A peptic ulcer is a sore that forms when acidic digestive juices wear away the lining of the digestive system. A peptic ulcer is a sore in the lining of the stomach, duodenum, or esophagus. Symptoms can include indigestion-like pain, nausea, and weight loss..
When a peptic ulcer affects the stomach it is called a gastric ulcer, one in the duodenum is called a duodenal ulcer, and an esophageal ulcer is an ulcer in the esophagus.
The most common causes are Helicobacter pylori (H. pylori) bacteria and the use of non-steroidal anti-inflammatory drugs.
Symptoms of peptic ulcers
Peptic ulcers do not always have symptoms.
The first symptom of peptic ulcer is usually stomach pain, caused by the ulcer and intensified by stomach acid coming in contact with it. However, it is not uncommon for people to have a peptic ulcer and no symptoms at all.
One of the most common symptoms of peptic ulcers is indigestion-like pain.
The pain may occur anywhere from the belly button to the breast bone. It can be brief, or it may last for several hours. It is more severe when the stomach is empty, and during sleeping hours. Eating certain foods may relieve it.
Other symptoms include:
- Difficulty getting food down (swallowing it)
- Food that is eaten regurgitates (comes back up)
- Feeling unwell after eating
- Weight loss
- Loss of appetite
Over-the-counter medications can often provide relief for these symptoms.
More rarely, ulcers can cause severe signs and symptoms, such as:
- Vomiting blood
- Black and tarry stools, or stools with dark blood
- Nausea and vomiting
These symptoms indicate a medical emergency. The patient should see a doctor.
Causes of peptic ulcers
Peptic ulcers normally occur because of: http://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/dxc-20231407
- H. pylori bacteria
- Non-steroidal anti-inflammatory drugs (NSAIDs).
H. pylori bacteria are responsible for about 80 percent of all gastric ulcers and 95 percent of duodenal ulcers. NSAIDs are known to cause about 20 percent of gastric ulcers and 5 percent of duodenal ulcers.H. pylori
Around two-thirds of all people carry H pylori. It is not clear why the bacteria only cause ulcers in some people.
H. pylori spread through food and water. They live in the mucus that coats the lining of the stomach and duodenum, and they produce urease, an enzyme that neutralizes stomach acid by making it less acidic. To compensate for this, the stomach produces more acid, and this irritates the stomach lining.
The bacteria also weaken the defense system of the stomach and causes inflammation. Patients with peptic ulcers caused by H. pylori need treatment to get rid of the bacterium from the stomach, and to prevent them coming back.
Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs (NSAIDS) are medications for headaches, period pains, and other minor pains.
Examples include aspirin and ibuprofen. Many NSAIDs are available over the counter, without a prescription.
These drugs lower the stomach's ability to make a protective layer of mucus. This makes it more susceptible to damage by stomach acid. NSAIDs can also affect the flow of blood to the stomach, reducing the body's ability to repair cells.
Other causes include:
- Genetics: A significant number of individuals with peptic ulcers have close relatives with the same problem, suggesting that genetic factors may be involved.
- Smoking: People who regularly smoke tobacco are more likely to develop peptic ulcers compared with non-smokers.
- Alcohol consumption: Regular heavy drinkers of alcohol have a higher risk of developing peptic ulcers.
- Mental stress: Mental stress has not been linked to the development of new peptic ulcers, but symptoms appear to be more severe in people with ulcers with ongoing mental stress.
Peptic ulcer diagnosis
There are a number of methods available to help diagnose peptic ulcers.
A patient's description of symptoms will normally cause a doctor to suspect a peptic ulcer.
Tests that can confirm a diagnosis include:
- Blood test to check for H. pylori
- Breath test, using a radioactive carbon atom to detect H. pylori
- Stool antigen test to detect H. pylori in the feces
- Upper gastrointestinal (GI) X-ray can help to identify some ulcers.
- Endoscopy, in which a long, narrow tube with a camera attached to the end is threaded down the patient's throat and into the stomach and duodenum.
If an ulcer is detected, the doctor may take a biopsy, a small sample of tissue for examination under a microscope. A biopsy can test for H pylori and rule out cancer.
The endoscopy may be repeated a few months later to determine whether the ulcer is healing.
Treatment of peptic ulcers
The type of Treatment usually depends on what caused the peptic ulcer, whether H. pylori or NSAIDs. Treatment will focus on either lowering stomach acid levels so that the ulcer can heal, or eradicating the H pylori infection.
Proton pump inhibitors (PPIs)
PPIs reduce the amount of acid the stomach produces. They are prescribed for patients who test negative for H. pylori infection. Treatment usually lasts 1-2 months, but if the ulcer is severe, treatment may last longer.
H pylori infection treatment
Patients infected with H. pylori will usually need PPIs and antibiotics. This treatment is effective in most patients, and the ulcer will start to disappear within days.
When treatment is over, the individual will have to be tested again to make sure the H. pylori have gone, especially if they still have symptoms of indigestion. If the infection remains, they will undergo another course of antibiotics, this time with different antibiotics.
A person who has a gastric ulcer caused by H. pylori infection has a slightly higher risk of developing stomach cancer, so it is important to confirm that treatment has worked.
Non-steroidal anti-inflammatory drugs
If the peptic ulcer comes from NSAIDs, the patient will have to stop taking them. Alternatives include acetaminophen, such as Tylenol and paracetamol.
If the person cannot stop taking NSAIDs, the doctor may minimize the dosage and review the patient's need for them later on.
Another medication may be prescribed long term, alongside the NSAID, possibly a PPI or an H2-receptor antagonist. H2-receptor agonists, such as cimetidine, reduce the amount of acid in the stomach.
Alginates help relieve indigestion caused by acid reflux by forming a foam barrier on the surface of the stomach contents, keeping the stomach acid within the stomach.
Even after the ulcer has healed and treatment has been completed, the patient may still have indigestion. In such cases, the doctor may advise some eating and lifestyle changes. If symptoms persist, low-dose PPI or H2-receptor antagonists might be prescribed.
Possible complications of peptic ulcers
The risk of complications increases if the ulcer is left untreated, or if treatment is not completed.
Internal bleeding can lead to slow blood loss and anemia. Severe blood loss will require hospitalization and transfusions.
A peptic ulcer can bore a hole through the wall of the stomach or small intestine, significantly increasing the risk of infection in the abdominal cavity, known as peritonitis.
Scar tissue caused by peptic ulcers can obstruct the passage of food through the digestive tract, making the patient feel full more easily.
Pyloric stenosis is a chronic inflammation in the lining of the stomach or duodenum. It can cause the passage between the stomach and the duodenum to narrow. Food will not pass through to the intestines, resulting in vomiting and weight loss.
Peptic ulcers can recur. Having a first ulcer increases the risk of developing another one later.