Description

Peptic ulcers are open sores in the lining of the stomach and the upper part of the small intestine. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers are:

  • Gastric ulcers , which appear in the interior of the stomach.
  • Duodenal ulcers , which appear in the interior of the upper part of the small intestine, called the duodenum.

The most common causes of peptic ulcers are infection with the germ Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (Nsaids). These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Stress and spicy foods do not cause peptic ulcers. But can make symptoms worse.

Symptoms

Many people with peptic ulcers have no symptoms. If there are symptoms, these can include:

  • A dull or burning pain in your stomach. For some people, the pain may be worse between meals and at night. For others, it may be worse after eating.
  • Feeling of fullness or bloating.
  • Belching.
  • Heartburn.
  • Nausea.

Peptic ulcers can cause bleeding of the ulcer. Below, symptoms may include:

  • Vomiting of blood-which may appear red or black.
  • Dark blood in stools, or stools, black or tarry stools.
  • Feeling light-headed or fainting.

When to see a doctor

Consult your health care provider if you are vomiting blood, dark blood in stools, or feel light-headed. Also consult with your health care professional if you nonprescription antacids and acid blockers relieve the pain, but the pain returns.

Causes

Peptic ulcers occur when acid in the organs that food travels through, called the digestive tract eats away at the inner surface of the stomach or the small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer, which is more often protects against acid. But if the amount of acid is increased or the amount of mucus decreases, you could develop an ulcer.

Common causes include:

  • Infection by Helicobacter pylori.This bacteria lives in the mucous layer that covers and protects tissues that line the stomach and small intestine. The H. pylori germ often does not cause problems. But it can cause swelling and irritation, the call of inflammation of the inner layer of the stomach. When this happens, it can cause an ulcer. It is not clear how H. pylori infection is spread. It can spread from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.
  • The Regular use of certain pain relievers. Take aspirin or nonsteroidal anti-inflammatory drugs (Nsaids) over time can irritate or inflame the lining of the stomach and the small intestine. These medications include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox DS, others), ketoprofen, and others. Does not include acetaminophen (Tylenol, others).

Infection by Helicobacter pylori. This bacteria lives in the mucous layer that covers and protects tissues that line the stomach and small intestine. The H. pylori germ often does not cause problems. But it can cause swelling and irritation, the call of inflammation of the inner layer of the stomach. When this happens, it can cause an ulcer.

It is not clear how H. pylori infection is spread. It can spread from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

Risk factors

If you are taking Nsaids, the following factors may increase the risk of peptic ulcers:

  • Old in age. This includes people over the age of 60 years.
  • Before peptic ulcer disease. People who have had a peptic ulcer before you have a higher risk of having another.
  • Nsaids use.Taking high doses of Nsaids or of two or more Nsaids increases the risk. So does taking NSAIDS with other medicines. These include other pain relievers, steroids, blood thinners, certain antidepressants called selective serotonin reuptake inhibitors (Ssris) and drugs to treat the bone-thinning disease osteoporosis. These include alendronate (Fosamax, Binosto), and risedronate (Actonel, Atelvia).

Nsaids use. Taking high doses of Nsaids or of two or more Nsaids increases the risk. So does taking NSAIDS with other medicines.

These include other pain relievers, steroids, blood thinners, certain antidepressants called selective serotonin reuptake inhibitors (Ssris) and drugs to treat the bone-thinning disease osteoporosis. These include alendronate (Fosamax, Binosto), and risedronate (Actonel, Atelvia).

Factors that do not cause peptic ulcers, but it can get worse include:

  • The habit of smoking. This can increase the risk of peptic ulcers in people who are infected with H. pylori.
  • The consumption of alcohol. Alcohol can irritate and erode the mucous membrane of the stomach. And increases the acid of the stomach.
  • Have no deal with stress.
  • Eat spicy foods.

Complications

Without peptic ulcer can cause:

  • Bleeding in the stomach or in the duodenum. The bleeding may be a slow loss of blood that leads to too few red blood cells, called anemia. Or you can lose a lot of blood so you need to be in a hospital or receive blood from a donor. The severe loss of blood can cause black or bloody vomit or black stools or bloody.
  • A hole, called a perforation of the wall of the stomach. Peptic ulcers can eat a hole through the wall of the stomach or the small intestine. This puts you at risk of infection of your abdomen, called peritonitis.
  • The lock. Peptic ulcers can keep food through the digestive tract. The obstruction can make you feel full easily and cause nausea, vomiting and weight loss.
  • Cancer of the stomach. Studies have shown that people infected with H. pylori have a higher risk of stomach cancer.

Prevention

To help prevent peptic ulcers:

  • Be careful with the drugs for the pain.If often, the use of Nsaids, which may increase the risk of peptic ulcer disease, taking steps to reduce your risk of stomach problems. For example, take pain medication with food. Work with your health care professional to find the lowest dose that gives you the relief of pain. Do not drink alcohol with medicines for the pain. Together, may increase your risk of stomach upset. If you need an NSAID, you may also need to take other medications to help protect your stomach. These include antacids, inhibitors of the proton pump, acid blockers, or agents cytoprotective. A class of Nsaids called COX-2 inhibitors may be less likely to cause peptic ulcers. But these medicines can increase the risk of heart attack.
  • If you smoke, find a way to quit smoking. Quitting smoking can reduce the risk of peptic ulcer disease. Talk with your health care professional to help you stop smoking.

Be careful with the drugs for the pain. If often, the use of Nsaids, which may increase the risk of peptic ulcer disease, taking steps to reduce your risk of stomach problems. For example, take pain medication with food.

Work with your health care professional to find the lowest dose that gives you the relief of pain. Do not drink alcohol with medicines for the pain. Together, may increase your risk of stomach upset.

If you need an NSAID, you may also need to take other medications to help protect your stomach. These include antacids, inhibitors of the proton pump, acid blockers, or agents cytoprotective.

A class of Nsaids called COX-2 inhibitors may be less likely to cause peptic ulcers. But these medicines can increase the risk of heart attack.

Diagnosis

To detect an ulcer, your health care professional may first take a medical history and a physical examination. You may also need tests, such as:

  • Laboratory tests for H. pylori.An analysis of blood, stool or breath test can show whether H. pylori infection is in your body. For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks down the substance in the stomach. Later, you blow into a bag, which is sealed. If H. pylori, your breath sample has the radioactive carbon in the form of carbon dioxide. If you take an antacid or an antibiotic, tell your health care professional. You may need to stop the medicine for a while. Both can affect the results of the test.
  • Endoscopy.During this procedure, the health care provider uses a long, flexible tube with a small camera, called an endoscope, to find in the upper part of your digestive system. Endoscopy involves passing an endoscope through the throat into the esophagus, the stomach and the small intestine to look for ulcers. If there is an ulcer, the doctor may remove a small sample of tissue for study in a laboratory. This is called a biopsy. A biopsy can also show whether H. pylori is found in the lining of the stomach. You are more likely to have an endoscopy if you are older, have signs of bleeding, or have recently had weight loss or difficulty eating and swallowing. If endoscopy shows an ulcer in the stomach, it is likely that it is a follow-up endoscopy after treatment. This can show if the ulcer has healed.
  • Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of the upper part of the digestive system makes the pictures of your esophagus, stomach and the small intestine. During the series of X-rays, which is swallowed a white liquid that has barium. The liquid coats your digestive tract and makes an ulcer easier to see.

Laboratory tests for H. pylori. An analysis of blood, stool or breath test can show whether H. pylori infection is in your body.

For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks down the substance in the stomach. Later, you blow into a bag, which is sealed. If H. pylori, your breath sample has the radioactive carbon in the form of carbon dioxide.

If you take an antacid or an antibiotic, tell your health care professional. You may need to stop the medicine for a while. Both can affect the results of the test.

Endoscopy. During this procedure, the health care provider uses a long, flexible tube with a small camera, called an endoscope, to find in the upper part of your digestive system. Endoscopy involves passing an endoscope through the throat into the esophagus, the stomach and the small intestine to look for ulcers.

If there is an ulcer, the doctor may remove a small sample of tissue for study in a laboratory. This is called a biopsy. A biopsy can also show whether H. pylori is found in the lining of the stomach.

You are more likely to have an endoscopy if you are older, have signs of bleeding, or have recently had weight loss or difficulty eating and swallowing. If endoscopy shows an ulcer in the stomach, it is likely that it is a follow-up endoscopy after treatment. This can show if the ulcer has healed.

Treatment

Treatment for peptic ulcers involves killing the H. pylori germ, if necessary. The treatment may also involve the detention of Nsaids or the reduction of the amount, if possible, and take medication to help the ulcer heal.

Medications may include:

  • Antibiotics to kill h. pylori. If you have H. pylori in your digestive tract, your health care professional may suggest a mixture of antibiotics. These may include amoxicillin (Amoxil, Larotid), clarithromycin (Biaxin XL), metronidazole (Flagyl, Likmez), tinidazole (Tindamax), tetracycline, and levofloxacin.
  • Medications that block acid.Proton pump inhibitors (Ppis) reduce stomach acid. Ppis include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and esomeprazole (Nexium) and pantoprazole (Protonix). The majority of the people taking Ppis in the form of a pill. In the hospital, the treatment of a bleeding ulcer can lead to a PPI given through a vein in the arm. This is known as intravenous administration. Long-term or high-dose use of inhibitors of the proton pump can increase your risk of hip, wrist and spine fracture. Ask your health care provider if calcium supplements may reduce this risk.
  • Medications to reduce acid in the stomach. Acid blockers, also called histamine (H-2) blockers, help relieve ulcer pain and help with healing. Acid blockers include famotidine (Pepcid AC), cimetidine (Tagamet HB), and nizatidine (Axid AR).
  • The antacids counteract the effects of acid in the stomach. These can relieve the pain quickly. But they aren't used to heal ulcers. Side effects can include diarrhea or constipation, depending on the main ingredients in antacids.
  • Medications that protect the lining of the stomach and the small intestine. These are the so-called agents cytoprotective. These include the prescription drug sucralfate (Carafate) and misoprostol (Cytotec).

Medications that block acid. Proton pump inhibitors (Ppis) reduce stomach acid. Ppis include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and esomeprazole (Nexium) and pantoprazole (Protonix).

The majority of the people taking Ppis in the form of a pill. In the hospital, the treatment of a bleeding ulcer can lead to a PPI given through a vein in the arm. This is known as intravenous administration.

Long-term or high-dose use of inhibitors of the proton pump can increase your risk of hip, wrist and spine fracture. Ask your health care provider if calcium supplements may reduce this risk.

Follow-up after treatment

Treatment for peptic ulcers often leads to healing of the ulcer. But if the symptoms are severe or if they are, even with treatment, your healthcare provider may suggest the endoscopy. This procedure can rule out other possible causes of your symptoms.

If your health professional is an ulcer during the endoscopy, you may need another endoscopy after treatment to make sure that the ulcer has healed.

Ulcers that do not heal

Peptic ulcers that do not heal with treatment are called refractory ulcers. Reasons for a sore that does not heal, which include:

  • Not taking medications as prescribed.
  • Have a type of H. pylori resistant to antibiotics.
  • Often, the use of analgesics, such as Nsaids, which increase the risk of ulcers.

With less frequency, and refractory ulcers can be the result of:

  • A large amount of acid in the stomach, such as in Zollinger-Ellison syndrome.
  • An infection other than H. pylori.
  • Cancer of the stomach.
  • Other conditions that can cause ulcerlike ulcers in the stomach and the small intestine, such as Crohn's disease.

Treatment of ulcers refractory to most often means getting rid of the factors that keeps the ulcer healing and trying to other antibiotics. If you smoke, your healthcare provider may suggest that you stop smoking. Smoking can delay the healing of the ulcer.

A serious complication of an ulcer, such as bleeding or a hole in the stomach, may need to be treated with endoscopy or surgery. But because there are many drugs that work well, people with peptic ulcers need of a surgery much less often than in the past.

Lifestyle and home remedies

You can find relief from the pain of a stomach ulcer if you:

  • Switch of pain relievers. If the use of analgesics regularly, ask your health care provider if acetaminophen (Tylenol, others) might work for you.
  • Control stress. Stress can make the symptoms of a peptic ulcer worse. Think about what causes stress and what you can do to relieve it. There are many ways to cope with stress. These include exercise, spend time with friends, deep breathing, writing in a journal or in meditation.
  • Do not smoke. Smoking can damage the lining of the stomach, increasing the chance of getting an ulcer. Smoking also increases the acid of the stomach.
  • Limit or avoid the consumption of alcohol. Too much alcohol can irritate and eating out of the mucosa in the stomach and intestines. This can cause the lining to become inflamed and bleed.

Alternative medicine

Products that contain bismuth can help with the symptoms of a peptic ulcer. There is also some evidence that zinc can help to heal the ulcers.

Talk with your health care professional before using any alternative medicine for peptic ulcers.

Preparing for your appointment

Make an appointment with your primary health care provider if you have symptoms that concern you. Your healthcare provider may send you to a specialist in the digestive system, called a gastroenterologist.

Here is the information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet or stop taking certain drugs.

Make a list of:

  • The symptoms, when they started and if they are worse when the stomach is empty.
  • Key personal information, including any other medical problems, the major stresses or recent life changes. Are the family history of peptic ulcer disease, H. pylori infection and cancer in the digestive tract.
  • All medications, vitamins or supplements that you take, including over-dose. Be sure to include pain medications you use, how much to take and how often you take.
  • Write questions to ask their health professional.

For peptic ulcers, some questions are:

  • What is the most likely cause of my symptoms?
  • What tests do I need? How do I prepare for them?
  • Is my condition likely to go away or to the last?
  • What treatment do you suggest?
  • I need to restrict my diet?
  • I have other medical conditions. How can I manage along with the sores?

Make sure that you ask all the questions that you have.

What to expect from your doctor

Your health care professional may ask:

  • Do you always have symptoms, or come and go?
  • How bad are the symptoms?
  • Are your symptoms get worse when you're hungry?
  • Nothing seems to improve the symptoms?
  • Does anything make your symptoms worse?
  • Do you have nausea? Has been vomiting?
  • Have you ever vomited blood or black material?
  • Have you noticed blood in your stools or black stools?

What you can do in the meantime

While you wait for your appointment, do not use tobacco or alcohol or eating spicy foods to help relieve your discomfort.

Symptoms and treatment of Peptic ulcer disease