What is an ulcer?
Peptic ulcers are sores or defects that develop in the lining of the lower esophagus, stomach or beginning of the small intestine (duodenum). We call upper GI tract uppers “peptic” because the digestive stomach enzyme called pepsin facilitates their development.
The primary symptom of peptic ulcers is burning pain in the abdomen. Gastric ulcer pain is usually worse with meals, while duodenal ulcer pain is usually worst when the stomach is empty, either between meals or at night.
If you have an ulcer, you can experience the pain for days, weeks, or even months at a time. The pain may be constant or intermittent, mild or severe, localized or radiating, for example to your back. Ulcers are common and may cause important complications, so it is important to take steps to identify, heal, and prevent them.
Peptic Ulcers: Is Stress a Culprit?
Contrary to popular belief, most ulcers do not actually result from stress or eating too many spicy foods.
In 2005, Drs. Barry Marshal and Robin Warren, from Australia, received the Nobel Prize in Medicine for discovering that a spiral-shaped bacterium that can colonize the human stomach is the offending cause in many cases.
Smoking tobacco, and drinking alcohol, may worsen ulcers, and as little as one baby aspirin daily can cause an ulcer.
What causes ulcers?
The most common cause of peptic ulcers is Helicobacter pylori bacteria. This strain of bacteria is common in the protective lining of many people’s stomach and small intestine. Though the bacteria does not cause problems in most people, in some cases it can lead to ulcers.
Common pain relief medications can also alter the body’s normal ulcer defense mechanisms, leading to peptic ulcers in the stomach or duodenum. People who take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are at increased risk of developing peptic ulcers.
Ulcers occasionally result from tumors of the stomach wall, such as lymphomas or cancer of the glands of the stomach.
Are ulcers dangerous?
Most commonly, ulcers cause abdominal pain. However, in a minority of cases ulcers may lead to internal hemorrhage, which may result in vomiting blood or black stools, plus symptoms of acute blood loss, such as dizziness or fainting. Rarely, ulcers can block the outlet of the stomach, causing nausea vomiting and bloating. Ulcer bleeding can be life-threatening, particularly in people with other medical conditions such as heart disease, or in the elderly.
How do we diagnose ulcers?
We may suspect ulcers by your symptoms, but we typically diagnose ulcers at upper endoscopy, when we examine your stomach with a thin flexible tube with a light and camera on the end. During endoscopy, we also obtain samples of the ulcer and the adjacent tissues, to test for cancer cells and for infection with H pylori.
How are peptic ulcers treated?
The treatment for ulcers depends in part on the specific cause. If your doctor finds H. pylori in your digestive tract through a lab test, we will prescribe antibiotics that will kill the bacteria. Ulcer treatment usually also requires medication to control stomach acid, usually for 8 weeks or so. These medications include protein pump inhibitors that block the production of stomach acid.
If your ulcer is from using NSAIDs, your doctor may recommend switching medications or lowering the dose. If you require on-going pain relief from NSAIDs, we usually recommend a daily dose of a proton pump inhibitor.