Peptic Ulcer

What is a peptic ulcer?

A peptic ulcer is a condition characterized by painful sores or ulcers on the inner wall of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the inner wall of the stomach from the effects of digestive fluids. However, many factors can reduce this protective layer, allowing an ulcer to form.

What causes an ulcer?

There is no single cause for ulcers. However, it is now clear that an ulcer is created by an imbalance, or abnormalities, between the digestive fluids, hydrochloric acid, and pepsin (a digestive enzyme) in the stomach and duodenum. An ulcer can be caused by:

• Infection with a type of bacterium called Helicobacter pylori (H. pylori).
• The use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen, and others. Even coated aspirin can still cause ulcers.
• Excessive acid production due to a condition known as Zollinger-Ellison syndrome (gastrinoma). The gastrinoma is a tumor of cells that produce stomach acid and increases acid production.

Can spicy foods cause ulcers?

Although spicy foods can make an ulcer more painful, they are not known to cause one.

What are the symptoms of an ulcer that I should watch for?

An ulcer may or may not have symptoms. When symptoms occur, they include:

• Burning pain in the middle or upper stomach between meals or at night
• Bloating
• Heartburn
• Nausea or vomiting

In severe cases, symptoms may include:

• Dark or black stools (due to bleeding)
• Vomiting
• Weight loss
• Severe pain in the middle or upper abdominal area

Am I at greater risk for an ulcer if I take anti-inflammatory drugs regularly?

The risk of an ulcer is related to the dosage of the anti-inflammatory medication (i.e., the more you take, the greater the risk). The risk increases with:

• Age (more likely over 60)
• Gender (more common in women than men)
• Use of corticosteroids (such as those taken for asthma or lupus) along with anti-inflammatories
• The duration you have been taking anti-inflammatories
• A history of ulcers

Is an ulcer a serious condition?

Although ulcers often heal on their own, their warning signs should not be ignored. If not properly treated, they can lead to serious health problems, including:

Bleeding

Perforation (a hole through the wall of the stomach)

Gastric outlet obstruction (due to swelling or scarring) that blocks the passage from the stomach to the small intestine. Taking anti-inflammatories can cause any of the above without warning. The risk is particularly increased for those over 75 and those with a history of peptic ulcers.

Who is more likely to develop ulcers?

 You may be more likely to develop an ulcer if you:

• Are infected with H. pylori
• Take anti-inflammatories (such as aspirin, ibuprofen, naproxen, and others)
• Have a family history of ulcers
• Smoke
• Have another condition, such as liver, kidney, or lung disease
• Drink alcohol regularly

How is an ulcer diagnosed?

Your doctor may be able to diagnose you just by talking to you about your symptoms. However, to confirm the diagnosis, you may need to undergo some tests. Initially, your doctor may ask you to take medication to reduce stomach acid for a short period to see if your symptoms improve.

If needed, your doctor may recommend a test called endoscopy. In this procedure, the doctor inserts a small, thin, lighted tube (endoscope) through your throat into your stomach to look for any abnormalities. This procedure is usually performed if you have severe ulcer symptoms.

Often, doctors will prescribe medication without confirming the diagnosis through endoscopy. If the cause is unlikely to be from taking anti-inflammatory drugs, it is very likely to be from H. pylori. Most doctors will test for the possible presence of H. pylori and treat it with antibiotics if present, in addition to prescribing medications to reduce symptoms.

H. pylori can be discovered either directly by taking biopsy samples during an endoscopy or indirectly through a blood test or breath test.

How are ulcers treated?

There are various ways in which an ulcer can be treated, including making lifestyle changes, taking medication, and/or surgery.

Lifestyle

If you have an ulcer, you should first avoid the factors that can cause it. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of anti-inflammatory drugs, then you need to stop them.

Medications

Proton pump inhibitors (PPIs): PPIs reduce acid and allow the ulcer to heal.

Antibiotics: Antibiotics are used to treat H. pylori. There are multiple combinations of antibiotics that are taken for two weeks, along with a PPI.

Endoscopy

Some bleeding ulcers may be treated through endoscopy.

Surgery

Surgery may be required if the ulcer has created a hole in the stomach wall or if there is severe bleeding.

Does milk help in treating an ulcer?

No. Milk may make your ulcer worse. It provides short-term relief from ulcer pain because it coats the stomach lining. However, milk also causes your stomach to produce more acid and digestive fluids, which can worsen the ulcer.

How can I prevent an ulcer?

• If you smoke, quit. People who smoke are twice as likely to develop ulcers. Ulcers also heal more slowly in smokers.
• Do not drink too much alcohol.
• If you have symptoms of an ulcer, contact your doctor. Do not misuse anti-inflammatory drugs.

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