Peptic Ulcers

Peptic ulcers are common: One in 10 Americans develops an ulcer at some time in his or her life. The leading cause of peptic ulcers is a bacterium known as Helicobacter pylori (H.pylori); a secondary cause is traceable to the long-term use of nonsteroidal anti-inflammatory agents, such as aspirin and ibuprofen. Contrary to popular belief, it is now known that peptic ulcers are not caused by spicy food or stress.

Frequently Asked Questions

Q. What is a peptic ulcer?
A.  A peptic ulcer is a sore in the lining of the stomach or duodenum, which is the beginning of the small intestine. If the ulcers are in the stomach they are called gastric ulcers. If the ulcers are found in the duodenum then they are called duodenal ulcers. If the ulcer is located in the lower section of esophagus they are called esophageal ulcers. It is possible to have more than one ulcer.

Q. What are the symptoms of a peptic ulcer?
A.  The most common symptoms of peptic ulcers are known collectively as dyspepsia. Peptic ulcers can occur without dyspepsia or any gastrointestinal symptoms, especially when caused by NSAIDs. Dyspepsia may be persistent or recurrent and can encompass a variety of problems in the upper abdomen, including the following:

  • Duodenal Ulcer Pain: often cause a gnawing pain in the upper stomach area several hours after a meal, and the pain is often relieved by eating a meal.
  • Gastric Ulcer Pain: may cause a dull, aching pain, often right after a meal; eating does not relieve the pain and may even worsen it.(pain may also occur at night)
  • Bloating
  • Feeling of fullness
  • Mild nausea
  • Sensation of acid backing up into the throat

Q. What are the causes of peptic ulcers?
A.  Although stress and spicy foods were once thought to be the main causes of peptic ulcers, doctors now know that the cause of most ulcers is the corkscrew-shaped bacterium Helicobacter pylori (H.pylori). H.pylori is the most common, but not the only, cause of peptic ulcers. Besides H.pylori other causes of peptic ulcers, or factors that may aggravate them, include:

  • Regular use of pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. The medications are available both by prescription and over-the-counter. Some over-the-counter NSAIDs include aspirin, ibuprofen, and naproxen. NSAIDs inhibit production of an enzyme which secrets a hormone like substance which protects the stomach lining. Without this protection, stomach acid can erode the lining, causing bleeding and ulcers.
  • Smoking: Nicotine in tobacco increases the volume and concentration of stomach acid, increasing your risk of an ulcer. Smoking may also slow healing during ulcer treatment.
  • Excessive alcohol consumption: Alcohol can irritate and erode the mucous lining of your stomach and increase the amount of stomach acid that’s produced. It’s uncertain, however, whether this alone can progress into an ulcer or whether other contributing factors must be present, such as H.pylori bacteria or ulcer-causing medications, such as NSAIDs.
  • Caffeine: Beverages and foods that contain caffeine can stimulate acid secretion in the stomach. This can aggravate an existing ulcer, but the stimulation of stomach acid cannot be solely attributed to caffeine.
  • Stress: Although stress per se isn’t a cause of peptic ulcers, it’s a contributing factor. Stress may aggravate symptoms of peptic ulcers and, in some cases, delay healing.

Q. How are peptic ulcers detected and diagnosed?
A.  In order to detect an ulcer, your doctor may request the following tests:

  • Gastrointestinal (upper GI) X-Ray: This test outlines your esophagus, stomach and duodenum. During this procedure, you are asked to swallow a white liquid that coats your digestive tract and makes the ulcer more visible. An upper GI X-ray can detect some ulcers, but not all.
  • Endoscopy: This is a more sensitive procedure. A long, narrow tube with an attached camera is threaded down your throat and esophagus into your stomach and duodenum. Using this procedure, your doctor can view your upper digestive tract and identify an ulcer.

If you doctor detects an ulcer, he or she may perform additional tests.

  • Biopsy: This test involves remove of small tissue samples near the ulcer. Then this tissue sample is examined under a microscope to rule out cancer. This tissue sample can be also used to detect the presence of H. pylori.
  • Blood Test: This test is used to identify the presence of the H. pylori antibodies.
  • Breath Test: This procedure is used to detect the presence of H. pylori through the use of radioactive carbon atoms. The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori, detecting when the bacteria have been killed or eradicated. With the blood test, H. pylori antibodies may sometimes still be present a year or more after the infection is gone.
  • Stool antigen test: This test is used to identify the presence of H. pylori in stool samples. It is useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment.

Q. How are peptic ulcers treated?
A.  Since a majority of ulcers stem from H. pylori, doctors tend to use a two-pronged approach to peptic ulcer treatment:

  • Kill the bacteria
  • Relieve the pain by reducing the level of acid in your digestive system.

Accomplishing these goals requires the use of a combination of the following medications:

  • Antibiotic Medications: Antibiotics commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil), clarithromycin (Biaxin), and metronidazole (Flagyl). Some companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent specifically for treatment of H. pylori infections. These combination treatments are sold under the names Prevpac and Helidac. Other medications prescribed in conjunction with antibiotics generally are taken for a longer period.
  • Antacids: An antacid may be taken in addition to an acid blocker or in place of one. Instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief.
  • Acid Blockers: Acid blockers are also called histamine (H-2) blockers. The acid blockers help reduce the amount of hydrochloric acid released into your digestive tract, which relieves ulcer pain and encourages healing.
  • Proton Pump Inhibitors: Another way to reduce stomach acid is to shut down the “pumps” within acid-secreting cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. These drugs are frequently prescribed to promote the healing of peptic ulcers. Proton pump inhibitors also appear to inhibit H.pylori.
  • Cytoprotective agents: This medicine is prescribed to help protect the tissues that line your stomach and small intestine. In addition to protecting the lining of your stomach and intestines, it also appears to inhibit H.pylori activity.

* If H.pylori isn’t identified in your system, then it’s likely that your ulcer is due to NASID or acid reflux, which can cause esophageal ulcers. In both cases your physician will try to reduce the acid levels.

Ulcers that fail to heal: Peptic ulcers that do not heal with treatment are called refractory ulcers. There are many reasons why an ulcer may not heal:

  • Not taking the medication as prescribed by your physician
  • Having an antibiotic resistant strain of H.pylori
  • Regular use of tobacco, alcohol or NSAIDs
  • Zollinger-Ellison syndrome or extreme over production of stomach acid
  • Infection other than H.pylori
  • Stomach cancer
  • Other digestive diseases



Additional Resources

This report is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option.