Peptic Ulcers

Peptic Ulcers

What is it?

Peptic ulcers are sores that develop in the gastrointestinal tract as a result of erosion from stomach acids. There are three types of peptic ulcers:

  • Gastric ulcers – found in the lining of the stomach
  • Esophageal ulcers – found in the esophagus
  • Duodenal ulcers – found in the duodenum, the upper part of the small intestines

Symptoms are similar for all types of peptic ulcers, and an endoscopy or upper gastrointestinal series may be required to determine the exact location of the ulcer. Most peptic ulcers occur in the stomach or duodenum. An estimated one in ten people will experience a peptic ulcer during his or her lifetime.

What causes it?

There are two primary causes of peptic ulcers. The first and most common cause is an infection by a type of bacteria known as Helicobacter pylori (H. pylori). 80% of gastric ulcers and 90% of duodenal ulcers develop because of an H. pylori infection. About 20% of Americans under the age of 40 and 50% of adults over the age of 60 are infected with H. pylori, although many will not develop ulcers. However, the bacteria can penetrate and weaken the protective mucosal lining of the stomach, making it more susceptible to damage from stomach acids. Doctors don’t fully understand how H. pylori is spread; it could be through bodily fluids or even contaminated water sources. The best way to try to avoid H. pylori is by practicing good hygiene.

Frequent or longtime use of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen can also increase your risk of developing an ulcer. These medications can irritate the lining of your stomach and small intestine, causing damage over time. However, many people who have ulcers from chronic NSAID use are also infected with H. pylori.

Who is at risk?

Peptic ulcers are the most common stomach disease, and an estimated 10% of the American population will suffer from a peptic ulcer at least once in his or her lifetime. Excessive alcohol use, use of NSAIDs, and cigarette and tobacco use increase the risk of developing a peptic ulcer. In fact, people who smoke are twice as likely to develop ulcers, and take longer to heal. People over the age of 60 are also at increased risk, as the stomach lining becomes more fragile as you age. The use of certain medications, including blood thinners, steroid medications, and corticosteroids increase the risk of NSAID-related ulcers. Women are more frequently affected than men, and you may be at higher risk if you have a family history of ulcers, or if you’ve experienced ulcers in the past.

Risk factors for peptic ulcers:

  • Frequent use of NSAIDs, corticosteroids, and blood thinners
  • Female
  • Over the age of 60
  • Smoking
  • Heavy alcohol use
  • Family or personal history of ulcers

Signs and Symptoms

Some people don’t suffer from any symptoms when they have a peptic ulcer. The most common symptom is a burning pain in the chest, stomach, or abdomen. The pain may come and go, and is often worse at night. Spicy foods can exacerbate the pain, but they do not cause ulcers. The pain can last for any length of time, from just a few minutes to several hours, and antacids or food may provide some relief. In severe cases, the ulcer may begin to bleed, causing symptoms of anemia, including fatigue and shortness of breath. Blood may show up in the stool or vomit, as well. If your stool is black and tarry, or you are vomiting a red or dark substance that could be blood, see a doctor immediately.

Diagnosis

The most common and accurate test for peptic ulcers is an esophagogastroduodenoscopy, or EGD. A camera is attached to a flexible tube and inserted into the patient’s mouth. This allows the doctor to view the stomach and upper portion of the bowels, and can detect even the smallest ulcers. If an ulcer is found, your doctor may take a biopsy of the tissue to examine it for the presence of H. pylori. H. pylori can also be detected via blood, breath, or stool tests.

Treatment

If the ulcer is due to an H. pylori infection, you will often be prescribed antibiotics to kill the bacteria. If an ulcer is due to overuse of NSAIDs, you should stop taking or reduce the NSAID. Avoid alcohol and cigarettes, as they can slow the healing process and even make ulcers worse. Most peptic ulcers are treated with acid reducers, including histamine antagonists (H2 antagonists or H2 blockers) or proton pump inhibitors (PPIs).

These types of drugs reduce the production of stomach acid, so stomach juices are less acidic. This soothes the stomach and duodenal lining and gives it time to heal. H2 blockers include Pepcid AC, Tagamet HB, and Zantac 75. Proton pump inhibitors like Prilosec OTC and Prevacid 24HR block the enzymes in the wall of the stomach that produce stomach acid.