Peptic ulcer facts* *Peptic ulcer disease facts medically edited by: Jay W. Marks, MD Peptic ulcers are sores in the lining of the stomach or duodenum. Peptic ulcer formation is related to H. pylori bacteria in the stomach andnonsteroidal anti-inflammatory medications (NSAIDs) in 50% of patients. For the remaining 50% there are miscellaneous or unknown causes. Ulcer pain may not correlate with the presence or severity of ulceration. The main symptom of peptic ulcer is upper abdominal pain which can be dull, sharp, or burning. (Bloating and burping are not symptoms of peptic ulcer, and vomiting , poor appetite, and nausea are uncommon symptoms of peptic ulcer.) Diagnosis of ulcer is made with upper GI series orendoscopy . Treatment of ulcers involves antibiotic combinations along with stomach acid suppression to eradicate H. pylori, eliminating precipitating factors such as NSAIDs and stomach acid suppression with medications alone . Complications of ulcers include bleeding, perforation, and blockage of the stomach (gastric obstruction). If a person with peptic ulcers smokes or take NSAIDs, the ulcers may recur after treatment. What is a peptic ulcer? A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the duodenum is called a duodenal ulcer. A peptic ulcer also may develop just above your stomach in the esophagus, the tube that connects the mouth to the stomach. But most peptic ulcers develop in the stomach or duodenum. Many people have peptic ulcers. You can have both gastric and duodenal ulcers at the same time and you also can have more than one ulcer in your lifetime. Peptic ulcers can be treated successfully. Seeing your doctor is the first step. What causes of peptic ulcers? Most peptic ulcers are caused by
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Transcript
Peptic ulcer facts*
*Peptic ulcer disease facts medically edited by: Jay W. Marks, MD
Peptic ulcers are sores in the lining of the stomach or duodenum.
Peptic ulcer formation is related to H. pylori bacteria in the stomach andnonsteroidal anti-
inflammatory medications(NSAIDs) in 50% of patients. For the remaining 50% there are
miscellaneous or unknown causes.
Ulcer pain may not correlate with the presence or severity of ulceration.
The main symptom of peptic ulcer is upper abdominal pain which can be dull, sharp, or burning.
(Bloatingand burping are not symptoms of peptic ulcer, and vomiting, poor appetite,
and nausea are uncommon symptoms of peptic ulcer.)
Diagnosis of ulcer is made with upper GI series orendoscopy.
Treatment of ulcers involves antibiotic combinations along with stomach acid suppression to
eradicate H. pylori, eliminating precipitating factors such as NSAIDs and stomach acid
suppression with medications alone .
Complications of ulcers include bleeding, perforation, and blockage of the stomach (gastric
obstruction).
If a person with peptic ulcers smokes or take NSAIDs, the ulcers may recur after treatment.
What is a peptic ulcer?
A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of
your small intestine. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the
duodenum is called a duodenal ulcer. A peptic ulcer also may develop just above your stomach in
the esophagus, the tube that connects the mouth to the stomach. But most peptic ulcers develop in
the stomach or duodenum.
Many people have peptic ulcers. You can have both gastric and duodenal ulcers at the same time
and you also can have more than one ulcer in your lifetime.
Peptic ulcers can be treated successfully. Seeing your doctor is the first step.
What causes of peptic ulcers?
Most peptic ulcers are caused by
Helicobacter pyloricus (H. pylori) a germ that causes infection
nonsteroidal anti-inflammatory drugs NSAIDs), such as aspirin andibuprofen
H. pylori is the most common cause of peptic ulcers. Doctors think H. pylorimay be spread through
unclean food or water or by mouth-to-mouth contact, such as kissing. Even though many people
have an H. pylori infection, most of them never develop an ulcer.
Use of NSAIDs is the second most common cause of peptic ulcers. But not everyone who takes
NSAIDs gets a peptic ulcer. Ulcers caused by NSAIDs are more often found in people who
are age 60 or older
are female
have taken NSAIDs for a long time
have had an ulcer before
Other causes of peptic ulcers are rare. One rare cause is Zollinger-Ellison syndrome - a disease that
makes the body produce too much stomach acid, which harms the lining of the stomach or
duodenum.
Stress or spicy food does not cause peptic ulcers, but either can make ulcer symptoms worse.
What are symptoms of peptic ulcers?
A dull or burning pain in your stomach is the most common symptom of peptic ulcers. You may feel
the pain anywhere between your belly button and breastbone. The pain often
starts between meals or during the night
briefly stops if you eat or take antacids
lasts for minutes to hours
comes and goes for several days or weeks.
Other symptoms of peptic ulcers may include
weight loss
poor appetite
bloating
burping
vomiting
feeling sick to your stomach
Even if your symptoms are mild, you may have peptic ulcers. You should see your doctor to talk
about your symptoms. Peptic ulcers can get worse if they aren't treated.
Call your doctor right away if you have
sudden or sharp pain that doesn't go away
black or bloody stools
bloody vomit or vomit that looks like coffee grounds
These symptoms could be signs that an ulcer has
broken a blood vessel
gone through, or perforated, your stomach or duodenal wall
stopped food from moving from you stomach into the duodenum
These symptoms must be treated quickly. You may need surgery.
How are peptic ulcers diagnosed?
Tell your doctor about your symptoms and which medicines you take. Be sure to mention those you
get without a prescription, such as Bayer, Motrin, Advil, or Aleve. These medicines are all NSAIDs.
To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. About half
of all people who develop an ulcer from NSAIDs also have an H. pylori infection.
Your doctor also may want to look inside your stomach and duodenum by doing an endoscopy or an
upper gastrointestinal (GI) series - a type of X-ray. Both procedures are painless.
For an endoscopy, you will be given medicine to relax you. Then the doctor will pass an endoscope -
a thin, lighted tube with a tiny camera - through your mouth to your stomach and duodenum. Your
doctor also may take a small piece of tissue - no bigger than a match head-to look at through a
microscope. This process is called a biopsy.
For an upper GI series, you will drink a liquid called barium. The barium will make your stomach and
duodenum show up clearly on the X-rays.
What is the treatment for peptic ulcers?
If you have peptic ulcers, they can be cured. Depending on what caused your ulcers, your doctor
may prescribe one or more of the following medicines:
a proton pump inhibitor (PPI) or histamine receptor blocker (H2 blocker) to reduce stomach acid
and protect the lining of your stomach and duodenum
one or more antibiotics to kill an H. pylori infection
a medicine that contains bismuth subsalicylate, such as Pepto-Bismol, to coat the ulcers and
protect them from stomach acid
These medicines will stop the pain and help heal the ulcers.
If an NSAID caused your peptic ulcers, your doctor may tell you to
stop taking the NSAID
reduce how much of the NSAID you take
take a PPI or H2 blocker with the NSAID
switch to another medicine that won't cause ulcers
You should take only the medicines your doctor tells you to take all medicines exactly as your
doctor tells you to, even if your pain stops
Tell your doctor if the medicines make you feel sick or dizzy or causediarrhea or headaches. Your
doctor can change your medicines.
And if you smoke, quit. You also should avoid alcohol. Smoking and drinking alcohol slow the
healing of ulcers and can make them worse.
Can antacids or milk help peptic ulcers heal?
Neither antacids - such as Tums - nor milk can heal peptic ulcers, although each may make you feel
better briefly. Check with your doctor before taking antacids or drinking milk while your ulcers are
healing.
Some of the antibiotics used for H. pylori infection may not work as well if you take antacids. And
while antacids may make ulcer pain go away for a while, they won't kill the H. pylori germ. Only
antibiotics can do that.
Many people used to think that drinking milk helped peptic ulcers heal. But doctors know now that
while milk may make ulcers feel better briefly, it also increases stomach acid. Too much stomach
acid makes ulcers worse.
What if peptic ulcers don't heal?
In many cases, medicines heal ulcers. If anH. pylori infection caused your ulcers, you must finish all
antibiotics and take any other medicines your doctor prescribes. The infection and ulcers will only
heal if you take all medicines as prescribed.
When you have finished your medicines, your doctor will do a breath or stool test to be sure the H.
pylori infection is gone. Sometimes, the H. pylori germ is still there, even after a person has taken all
the medicines correctly. If that happens, your doctor will prescribe different antibiotics to get rid of
the infection and cure your ulcers.
Rarely, surgery is needed to help ulcers heal. You may need surgery if your ulcers
don't heal
keep coming back
bleed
perforate the stomach or duodenal wall
block food from moving out of the stomach
Surgery can
remove the ulcers
reduce the amount of acid in your stomach
Can peptic ulcers come back?
Yes. If you smoke or take NSAIDs, your ulcers may come back. If you need to take an NSAID, your
doctor may switch you to a different medicine or add medicines to help prevent ulcers.
What can I do to prevent peptic ulcers?
To help prevent ulcers caused by H. pylori,
wash your hands with soap and water after using the bathroom and before eating
eat food that has been washed well and cooked properly
drink water from a clean, safe source
To help prevent ulcers caused by NSAIDs,
stop using NSAIDs, if possible
take NSAIDs with a meal, if you still need NSAIDs
use a lower dose of NSAIDs
ask your doctor about medicines to protect your stomach and duodenum while taking NSAIDs
ask your doctor about switching to a medicine that won't cause ulcers
In the digestive system, an ulcer is an area where tissue has been destroyed by gastric juices and stomach acid. Peptic ulcer disease is a general term for ulcers that occur in the stomach or duodenum (upper part of the small intestine).
A peptic ulcer is an erosion or sore in the wall of the gastrointestinal tract. The mucous membrane lining the digestive tract erodes and causes a gradual breakdown of tissue. This breakdown causes a gnawing or burning pain in the upper middle part of the belly (abdomen). Although most peptic ulcers are small, they can cause a considerable amount of discomfort.
Peptic ulcers are a very common condition in the United States and throughout the world.
In the United States, about 10% of the population will develop a duodenal ulcer at some point in their lives.
Peptic ulcer disease affects about 4.6 million people annually. The occurrence of peptic ulcer disease is similar in men and women. Approximately 11%-14% of men
and 8%-11% of women will develop peptic ulcer disease in their lifetime. The mortality rate for peptic ulcer disease is approximately one death per 10,000 cases. The mortality
rate due to ulcer hemorrhage is approximately 5%.
Ulcers can occur at any age, although they are rare in children and teenagers.
The good news is that we have learned a lot about ulcers in the past 20 years and effective therapies are now available.
Peptic Ulcers Causes
When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.
The food is partially digested in the stomach and then moves on to the duodenum to continue the process.
Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall.
In the past it was throught that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.
Now it is understood that people with ulcers had an imbalance between acid and pepsin coupled with the digestive tract's inability to protect itself from these harsh substances.
Research done in the 1980s showed that ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori.
Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.
Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slows healing of existing ulcers.
Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen andnaproxen), and newer anti-inflammatory medications (such as celecoxib[Celebrex])
Alcohol Stress: physical (severe injuries or burns, major surgery) or emotional Caffeine Cigarette smoking Radiation therapy:-used for diseases such as cancer
People who take aspirin or other anti-inflammatory medication are at increased risk even if they do not have H pylori infection.
Elderly people with conditions such as arthritis are especially vulnerable. People who have had prior ulcers or intestinal bleeding are at higher-than-normal risk. If a person takes these medications regularly, alternatives should be discussed with a health care
professional. This is especially true if the affected individual has an upset stomach or heartburn after taking these medications.
H pylori bacteria spread through the stools (feces) of an infected person.
The stool contaminates food or water (usually through poor personal hygiene). The bacteria in the stool make their way into the digestive tracts of people who consume this food or
water. This is called fecal-oral transmission and is a common way for infections to spread.
The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum.
Many people who are exposed to the bacteria never develop ulcers. People who are newly infected usually develop symptoms within a few weeks. Researchers are trying to discover what is different about the people who develop ulcers.
Infection with H pylori occurs in all ages, races, and socioeconomic classes.
It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
African Americans and Hispanic Americans are more likely to have the bacteria than whites and Asian Americans.
It is important to distinguish between ulcers caused by H pylori and those caused by medications only, because the treatment is completely different.
Ulcers can be linked with other medical conditions.
People who worry excessively are usually thought to have a condition calledgeneralized anxiety disorder. This disorder has been linked with peptic ulcers.
A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.
Peptic Ulcer Symptoms
Ulcers do not always cause symptoms. Sometimes, a serious complication such as bleeding is the first sign of an ulcer.
The most common symptom of peptic ulcers isabdominal pain.
The pain is usually in the upper middle part of the abdomen, above the belly button (navel) and below the breastbone.
The pain can feel like burning or gnawing, and it may go through to the back. Pain often comes several hours after a meal when the stomach is empty. The pain is often worse at night and early morning. It can last anywhere from a few minutes to several hours. The pain may be relieved by food, antacids, or vomiting.
Other symptoms of peptic ulcers include the following:
Nausea Vomiting Loss of appetite Loss of weight
Severe ulcers may cause bleeding in the stomach or duodenum. Bleeding is sometimes the only symptom of an ulcer. This bleeding can be fast or slow. Fast bleeding reveals itself in one of the following ways:
Vomiting of blood or dark material that looks something like coffee grounds: This is an emergency and warrants an immediate visit to an emergency department.
Blood in the stool or black, tarry, sticky-looking stools
Slow bleeding is often more difficult to detect, because it has no dramatic symptoms.
The usual result is low blood cell count (anemia). The symptoms of anemia are tiredness (fatigue), lack of energy (lethargy), weakness, rapid heartbeat
(tachycardia), and pales skin (pallor).
When to Seek Medical Care
If you have burning pain in your upper stomach that is relieved by eating or taking antacids, call a health care professional for an appointment. Don't assume you have an ulcer. Certain other conditions can cause similar symptoms.
If you vomit blood or have other signs ofgastrointestinal bleeding, go to an emergency department right away. Peptic ulcers can cause massive bleeding, which requires blood transfusion or surgery.
Severe abdominal pain suggests perforation or tearing of an ulcer. This is an emergency that may require surgery to fix a hole in your stomach.
Vomiting and abdominal pain also can be a sign of an obstruction, another complication of peptic ulcers. This also may require emergency surgery.
Peptic Ulcer PreventionPeptic ulcers can be prevented by avoiding things that break down the stomach's protective barrier and increase stomach acid secretion. These include alcohol, smoking, aspirin, nonsteroidal anti-inflammatory drugs, and caffeine.
Preventing infection with H pylori is a matter of avoiding contaminated food and water and adhering to strict standards of personal hygiene. Wash hands carefully with warm water and soap every time the bathroom is used, diaper changed, and before and after preparing food.If you need the pain relief and anti-inflammatory action of aspirin or an NSAID, you can reduce your risk of ulcers by trying the following:
Try a different NSAID, one that is easier on the stomach. Reduce the dose or the number of times you take the medication. Substitute another medication, such as acetaminophen (Tylenol). Talk to your health care professional about how you can protect yourself.
Following the treatment recommendations of your health care professional can help prevent recurrence of ulcers. This includes taking all medications as prescribed, especially if you have H pylori infection.http://www.emedicinehealth.com/peptic_ulcers/page9_em.htm#Prevention
What Is Peptic Ulcer Disease?Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.
What Causes Ulcers?
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:
Infection with a type of bacteria called Helicobacter pylori (H. pylori) Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve,
Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.
An ulcer may or may not have symptoms. When symptoms occur, they include:
A gnawing or burning pain in the middle or upper stomach between meals or at night Bloating Heartburn Nausea or vomiting
In severe cases, symptoms can include:
Dark or black stool (due to bleeding) Vomiting blood (can have a "coffee-grounds" appearance) Weight loss Severe pain in the mid to upper abdomen
How Serious Is an Ulcer?
Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:
Bleeding Perforation (a hole through the wall of the stomach) Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach
to the small intestine.
Taking NSAIDs can cause any of the above without warning. The risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.
Who Is More Likely to Get Ulcers?
You may be more likely to develop ulcers if you:
Are infected with the H. pylori bacterium Take NSAIDs such as aspirin, ibuprofen, naproxen, and many others Have a family history of ulcers Have another illness, such as liver, kidney, or lung disease Drink alcohol regularly Are 50 years old or older
How Are Ulcers Diagnosed?
Your doctor may be able to make an ulcer diagnosis just by talking with you about your symptoms. However, to confirm the diagnosis one of several tests should be taken. First, your doctor may ask you to take an acid-blocking medication such as those used to treat heartburn for a short period of time to see if your symptoms improve.
If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe symptoms of ulcers.
Often, doctors will frequently treat without confirming the diagnosis using endoscopy. If the cause is not likely to be from NSAIDs, then it is very likely to be from H. pylori. Most doctors will now test for H. pylori and will treat specifically for that in addition to giving medications to reduce the symptoms.
What Is Peptic Ulcer Disease?(continued)
How Are Ulcers Treated?
Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems.
There are several ways in which ulcers can be treated, including making changes to ones lifestyle, taking medication, and/or undergoing surgery.
Lifestyle Changes to Treat an Ulcer
To treat an ulcer, first eliminate substances that can be causing the ulcers. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they need to be stopped.
Ulcer Medications
Ulcer medications can include:
Proton pump medications (PPI). Proton pump medications reduce acid levels and allow the ulcer to heal. They include Prilosec, Prevacid, Aciphex, Protonix, Kapidex, Zegerid, and Nexium.
Antibiotics. If you have H. pylori infection, then antibiotics are used. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Some doctors also recommend taking Pepto-Bismol.
Upper Endoscopy . Some bleeding ulcers can be treated through the endoscope. Surgery. Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach or if
there is serious bleeding.
Will Drinking Milk Help Cure an Ulcer?
No. Milk can make your ulcer worse. Milk provides brief relief of ulcer pain because it coats the stomach lining. But milk can also stimulate your stomach to produce more acid and digestive juices, which can aggravate ulcers.
How Can I Prevent Ulcers?
To try and prevent ulcers from developing:
Don't smoke. Avoid alcohol. Don't overuse aspirin and/or NSAIDs. If you have symptoms of an ulcer, contact your doctor.