Peptic ulcers affect the digestive system.
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.
What are the symptoms of peptic ulcers?
It is not uncommon for people to have a peptic ulcer and no symptoms at all. However, one of the most common symptoms of peptic ulcers is indigestion-like pain.
The pain may occur anywhere from the belly button to the breastbone. It can be brief or may last for hours. It is more severe when the stomach is empty or right after eating (depending on where it is located); sometimes it is worse during sleep. Eating certain foods may relieve it, and some foods may make it worse.
Other symptoms include:
- difficulty swallowing food
- 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. Rarely, ulcers can cause severe signs and symptoms, such as:
- vomiting blood - requires immediate attention
- black and tarry stools, or stools with dark red blood
- nausea and vomiting - especially persistent and severe
These symptoms indicate a medical emergency. The patient should see a doctor immediately.
Causes of peptic ulcers
Peptic ulcers normally occur because of:
- H. pylori bacteria
- non-steroidal anti-inflammatory drugs (NSAIDs)
H. pylori bacteria are responsible for the majority of gastric and duodenal ulcers. NSAIDs are a less likely cause.
How does H. pylori cause ulcers?
Although many people naturally 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.
How do non-steroidal anti-inflammatory drugs cause ulcers?
They 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 of peptic ulcers
- 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.
- Corticosteroid use - people on large or chronic doses of corticosteroids are also at greater risk.
- 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 who are experiencing ongoing mental stress.
Treating peptic ulcers
The type of treatment usually depends on what caused the peptic ulcer. 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. If necessary, they will undergo another course of different antibiotics.
Non-steroidal anti-inflammatory drugs
If the ulcer comes from NSAIDs, the patient will have to stop taking them. Alternatives include acetaminophen. If the person cannot stop taking NSAIDs, the doctor may minimize the dosage and review the patient's need for them later. Another medication may be prescribed long term, alongside the NSAID.
Even after the ulcer has healed and treatment has been completed, the patient may still have indigestion. In such cases, the doctor might advise some diet and lifestyle changes. If symptoms persist, low-dose PPI or H2-receptor antagonists might be prescribed. In severe cases with bleeding, an endoscopy may be needed to stop the bleeding at the ulcer site.
Peptic ulcer diagnosis
Blood tests are a method of diagnosis for 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, though a positive test does not always mean there is an active infection.
- 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 - a long, narrow tube with a camera attached to the end is threaded down the patient's throat and into the stomach and duodenum. This is the best diagnostic test.
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 look for evidence of cancer. The endoscopy may be repeated a few months later to determine whether the ulcer is healing.
Complications of peptic ulcers
The risk of complications increases if the ulcer is left untreated, or if treatment is not completed. Complications can include:
- Internal bleeding
- Hemodynamic instability - a result of internal bleeding; this can affect multiple organs and be a serious complication.
- Peritonitis - the ulcer bores a hole through the wall of the stomach or small intestine.
- Scar tissue.
- Pyloric stenosis - a chronic inflammation in the lining of the stomach or duodenum.
Peptic ulcers can recur. Having a first ulcer increases the risk of developing another one later.