Peptic Ulcer Disease

A peptic ulcer is a sore that forms when stomach acids eat away the inside lining of your esophagus, stomach or top part of your small intestine. It may have stomach pain and the ulcers can also bleed.

Your digestive tract has a layer of mucous that protects it from the acidic fluids that pass through it. If you have too much acid or your mucous layer is worn away, you can develop an ulcer.

You Are at Risk for Peptic Ulcer Disease if You:

  • Use too much pain-reliever medication – Over-the-counter and prescription drugs can irritate the lining of the stomach and small intestine.
  • Use other prescription medications – Other medications can contribute to peptic ulcers, including bisphosphonates (to treat osteoporosis) and potassium supplements.
  • Drink alcohol – This irritates the lining of your stomach and increases your production of stomach acid.
  • Smoke or chew tobacco – This increases your risk if you have the H. pylori bacteria.
  • Have had radiation treatment.
  • Have the bacteria H. pylori – There is a bacteria called Helicobacter pylori (H. pylori) that is spread from person to person and through food and water. This common bacteria lives in the mucous layer of the stomach and small intestine. Usually, H. pylori causes no problems for people who are infected with it, and they never know they have it. Sometimes, it inflames the inner lining of the stomach and causes an ulcer.
  • Have a condition called Zollinger-Ellision syndrome – This causes ulcers in the stomach and duodenum.

Peptic ulcers are not caused by stress or eating spicy foods.

Symptoms

The most common symptom of a peptic ulcer is burning pain. This happens when the pain from an ulcer is irritated by stomach acid.

The pain may:

  • Feel worse at night
  • Feel worse when you haven't eaten
  • Come and go over days and weeks
  • Occur from your belly button to your breastbone
  • Feel better when you take antacids

More severe symptoms include:

  • Weight loss without trying
  • Changes in your appetite
  • Nausea
  • Vomiting or vomiting blood
  • Dark blood in stool or black, tarry stool

If you have a peptic ulcer and you don't have it treated, you can get:

  • Infection
  • Internal bleeding
  • Scar tissue

See your doctor if you have signs of a peptic ulcer and don't get relief from over-the-counter medications.

Diagnosis

Tests to check for a peptic ulcer include:

  • Blood, stool or breath tests to check for the H. pylori bacteria
  • X-ray – You drink a chalky liquid that coats the lining of your digestive tract and then have X-rays of your upper GI system. The chalky substance makes your insides show up better on X-rays.
  • Endoscopy  – Your doctor inserts an endoscope (flexible tube equipped with a light and tiny camera) down your throat to see inside your esophagus, stomach and small intestine to check for ulcers. If needed, your doctor can get tissue samples (biopsy) during endoscopy. These samples are examined in a lab to check for problems.

Treatment

The treatment for a peptic ulcer depends on what caused it.

Treatments include:

  • Medication to get rid of the H. pylori bacteria – If your doctor finds that you have the H. pylori bacteria, you may receive antibiotics to kill the bacteria.
  • Medications to protect your digestive tract – Drugs called cytoprotective agents help to protect the lining of your stomach and small intestine. These can be over-the-counter or prescription medications.
  • Antacids – These neutralize acid. They may make your symptoms better for the short term, but they can't fix damage that has occurred. Using antacids too much can cause problems like diarrhea and constipation.
  • H-2 receptor blockers – These reduce the amount of acid your body makes. They do not act as quickly as antacids but help relieve your symptoms longer.
  • Proton pump inhibitors – These block the acid your body makes, which can let your digestive treat heal.

If your symptoms continue, your doctor may suggest endoscopy to see if your ulcer has gotten better or if you have another problem. If bleeding is found during this procedure, it can often be stopped with instruments inserted through the endoscope.

Some peptic ulcers don't heal with treatment (refractory ulcers). Reasons ulcers might not heal include:

  • Resistance to antibiotics – Some H. pylori bacteria resist treatment.
  • Smoking – Wounds such as ulcers heal more slowly if you smoke.
  • Pain medication – If you continue to use pain medications that can cause peptic ulcers, you may not heal.
  • Another infection – You might have an infection besides H. pylori.
  • Diseases – You could have another disease that makes ulcers worse, including Crohn's disease or stomach cancer. Or you could have a condition called Zollinger-Ellison syndrome in which your body makes too much stomach acid.

If your peptic ulcer hasn't healed, your doctor will explore other treatment options or tests to find out the cause.

How to Prevent Peptic Ulcer Disease

You can take these steps to prevent a peptic ulcer:

  • Avoid infection – H. pylori may be spread through food and water or from person to person. Wash your hands with soap and water, and make sure your food is completely cooked.
  • Be careful with pain medication, especially aspirin, ibuprofen and naproxen – These medications increase your risk for peptic ulcer. If you must use them, take them with food. Take the lowest dose possible. Avoid alcohol if you use pain medication.
  • Do not use tobacco.
  • Limit alcohol intake.

Find an Aurora Health Care GI Specialist