Peptic Ulcers

Peptic ulcers are usually associated with aching or burning pains in the stomach. They can occur as gastric ulcers (in the stomach) or as duodenal ulcers (in the small intestine). Peptic ulcers are formed when the lining of the stomach is exposed to stomach acid. Usually, a protective mucous lining prevents this from happening but this lining can be damaged by some medicines, such as non-steroidal anti-inflammatory drugs, and by the bacteria Helicobacter pylori. Peptic ulcers can be treated effectively using medicines that reduce the amount of acid the stomach produces, thereby allowing the ulcer to heal. Antibiotic combinations can also be used to combat the bacterial infection when Helicobacter pylori is the cause of the ulcers.

Small ulcers may not cause any symptoms. Large ulcers can cause serious bleeding. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through is called a perforation of the intestinal lining - a perforation is a medical emergency.

What causes peptic ulcers and who is at risk?

The most common cause of damage to the mucous lining is infection of the stomach with a bacterium called Helicobacter pylori (H.pylori). Most people with peptic ulcers have this organism living in their gastrointestinal (GI) tract. On the other hand, many people have this organism living in their GI tract but they don't get an ulcer.

Other factors can make it more likely for you to get an ulcer, including:

In addition, if you have a family history of ulcers or if you are blood type O, you are more likely to get a duodenal ulcer. There is also a rare condition called Zolliger-Ellison syndrome in which a tumor in the pancreas secretes a substance that causes ulcers throughout the stomach and duodenum.

Many people believe that stress causes ulcers. It is not clear if this is true. While critically ill patients who are on a breathing machine are at risk of so-called "stress ulceration," everyday stress at work or home doesn't appear to cause peptic ulcers.

Symptoms of peptic ulcers

Abdominal pain  is a common symptom but it may not always be present. The abdominal pain from peptic ulcers can differ a lot from person to person. For example, the pain may get better or worse after eating a meal.

Other possible symptoms include:

It is important to note that you may have no symptoms at all from an ulcer.

Diagnosis

To diagnose an ulcer, your doctor will order one of the following tests:

  • An upper GI -- a series of x-rays taken after you drink a substance called barium.
  • An esophagogastroduodenoscopy (EGD) -- a special test performed by a gastroenterologist in which a thin tube is inserted through your mouth into the gastrointestinal tract to look at your stomach and small intestines.

During an EGD, the doctor may take a biopsy from the wall of the intestines to test for H. pylori.

Your doctor may also order:

Call 911 if you:

    Suddenly develop sharp abdominal pain.

    Have symptoms of shock like fainting, excessive sweating, or confusion.

    Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)

    Have a rigid, hard abdomen that is tender to touch.

Call your doctor if:

Call your doctor if:

  • You have ulcer symptoms.
  • You feel dizzy or lightheaded.

Treatment Options

You should see a doctor if you have symptoms of an ulcer. Treatment often involves a combination of medications to kill the Helicobacter pylori bacteria, reduce acid levels, and protect the GI tract. This combination strategy allows your ulcer to heal and reduces the chance it will come back. Take all of your medications exactly as prescribed.

The medications may include one or more of the following:
  • Antibiotics to kill Helicobacter pylori
  • Acid blockers (like cimetidine, ranitidine, or famotidine)
  • Proton pump inhibitors (such as omeprazole)
  • Medications that protect the tissue lining (like sucralfate)
  • Bismuth (may help protect the lining and kill the bacteria)

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. If bleeding cannot be stopped using an EGD procedure or if the ulcer has caused a perforation, then surgery may be required.

Prevention:

See Also:

Last updated: 2013-04-09 by L. Anderson, PharmD

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