Peptic Ulcers

A peptic ulcer is a sore on the lining of the stomach, esophagus or duodenum (the beginning of the small intestine). This kind of ulcer is common. According to the National Institutes of Health, one in every ten Americans will have an ulcer at some point. The American Academy of Family Physicians (AAFP) says peptic ulcers can be categorized by location. A peptic ulcer in the stomach is called a gastric ulcer; in the duodenum, a duodenal ulcer; and in the esophagus, an esophageal ulcer.

Stomach pain can indicate a number of other problems. (Read about "Indigestion") But the type of pain associated with peptic ulcers has certain distinct characteristics. According to the American Gastroenterological Association:

• it's like a dull, gnawing ache
• it comes and goes for several days or weeks
• it occurs 2 to 3 hours after a meal
• it occurs in the middle of the night (when the stomach is empty)
• it's relieved by food

Other symptoms include weight loss, loss of appetite, bloating, burping, nausea and vomiting.

Causes of peptic ulcers

Contrary to some long-held beliefs, experts now say that peptic ulcers are not caused by stress or spicy foods. (Read about "Stress") According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the main cause of peptic ulcer is a bacterial infection. (Read about "Microorganisms") Researchers have discovered that a type of bacteria called Helicobacter pylori (H. pylori) is a primary cause of peptic ulcers. This bacterium is very common, but most people infected with it do not develop ulcers.

We may come into contact with H. pylori through food or water. Basically, the bacteria weakens the stomach's lining, allowing acid to get through, causing irritation and ultimately letting a sore develop.

In addition to the most common bacterial cause, the American Gastroenterological Association says the second most common cause of ulcers is long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), such as aspirin and ibuprofen, as can happen with people with certain chronic conditions such as arthritis or chronic pain. (Read about "Arthritis and Rheumatic Diseases" "Chronic Pain") In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. (Read about "Stomach Cancer" "Pancreatic Cancer")

Getting help

If you suspect an ulcer, it's important to see your doctor right away. If an ulcer is suspected, the doctor can test you for H. pylori. Testing for H. pylori can be done with a blood test, a breath test or a stool test. (Read about "Laboratory Testing") An upper gastrointestinal (GI) x-ray (Read about "X-rays") may be used to examine the digestive tract. Upper esophagogastroduodenal endoscopy (Read about "Endoscopy") is another procedure that can be used in diagnosing ulcers. The Centers for Disease Control and Prevention (CDC) say that during endoscopy, biopsy (Read about "Biopsy") specimens of the stomach and duodenum are obtained and the diagnosis of H. pylori can be made. Testing is important because treatment for an ulcer caused by H. pylori is different from that for an ulcer caused by NSAIDs.

NIDDK says that H.pylori peptic ulcers are usually treated with a combination of drugs. Among the types of drugs that can be used are:

• antibiotics to kill the bacteria (Read about "Antibiotics")
• drugs called H2 blockers to reduce stomach acid
• proton pump inhibitors (PPIs) to inhibit acid secretion
• drugs to protect the stomach lining

If H.pylori is not present, H2 blockers or PPIs may be used without antibiotics to reduce acid secretions. Changes in any identifiable causes of the ulcer, such as overuse of NSAIDs, would need to be considered as well. During treatment, it's important to follow your doctor's directions exactly.

AAFP says it's also important to contact your doctor if you develop any of the following emergency symptoms:

• sharp sudden stomach pain
• bloody or black stools
• bloody vomit or vomit that looks like coffee grounds
• you feel cold, clammy, weak or dizzy
• you keep losing weight for no reason

These could be signs of a serious problem such as bleeding (Read about "Gastrointestinal Bleeding"), obstruction or perforation, which require immediate medical care. The bleeding could also result in anemia (Read about "Anemia") with other resultant health problems.

Related Information:

    Digestive System