Peptic Ulcers

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Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.

Peptic ulcers include:

  • Gastric ulcers that occur on the inside of the stomach.
  • Esophageal ulcers that occur inside the hollow tube (esophagus) that carries food from your throat to your stomach.
  • Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum).

It’s a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial infection or some medications — not stress or diet — cause most peptic ulcers.

SYMPTOMS

PAIN IS THE MOST COMMON SYMPTOM

Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

  • Be felt anywhere from your navel up to your breastbone
  • Be worse when your stomach is empty
  • Flare at night
  • Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
  • Disappear and then return for a few days or weeks

OTHER SIGNS AND SYMPTOMS

Less often, ulcers may cause severe signs or symptoms such as:

  • The vomiting of blood — which may appear red or black
  • Dark blood in stools or stools that are black or tarry
  • Nausea or vomiting
  • Unexplained weight loss
  • Appetite changes

RISK FACTORS

You may have an increased risk of peptic ulcers if you:

  • 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.

COMPLICATIONS

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.
  • Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  • Scar tissue. Peptic ulcers can also produce scar tissue that can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

TESTS AND DIAGNOSIS

In order to detect an ulcer, you may have to undergo diagnostic tests, such as:

USING 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 the presence of H. pylori 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.

X-RAY OF YOUR UPPER DIGESTIVE SYSTEM

Sometimes called a barium swallow or upper gastrointestinal series, this series of X-rays 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.

TREATMENTS AND DRUGS

Treatment for peptic ulcers depends on the cause. Treatments can include:

  • Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid.
  • Medications that block acid production and promote healing. Proton pump inhibitors reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole, lansoprazole , rabeprazole, esomeprazole and pantoprazole . Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.
  • Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over-the-counter, acid blockers include the medications ranitidine, famotidine cimetidine.
  • Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.
  • Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Options include the prescription medications sucralfate and misoprostol.

FOLLOW-UP AFTER INITIAL TREATMENT

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

ULCERS THAT FAIL TO HEAL

Peptic ulcers that don’t heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. These reasons may include:

  • Not taking medications according to directions.
  • The fact that some types of H. pylori are resistant to antibiotics.
  • Regular use of tobacco.
  • Regular use of pain relievers that increase the risk of ulcers.

Less often, refractory ulcers may be a result of:

  • Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
  • An infection other than H. pylori
  • Stomach cancer
  • Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn’s disease Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.
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