Peptic ulcer disease, the most common non-cancerous stomach condition, is characterized by the presence of a sore in the stomach's lining. About 14.5 million Americans suffer from peptic ulcer disease, or gastric ulcer, which it is also known as. The condition occurs when surface stomach cells become irritated and inflamed, most often from infection with H. pylori bacteria (Helicobacter pylori bacteria) and/or chronic use of nonsteroidal anti-inflammatory (NSAID) drugs such as aspirin and ibuprofen, or corticosteroids.
When an ulcer occurs in the upper small intestine, also known as the duodenum, it is called a duodenal ulcer. When an ulcer is found in the lower part of the esophagus, it is an esophageal ulcer, which is associated with gastroesophageal reflux disease (GERD), a disorder covered in the section on Esophageal Diseases.
Up until the 1980s, physicians and patients believed that peptic ulcers were caused by stress and eating spicy foods, until Australian researchers discovered that infection with H. pylori bacteria is actually the most significant risk factor for peptic ulcer disease.
H. pylori is a common bacterium transmitted by food, water and by mouth. It infects 75% of the world's population, but only 2-20% of people infected with the bacteria will develop ulcers. The reason why is not yet understood, but is thought to depend on the individual's genetic makeup, the strain of H. pylori involved, and other unknown factors.
H. pylori is well-adapted to live in the stomach in spite of exposure to acids. These bacteria secrete an enzyme, urease, that reduces the stomach's acidity, thereby making it a more hospitable environment in which to survive. H. pylori weakens the protective mucous layer which coats the stomach and the duodenum, enabling acid to reach the lower levels of the stomach lining. This causes chronic irritation and inflammation, and invites more bacteria to colonize injured tissue, causing a vicious cycle of irritation and inflammation.
Peptic ulcer symptoms include abdominal discomfort, which may feel like a dull ache or sharp pain in the area from the navel to the breastbone. This pain may last a few minutes or hours, and may occur 2-3 hours after eating, or worsen when the stomach is empty. It may be sporadic, coming and going for days or weeks. Discomfort may worsen at night or when reclining. You may feel nauseated or bloated; have a poor appetite, and weight loss. The pain often may be relieved when eating, and by anti-acid medications. More serious and rarer symptoms of a peptic ulcer are bloody or tarry stools and vomiting blood.
Although infection with H. pylori is the major cause of peptic ulcers, other causes and factors may contribute to their development, including:
If our gastrointestinal specialists suspect a peptic ulcer, they will generally perform an endoscopy, in which a narrow tube equipped with a light and tiny camera is inserted into the esophagus (via the mouth) and into the stomach and duodenum after a local anesthetic is given. The endoscopy will help your physician visualize the esophagus, stomach and duodenum, and, during the exam, he or she will probably take a small biopsy of the stomach to determine whether H. pylori is present.
Other tests to check for the presence of H. pylori include a blood test to determine the presence of bacterial antibodies, and a breath test. The breath test takes about a half hour, during which your breath is tested before and then after drinking a liquid containing radioactive carbon. If H. pylori is present, your breath sample will contain evidence of it. A stool antigen test may also be done.
Treatment of peptic ulcers depends on their cause. As infection with H. pylori is usually discovered in patients with peptic ulcer disease, treating the infection with a combination of antibiotics is first-line therapy for treating a peptic ulcer. Generally, two antibiotics are prescribed for two weeks.
Our specialists will also prescribe one of two classes of drugs to block stomach acid production: either proton-pump inhibitors or histamine (H-2) blockers. He or she will most likely also prescribe a stomach buffer or protector, such as Pepto-Bismol (bismuth subsalicylate), Carafate (sucralfate), or (Cytotec) misoprostol, which help protect the injured stomach lining while it is healing.
If your ulcer is not H. pylori-related but rather associated with use of NSAIDs, corticosteroid use, or acid reflux, antibiotics are not prescribed, but only an acid blocker and stomach protector, in addition to lowering the dose or stopping use of the offending drug. Antacids may also be included in treatment in addition to an acid blocker. If GERD is the cause of an esophageal ulcer, your physician will treat that (see entry for GERD).
If left untreated, peptic ulcers may cause serious complications, including internal bleeding and serious infection of the abdominal cavity, called peritonitis. They may also cause scar tissue to form in the stomach or duodenum that may block food from passing through the digestive track, causing feelings of fullness after eating, vomiting, and weight loss.
Our gastrointestinal specialists closely follow patients with peptic ulcers to ensure that healing occurs. This means that physicians follow up treatment with additional tests throughout the healing period, which may include breath and stool tests, and endoscopy.
Very rarely a peptic ulcer may not heal in spite of treatment. Called a refractory ulcer, this may occur if the bacteria is resistant to medication given, or use of NSAIDs, tobacco or alcohol impede the healing process. Your physician will work with you to determine what might be the cause. Infrequently, other factors cause refractory ulcers, including other digestive diseases such as Crohn's disease, stomach cancer, an infection with a pathogen other than H. pylori, or Zollinger-Ellison syndrome (a rare condition characterized by overproduction of stomach acid).