Peptic Ulcers

By Sonia GulatiΙ November 17, 2011

Peptic ulcers are open sores that can develop in the stomach (gastric ulcers), in the esophagus (esophageal ulcers), or in the duodenum (duodenal ulcers). Peptic ulcers occur when the mucosal lining of the gastrointestinal tract is degraded by increased amounts of acid.

Contrary to popular belief, peptic ulcers are not caused by stress or spicy food. The most common causes of peptic ulcers is the bacterium Helicobacter pylori (H. pylori) or the frequent consumption of non-steroidal anti-inflammatory drugs (NSAIDs). Treatment for peptic ulcers will vary depending on the cause of the ulcer. For most cases, a peptic ulcer can successfully be treated and heal completely.

Symptoms

The most common symptom of peptic ulcers is abdominal pain. This pain occurs when stomach acid comes into contact with the ulcer. This pain is often characterized as:

A burning or gnawing pain that may go through to the back
It can be felt at any point between the navel and the breastbone
It is often worse at night
Occurs two to three hours after eating a meal
It subsides after you eat or take an antacid

Other symptoms sometimes associated with peptic ulcers include:

Nausea or vomiting (in some cases, blood may be vomited)
Dark and tarry stools
Weight loss
Loss of appetite

Cause

The following are some common causes of peptic ulcers:

Helicobacter pylori. H. pylori are bacteria commonly found within the stomach and the small intestine. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Most individuals infected by H. pylori are asymptomatic. However, H. pylori are found in more than 80 percent of patients with gastric and duodenal ulcers.

Regular use of NSAIDs. NSAIDs are often taken to treat inflammatory conditions such as arthritis. Common over the counter NSAIDs include Aspirin, Ibuprofen (Motrin), or Naproxen (Naprosyn).

Risk Factors

Smoking. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
Alcohol. Drinking alcohol can both corrode the mucous lining of your stomach as well increases the amount of stomach acid that's produced.
Stress. Although stress by itself does not cause peptic ulcers, it maybe a contributing factor.
Genetics. Having a family members who have peptic ulcers may increase the likelihood of suffering from the same condition.

Diagnosis

In order to assess if you have a peptic ulcer your doctor may recommend:

Barium Upper GI x-ray. The barium upper GI x-ray is a relative easy test to perform and does not involve any risk. Barium is a chalky white substance that is administered orally. It coats the digestive tract and makes your ulcer more visible.

An upper endoscopy. This procedure involves the insertion of a flexible tube through the mouth to inspect the stomach, esophagus, and duodenum. The endoscopy allows the doctor to visually inspect the ulcer. If an ulcer is found the doctor may also take a biopsy. A biopsy can later be used to test for H. pylori infection as well as exclude other causes of the ulcer such as cancer.

Tests for H. pylori. If an ulcer is detected your doctor will want to assess if you are infected with H. pylori. A blood test, stool test, and a breath test can all be used to detect H. pylori.

Treatment

The overall goal for treating peptic ulcers is to either kill the H. pylori bacterium (if H. pylori is present) or to reduce the level of acid in the digestive system to relieve pain and encourage healing of the digestive tract.

Treatment regimens for peptic ulcers include:

Antibiotics. Antibiotics are prescribed if an H. pylori infection is found in your digestive tract. Usually, a two- week course of a combination of antibiotics is used to treat the infection. Commonly prescribed antibiotics for the treatment of H. pylori include amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline.

Proton pump inhibitors. This type of medication reduces the amount of stomach acid by blocking the cells that produce acid. These drugs include both over-the-counter and prescription medications. Common proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture.

Acid blockers (also referred to as histamine (H-2) blockers). These medications decrease the amount of acid released into your digestive tract. These medications are available by prescription or over-the-counter. Common acid blockers include ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).

Antacids. Antacids neutralize existing stomach acid and can provide rapid pain relief. These are usually provided in conjunction with other peptic ulcer treatments. Common antacids include Tums, Rolaids and Maalox.

Cytoprotective Agents. These medications protect the tissue that lines the stomach and small intestine. These medications are available by prescription or over-the-counter. Common cytoprotective agents include sucralfate (Carafate), misoprostol (Cytotec) and bismuth subsalicylate (Pepto-Bismol).