Peptic Ulcer

A peptic ulcer is a sore in the lining of the stomach or duodenum. Peptic ulcers found in the stomach are called gastric ulcers, and those found in the duodenum (upper part of the small intestine) are called duodenal ulcers. More than one ulcer may form.

Peptic ulcers occur in the wall of the stomach and duodenum. Source: National Digestive Disease Clearing House, NIH

Prevalence

In the United States, peptic ulcers affect approximately 4.5 million people every year.^[1] The incidence varies from country-to-country. The disease is more prevalent in countries with a high incidence of H. pylori infection, or extensive use of non-steroidal anti-inflammatory drugs. ^[2] Incidence is similar in men and women. Approximately 1 in 100,000 people die from the disease. ^[3]

Symptoms

A burning pain in the gut is the most common symptom of a peptic ulcer.

Burning pain in the gut is the most common symptom of peptic ulcers. Source: National Digestive Disease Clearing House, NIH

Several characteristics of the pain are listed below:

• a dull ache
• comes and goes for a few days or weeks
• starts 2 to 3 hours after a meal
• comes in the middle of the night on an empty stomach
• usually goes away after eating

Besides pain, some other symptoms of peptic ulcers include the following:

• weight loss
• loss of appetite
• pain while eating
• feeling sick to the stomach
• vomiting

Sometimes symptoms are mild. However, the ulcer worsens if treatment is not sought. These symptoms are more serious and require medical attention:

• sudden sharp pain that does not go away
• black or bloody stools
• bloody vomit or vomit that looks like coffee grounds

These symptoms are signs that the ulcer has caused serious problems, such as tearing of the stomach or duodenal wall, rupturing of a blood vessel, or blockage of food passage from the stomach to the duodenum. These symptoms require immediate medical attention.

Causes

Below is a list of some causes of peptic ulcers:

• bacteria called Helicobacter pylori, or H. pylori for short
• non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (aspirin) and ibuprofen (Advil, Motrin)
• other diseases such as cancerous tumors in the stomach or pancreas (this cause is rare)

The body makes strong acids that digest food. A lining protects the inside of the stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall. H. pylori causes almost two-thirds of all ulcers. Many people have H. pylori infections. But not everyone who has an infection will develop a peptic ulcer.

Whether ulcers in patients receiving NSAIDs are caused by the medications or an infection is controversial.^[4] Research has shown that pre-treatment with omeprazole (Prilosec, Zegerid) to patients beginning on NSAID treatment prevents the formation of ulcers. Data have also shown that NSAID users who test positive for H. pylori are more likely to get ulcers than those negative for the bacteria.

Whether stress is a cause of peptic ulcers is also controversial. Some research suggests that not all ulcers are caused by bacteria, and that other conditions may contribute. Some experts argue that stress, if not a direct cause of ulcers, is at least a complication. Some ulcers could be caused by both; stress increases the acidity of the stomach, and H. pylori thrives in an acidic environment.

Spicy foods do not cause ulcers. But they can make ulcers worse. Alcohol or smoking can make ulcers worse as well.

Risk

Below are several risk factors for developing a peptic ulcer:

• an H. pylori infection

• frequent NSAIDs

• smoking cigarettes

• alcohol use

• relatives who have peptic ulcers

• 50 years old or older

Diagnosis

Peptic ulcers can be diagnosed by x-rays, endoscopy, biopsy, or bacterial culture. An upper gastrointestinal series, or a group of x-rays of the stomach and duodenum, can reveal an ulcer(s). Patients take barium to contrast the stomach and duodenum on X-ray. Ulcers are also diagnosed by an endoscopy, in which a thin lighted tube with a tiny camera on the end is inserted through the nose or mouth to look at the inside of the stomach and duodenum (see video below). Biopsy or removal of a tiny piece of tissue for testing, can also be diagnostic. Peptic ulcers caused by H. pylori infections can be diagnosed by testing breath, blood, or tissue for the presence of the bacteria.

Treatment

Peptic ulcers are treatable. Medicines for peptic ulcers are usually of two kinds:

• proton pump inhibitors or histamine receptor blockers to stop the stomach from making acid

• antibiotics to kill the H. pylori bacteria

Symptoms usually subside following treatment with these drugs, used either alone or in combination.

Discontinuation of NSAIDs help heal ulcers that are cause by these drugs. However, eradication of an H. pylori infection may reduce the risk of developing ulcers in NSAIDs users (see “Causes”).

Antacids help the symptoms of peptic ulcers by reducing stomach acidity. Over-the-counter antacids need to be taken several times a day, and since antacids do not kill the bacteria, the ulcer could come back even if the pain goes away.

In most cases, ulcers are healed without surgery. However in rare cases, surgery might be required to remove the ulcers and reduce the amount of acid made in the stomach.

Interesting Fact

The first scientific paper that presented evidence of H. pylori as the cause of peptic ulcers, published in 1982, was not well-received by the medical community. The majority of physicians and researchers were skeptical of the suggestion. To help show a connection, one of the authors of the paper drank a collection of organisms collected from a patient with gastritis. He became infected with gastritis and took antibiotics to fully eradicate the bacteria. This experiment helped to establish the link between bacterial infection and ulcers.

References

1. ↑ Emedicine. Peptic Ulcer Disease. Accessed May 15, 2008.
2. ↑ Emedicine. Peptic Ulcer Disease. Accessed May 15, 2008.
3. ↑ Emedicine. Peptic Ulcer Disease. Accessed May 15, 2008.
4. ↑ EurekAlert. H pylori eradication reduces risk of peptic ulcers for patients taking non-steroidal anti-inflammatory drugs. Accessed May 15, 2008.

External Links

The Helicobacter Foundation

American Gastroenterological Association (AGA)

H. pylori and Cancer: Fact Sheet