Peptic ulcer disease
- Category: Gastroenterology
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Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.
Peptic ulcers include:
- Gastric ulcers that occur on the inside of the stomach
- Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)
The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and certain other painkillers, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, Anaprox, others). Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.
Symptoms and causes of the peptic ulcer disease
- Burning stomach pain
- Feeling of fullness, bloating or belching
- Fatty food intolerance
The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.
Nearly three-quarters of people with peptic ulcers don't have symptoms.
Less often, ulcers may cause severe signs or symptoms such as:
- Vomiting or vomiting blood — which may appear red or black
- Dark blood in stools, or stools that are black or tarry
- Trouble breathing
- Feeling faint
- Nausea or vomiting
- Unexplained weight loss
- Appetite changes
When to see a doctor
See your doctor if you have the severe signs or symptoms listed above. Also see your doctor if over-the-counter antacids and acid blockers relieve your pain but the pain returns.
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.
Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Common causes include:
- A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach's inner layer, producing an ulcer.
- It's not clear how H. pylori infection spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.
- Regular use of certain pain relievers. Taking aspirin, as well as certain over-the-counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. These medications include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, Anaprox, others), but not acetaminophen (Tylenol).
- Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.
- Other medications. Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate (Fosamax) and risedronate (Actonel), can greatly increase the chance of developing ulcers.
In addition to taking certain pain medications, including aspirin, you may have an increased risk of peptic ulcers if you:
- Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
- Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.
- Have untreated stress.
- Eat spicy foods.
Alone, these factors do not cause ulcers, but they can make them worse and more difficult to heal.
Left untreated, peptic ulcers can result in:
- Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
- Infection. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
- Obstruction. Peptic ulcers can lead to swelling, inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight.
Diagnosis of the peptic ulcer disease
In order to detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:
- Laboratory tests for H. pylori. Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. He or she may look for H. pylori using a blood, stool or breath test. The breath test is the most accurate. Blood tests are generally inaccurate and should not be routinely used.
For the breath test, you drink or eat something containing radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you're infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide.
If you are taking an antacid prior to the testing for H. pylori, make sure to let your doctor know. Depending on which test is used, you may need to discontinue the medication for a period of time because antacids can lead to false-negative results.
- Endoscopy. Your doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.
If your doctor detects an ulcer, small tissue samples (biopsy) may be removed for examination in a lab. A biopsy can also identify whether H. pylori is in your stomach lining.
Your doctor is more likely to recommend endoscopy if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing. If the endoscopy shows an ulcer in your stomach, a follow-up endoscopy should be performed after treatment to show that it has healed, even if your symptoms improve.
- Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.