Peptic Ulcers

Peptic ulcers are caused by an imbalance between acid and pepsin enzyme in the stomach and duodenum. The imbalance of digestive fluids causes the protective mucus lining of the stomach and duodenum to become inflamed and weak, which leads to the formation of ulcers.

You are more likely to get peptic ulcers if you use nonsteroidal anti-inflammatory medications (NSAIDS) such as aspirin, ibuprofen, and naproxen for long periods of time.

Another common cause of peptic ulcers is Helicobacter pylori (H. pylori), a type of bacterial infection in the stomach. In the US, approximately 30 to 40 percent of people have an H. pylori infection, although most never develop a peptic ulcer.

In addition, tumors produced by a rare disorder known as Zollinger-Ellison syndrome can increase acid output and cause ulcers.

Many people with ulcers do not experience any symptoms. If symptoms do occur, they can include:

• A burning pain in your stomach or upper abdomen
• Nausea or vomiting
• Bloating
• Heartburn

Stomach or abdominal pain may occur more frequently between meals or at night. The pain may even wake you at night. Your pain may get better or worse after eating a meal.

In severe cases, ulcers can bleed, which is a serious complication. Bleeding from an ulcer can be slow and go unnoticed or can cause life-threatening hemorrhage that requires immediate medical attention. Slowly bleeding ulcers might not produce any symptoms until anemia occurs. Symptoms of a rapidly bleeding ulcer include vomiting blood or blood in your stools. Your stools may appear very dark or black if they contain blood.

To diagnose peptic ulcer disease, your doctor will first review your medical history and conduct a physical exam. Be sure to tell your doctor about your symptoms and risk factors.

Your doctor may order blood tests, stool tests, and a urea breath test to check for the presence of H. pylori bacteria. Other tests your doctor may order to confirm the diagnosis include:

• Upper gastrointestinal (GI) endoscopy
• Upper GI series with barium swallow
• CT scan

Treatment will depend on the cause of your peptic ulcer. Sometimes, ulcers can be resolved with lifestyle changes, such as eliminating the use of NSAIDs. Your doctor may prescribe medication to treat your ulcer. If your ulcer is caused by an H. pylori infection, you will need antibiotics. Other ulcers can be treated with:

• An over-the-counter H2 blocker such as Zantac®, Tagamet®, or Pepcid AC®
• A prescription proton pump inhibitor (PPI) such as Prilosec®, Prevacid® or Nexium®
• A tissue lining protector called Carafate®

H2 blockers and PPIs reduce stomach acid and protect the lining of your stomach and duodenum. The protectant coats ulcers and protects them against acid and enzymes to allow healing. Most ulcers heal with medication in about 8 weeks.