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What Are Ulcers?


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There is no clear evidence to suggest that the stress of modern life or a steady diet of fast food causes ulcers in the stomach and small intestine, but they are nonetheless common in our society: About one out of every 10 Americans will suffer from the burning, gnawing abdominal pain of a peptic (or gastric) ulcer sometime in life.

Peptic ulcers are holes or breaks in the protective lining of the duodenum (the upper part of the small intestine) or the stomach -- areas that come into contact with stomach acids and enzymes. Duodenal ulcers are more common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus or swallowing tube and are often a result of alcohol abuse.

While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers.

Other factors also seem to contribute to ulcer formation. Overzealous use of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen), heavy alcohol use, and smoking exacerbate and may promote the development of ulcers. Research indicates that heavy smokers are more prone to developing duodenal ulcers than are nonsmokers, that people who drink alcohol are more susceptible to esophageal ulcers, and that those who take aspirin frequently for a long period of time are more likely to develop stomach ulcers than those who don't.

Duodenal ulcers tend to appear in people with type O blood, possibly because they do not produce the substance on the surface of blood cells (hence type O) that may protect the lining of the duodenum.

Fortunately, peptic ulcers are relatively easy to treat; in many cases they are cured with antibiotics, antacids, and other medications that reduce the amount of acid produced by the stomach. There are also a variety of self-help and alternative treatments that can aid in relieving pain and in healing ulcers. Still, the dangers associated with peptic ulcers -- such as anemia, profuse bleeding, and stomach cancer -- are serious, so ulcers should always be monitored by your doctor.

Causes

The following are the most important causes of peptic ulcers.

The most common cause is infection of the stomach with bacteria called Helicobacter pylori or H. pylori. This infection is quite common; about half of the world's population is infected. These bacteria cause the stomach to make too much acid, which damages the lining of the stomach or duodenum and can cause the ulcer.

Some medicines, called non-steroidal anti-inflammatory drugs (NSAIDs), can cause peptic ulcers. Examples of these medicines include aspirin, ibuprofen, naproxen and diclofenac. However most people can take these safely. If you are in doubt which painkillers to take, ask your pharmacist.

Smoking and drinking excessive alcohol increase your chances of developing a peptic ulcer.

Symptoms

Some people with a peptic ulcer have no symptoms. However, many people have upper abdominal pain usually just below the breastbone (sternum). You may sometimes feel a pain in your back. The pain usually comes on an hour or two after eating and can be relieved by more food or antacid medicine. It may also wake you at night.

Belching

Heartburn

General discomfort in the abdomen

Bloating or fullness after eating

Feeling sick

Vomiting

Conditions

Difficulty swallowing

Lost weight without trying to

A reduced appetite

Seen blood in your vomit or bowel movements

Treatment

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), reduce acid levels, and protect the GI tract. This strategy allows your ulcer to heal and reduces the chance it will come back.

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Take all of your medications exactly as prescribed.

Medications may include one or more of the following:

Acid blockers (such as cimetidine, ranitidine, or famotidine)

Antibiotics to kill H. pylori

Bismuth to help protect the lining and kill the bacteria

Medications that protect the tissue lining (such as sucralfate)

Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)

If you have an ulcer without an H. pylori infection, your doctor will likely prescribe a proton pump inhibitor for 8 weeks. You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.

Complications

Bleeding inside the body (internal bleeding)

Gastric outlet obstruction

Inflammation of the tissue that lines the wall of the abdomen (peritonitis)

Perforation of the stomach and intestines

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