—reduce the amount of stomach acid released into the digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid).
Antacids that neutralize stomach acid. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren't used to heal an ulcer.
Medications that protect the lining of the stomach and small intestine: In some cases, a doctor may prescribe medications called cytoprotective agents that help protect the tissues that line the stomach and small intestine. Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).
Peptic ulcers that don't heal with treatment are called refractory ulcers. The main reasons why an ulcer fails to heal are:
Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.
The risk of peptic ulcer may be reduced by: