Peptic ulcer

Peptic ulcers are sores in the lining of the stomach and the duodenum (the first part of the small intestine). They affect more than 4 million people in the United States each year; 1 in 10 individuals develop a peptic ulcer at some time. Peptic ulcer can occur at any age.

Duodenal ulcers usually appear between ages 30 and 50 and are more common in men than women. Stomach ulcers tend to occur later in life, after age 60, and affect women more often than men.

The cause of most stomach and duodenal ulcers is infection with a type of bacteria called Helicobacter pylori. Other irritants include non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, alcohol, coffee with or without caffeine, and smoking.

A rare cause of peptic ulcer is a condition called Zollinger-Ellison syndrome, in which stomach acid is produced in higher-than-normal amounts.

Peptic ulcers often run in families and occur more often in people with type O blood. Despite the popular belief that ulcers are a side effect of living a high-pressure life, experts no longer believe that stress causes ulcers — although it may make a person more sensitive to the pain of an ulcer.

Symptoms of peptic ulcer

Some people with peptic ulcer have no symptoms. The most common symptom is a burning pain in the upper abdomen. It usually occurs two to three hours after eating, or very late at night. The pain can last minutes or hours.

When the ulcer occurs on the back wall of the duodenum, pain is sometimes also felt in the back.

Less common symptoms include:

  • belching
  • a bloated feeling
  • nausea,
  • vomiting
  • loss of appetite

With a duodenal ulcer, nausea, vomiting, or pain that is worsened by eating usually indicate swelling or obstruction of the narrow channel that connects the stomach to the duodenum.

Ulcers can cause gastrointestinal bleeding. This can lead to vomiting bloody material (the partially digested blood looks like coffee grounds), or passage of black bowel movements. Anemia from bleeding can cause weakness and faintness or fainting.

Ulcers can get progressively deeper and penetrate through the wall of the stomach or duodenum, producing sudden and severe pain and shock. This is a medical emergency.

Diagnosing peptic ulcers

In addition to asking you about your symptoms and medical history, your doctor will likely perform several tests to confirm a diagnosis and to help determine treatment.

Most diagnostic testing includes a check for Helicobacter pylori bacteria. It can be detected by analyzing blood, stool, or breath.

Endocsopy is another commonly done test for peptic ulcer. It involves passing a thin tube fitted with a camera and light down the throat and into the upper digestive system. This can establish the location and size of any erosion. A biopsy of the stomach or duodenum can also be made during endoscopy.

A blood test for anemia may be done, and a stool sample may be checked for the presence of blood. Both of these tests can indicate a bleeding ulcer.

Treating peptic ulcer

For ulcers caused by Helicobacter pylori, treatment requires a combination of medications. The goals of treatment are to:

  • kill the bacteria in the body
  • reduce the amount of acid in the stomach
  • protect the lining of the stomach and intestines

Standard therapy today is called "triple therapy." It requires taking two antibiotics and one acid-suppressing medication for one to two weeks.

Ulcers caused by taking a non-steroidal anti-inflammatory drug are treated by stopping that medication and taking medications to limit the amount of acid in the stomach as the ulcer heals. These may include antacids to neutralize gastric acids or medications to decrease the amount of acid produced by the stomach, such as an H2 blocker or a proton pump inhibitor.

Emergency treatment may be needed if an ulcer causes serious bleeding. A blood transfusion may be necessary if the bleeding is severe.

In rare circumstances, surgery may be needed to treat a perforated or bleeding peptic ulcer. Surgery for peptic ulcer disease may involve closing a bleeding artery.