Prepyloric ulcers are a type of peptic or gastric ulcer. These open sores develop in the upper digestive tract, just above the pylorus, which is the opening to the small intestine.

The tissues of the digestive system have natural defenses against acidic digestive fluids. However, certain factors can undermine these natural defenses, damaging the mucosal lining and causing ulcers. Damaging factors include bacterial infection, taking certain medications, and smoking.

Prepyloric ulcers can cause considerable discomfort and pain. However, treatments are available to reduce stomach acid and treat any underlying infection, thereby allowing the ulcer to heal.

This article describes what prepyloric ulcers are and their causes, symptoms, and treatment.

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Prepyloric ulcers are a type of gastric ulcer. According to a 2022 review, doctors classify gastric ulcers into four types based on the ulcer’s location in the body.

Prepyloric ulcers develop in the upper digestive tract, in an area above the pylorus. The pylorus is a muscular valve located at the end of the stomach. It regulates the flow of partially digested food from the stomach into the small intestine.

A prepyloric ulcer occurs when there is damage to the protective mucosal lining of the stomach and small intestine.

According to the American College of Gastroenterology (ACG), one common cause of prepyloric ulcers is a bacterial infection with Helicobacter pylori (H. pylori). This is because H. Pylori can damage the mucosal lining.

The ACG adds that another common cause of prepyloric ulcers is medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). These medications inhibit the production of hormone-like substances called prostaglandins. These substances are essential for maintaining the integrity of the mucosal lining.

Damage to the mucosal lining can cause stomach acid to come into contact with the gastric epithelium. This is a large collection of cells that secrete acid, mucus, and other substances into the small intestine. When stomach acid makes contact with the gastric epithelium, it can cause damage that results in an ulcer.

Without treatment, an ulcer can deepen until it reaches the outer lining of the stomach, called the serosal layer. In severe cases, this lead to a perforation that allows gastric contents to leak into the abdominal cavity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, common symptoms of a prepyloric ulcer include:

If the ulcer is bleeding or has caused a perforation, people may experience the following:

When diagnosing a prepyloric ulcer, a doctor will ask about a person’s medical history and conduct a physical examination. The doctor will also order one or more of the following diagnostic tests:

  • upper gastrointestinal endoscopy to examine the lining of the digestive tract
  • blood and breath tests to check for H. pylori infection
  • stool tests to look for blood or an infection

The treatment for prepyloric ulcers may involve a combination of the following:

  • Medications: Drugs called proton pump inhibitors and H2 blockers can reduce stomach acid production, helping to heal an ulcer. If there is an H. Pylori infection, doctors may prescribe antibiotics to treat it.
  • Lifestyle changes: Smoking cessation is critical, as smoking can delay the healing of an ulcer and increase the risk of complications.
  • Surgery: Doctors may recommend surgery for ulcers that are severe, unresponsive to medication, or causing a perforation. Surgery will involve removing the damaged tissue or repairing a perforation.

The role of diet in the development and treatment of prepyloric ulcers is a topic of ongoing debate. Some healthcare professionals believe certain foods can exacerbate symptoms or increase the risk of developing an ulcer. Others believe dietary changes have little effect on the condition.

According to the Canadian Society of Intestinal Research, a high fiber diet decreases the risk of developing ulcers, as these foods help slow digestion and reduce bile acid concentration. This means that people with prepyloric ulcers may benefit from foods that are high in soluble fiber, such as:

While dietary changes alone may not be enough to treat a prepyloric ulcer, they may help as part of a broader treatment plan. People should work closely with a doctor to determine the most appropriate treatment approach, including any necessary dietary modifications.

A person who experiences symptoms of a prepyloric ulcer should contact a doctor as soon as possible. Anyone who develops symptoms of a bleeding or perforated ulcer should seek emergency medical attention.

A perforated prepyloric ulcer that has released gastric contents into the abdominal cavity is a life threatening emergency. A person may require immediate surgery and intensive medical care involving antibiotics and other medications.

Prepyloric ulcers are peptic ulcers that occur in the area of the pylorus. They can cause various symptoms, including abdominal pain, nausea, and vomiting. A prepyloric ulcer that has perforated and released gastric contents into the abdominal cavity is a medical emergency.

The causes of prepyloric ulcers vary but can include H. pylori infection and the use of NSAIDs or low dose aspirin. Certain lifestyle factors, such as smoking and alcohol consumption, can also increase the risk of peptic ulcers.

Diagnosis typically involves a physical exam along with diagnostic tests such as upper gastrointestinal endoscopy and blood, breath, and stool tests.

The treatment for a prepyloric ulcer may involve medications to reduce stomach acid production and antibiotics to treat an H. Pylori infection. In rare cases, a person may require surgery.