Definition

Peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. This area of the small intestine is called the duodenum. Peptic ulcers may be named by their location:

• Gastric ulcers —in the stomach
• Duodenal ulcers —in the duodenum

Gastric Ulcer

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Causes

Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:

• Bacterium Helicobacter pylori (H pylori) —common cause
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs)—blocks the body's ability to protect the stomach lining; common cause
• Diseases that cause acid production to increase, such as Zollinger-Ellison syndrome

Rare causes include:

• Radiation therapy
• Bacterial or viral infections
• Alcohol abuse
• Injury
• Severe stress (eg, surgery, trauma , head injury, shock , or burns )

Risk Factors

Risk factors for ulcer from H pylori infection include:

• Age: 60 or older
• Sex: male
• Race: Black and Hispanic
• Lower socio-economic group
• A crowded and unsanitary living environment
• Cigarette smoking
• Family history of ulcer disease
• Type O blood

Risk factors for ulcer from anti-inflammatory drugs include:

• Age: 60 or older
• Sex: male
• History of stomach upset from NSAIDs
• Prior peptic ulcer disease
• Cigarette smoking
• Alcohol abuse

Symptoms

Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food may increase gastric ulcer pain. Food will often relieve duodenal ulcer pain.

Symptoms include:

• Gnawing pain
  • May awaken you from sleep
  • May change when you eat
  • May last for a few minutes or several hours
  • Feels like unusually strong hunger pangs
• Nausea
• Vomiting
• Loss of appetite
• Bloating
• Burping

Ulcers can cause serious problems and severe abdominal pain. Problems include:

• Bleeding—symptoms may include:
  • Black, tarry stools
  • Vomiting what looks like coffee grounds
  • Weakness
  • Dizziness
  • Anemia
• Perforated ulcer—a breaking through the wall of the stomach or duodenum that will cause:
  • Sudden and severe pain
• Scar tissue that narrows and eventually closes off the outlet of the stomach to the intestines and can cause:
  • Vomiting
  • Weight loss
  • Intense pain

Duodenal Ulcer

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Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tell your doctor about all medication you are taking.

Tests may include:

• Rectal exam and stool guaiac test —to test for hidden blood
• Blood test or breath test—to check for H pylori infection
  • A blood test can also check for Zollinger-Ellison syndrome
• Upper GI series —a series of x-rays of the upper digestive system taken after drinking a barium solution
• Endoscopy—a thin, lighted tube inserted down the throat to look inside the digestive tract used to:
  • Obtain tissue samples to test for H pylori infection or for cancer
  • Eliminate other serious causes of gastrointestinal symptoms

Treatment

The goal is to remove the source of the problem and heal the ulcer. Gastric ulcers may take longer to heal.

Treatments include:

Prevention

To decrease the risk of ulcer from H pylori infection:

• Wash your hands after using the bathroom and before eating or preparing food.
• Drink water from a safe source.
• Don't smoke . Cigarette smoking increases the chances of getting an ulcer.

To decrease the risk of ulcer from NSAIDs:

• Use other drugs when possible for managing pain.
• Take the lowest possible dose.
• Do not take drugs longer than needed.
• Do not drink alcohol while taking the drugs.
• Ask your doctor about switching to a newer NSAID. Look for one that is less likely to cause ulcers. Talk to your doctor about taking other drugs to protect your stomach and intestine lining.
• Don't smoke. Cigarette smoking increases the chances of getting an ulcer.