What’s Giving You an Ulcer?

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Peptic ulcers are nonhealing defects or sores in the lining of the stomach (gastric ulcers) and duodenum (duodenal ulcers). Gastric ulcers are more common with advanced age, because older people are more likely to be infected with H. pylori or to use nonsteroidal anti-inflammatory drugs (NSAIDs).

Peptic ulcers occur when the lining of the stomach or duodenum becomes damaged, usually by acid. More than half of peptic ulcers result from H. pylori gastritis. NSAIDs and some other drugs also can damage the lining of the stomach, increasing the risk of gastric ulcers. Smoking increases the risk of ulcers. Psychological stress may also play a role in peptic ulcer development, but contrary to popular belief it’s not the primary cause.

Symptoms of a peptic ulcer

The symptoms of a peptic ulcer depend on whether the ulcer is in your stomach or duodenum. A gastric ulcer typically results in pain in the upper abdomen, often 15 to 30 minutes after eating. Because of the pain, you may be afraid to eat and you may lose weight. With a gastric ulcer, pain rarely occurs at night or when you are fasting. A duodenal ulcer, on the other hand, usually results in pain in the upper abdomen two to three hours after meals, when the stomach is empty. The pain can awaken you at night and is relieved by eating.

If not treated, peptic ulcers can lead to complications such as bleeding, perforation into the abdominal cavity, or penetration into adjacent organs. Less frequently, an ulcer can deform the stomach or duodenum and block the passage of food, resulting in nausea and vomiting that do not improve with treatment.

Peptic ulcers can be diagnosed using an upper endoscopy or an upper GI series of X-rays or CT scan. During endoscopy, a peptic ulcer appears as a round or elongated defect in the lining of the stomach or duodenum. On an upper GI series, barium accumulates inside the ulcer or shows changes in the normal appearance of the folds of the lining. A CT scan can show a defect in the lining of the stomach or duodenum, which indicates an ulcer.

Treating your ulcer

Peptic ulcers caused by NSAIDs are treated by stopping the medication and suppressing gastric acid production by taking an H-2 blocker or proton pump inhibitors (PPI). Those caused by H. pylori are best treated by eradicating the bacterium from the stomach or duodenum. Traditionally, doctors have usually prescribed triple therapy, consisting of a PPI and two antibiotics. However, because of drug resistance, quadruple therapy is the preferred treatment. This consists of bismuth subsalicylate (Pepto-Bismol and other brands), two antibiotics, and a PPI. These drugs need to be taken together for 10 to 14 days. Antibiotic therapy cures 80 to 90 percent of ulcers caused by H. pylori. If the H. pylori infection is not eradicated, the likelihood is high that peptic ulcers will recur.

Continued use of NSAIDs, cigarette smoking, or alcohol consumption lowers the chances that gastric ulcers will heal. Bleeding ulcers are commonly treated with endoscopic therapy that stops the bleeding, followed by medication. Ulcers were once commonly treated with surgery, but now they can be effectively treated with endoscopic intervention and medication, so surgery is rarely needed. Surgery is still used, however, for people with ulcer complications-for example, to stop bleeding that is too severe to be controlled endoscopically, to close perforations, or to open up the gastric outlet. With current treatments, ulcers rarely progress to this stage.

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