ULCERS: OVERVIEW

An ulcer is an open sore on the surface of an organ or tissue. The most common type of ulcer is the peptic ulcer located in the stomach or the duodenum. If the ulcer is in the stomach, it is called a gastric ulcer. Duodenal ulcers are in the first part of the small intestine called the duodenum. If the stomach makes too much acid and pepsin, duodenal ulcers may form.

A major cause of most duodenal and gastric ulcers is an Helicobacter pylori (H. pylori) bacterial infection. Up to 80 to 90 percent of duodenal ulcer patients may have H. pylori gastritis. Successful treatment of H. pylori heals the ulcer. Once the H. pylori has been treated there is less than a 10 percent chance the ulcer will return.

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of ulcers. In fact, when studying the effect of the H. pylori bacteria on ulcer disease it was found that in patients with peptic ulcer disease either the bacteria was present or the patient was taking NSAIDS. Individuals at higher risk for NSAID ulcers are the elderly, men, and people who have chronic pain, alcohol abuse, or who have had a peptic ulcer in the past.

Examples of NSAIDs are aspirin, ibuprofen, and naproxen. These may have a damaging effect on the lining of the stomach. Regular users of NSAIDs also may suffer serious complications from peptic ulcers, such as bleeding, rupture, or death. Many times ulcer patients with complications do not have any symptoms.

Ulcers can be present without symptoms. The first sign may be bleeding. The most common symptom of ulcers is pain in the area of the upper abdomen. Though usually not severe, the pain may come and go throughout the day or night. It may be gnawing, aching, or hunger-like. There may be a feeling of fullness, heartburn, bloating, or nausea. Gastric ulcers usually cause pain 1 to 3 hours after eating. Eating may relieve the pain of duodenal ulcers, or make gastric ulcers hurt more. Anyone with ulcers needs to see a healthcare provider, especially if there is bleeding.

The most common test used to diagnose ulcers is an endoscopy. With endoscopy, a flexible tube is passed through the mouth that allows the provider to see the lining of the esophagus and stomach. This is done to rule out cancer or see if there is an infection. A biopsy can be done during the endoscopy by removing a small piece of tissue through the endoscope. X-rays used to be the common test to check for ulcers and are still used for some cases. Duodenal ulcers are not a risk for cancer so taking a biopsy is not necessary. Breath or blood tests may be done to test for H. pylori.

Antibiotics are given for an ulcer caused by a H. pylori infection. Treatment may also include drugs that reduce stomach acid and a medication to coat the surface of the ulcer to aid healing. Ulcers treated with antibiotics are usually cured and do not come back. If an ulcer has another cause, it may be necessary to take a smaller dose of the medicine for a long time.

If people who develop ulcers are taking NSAIDs for pain control, other medications may be tried. If a person cannot be taken off the NSAIDs, there are medications they can take to help prevent an ulcer.

Lifestyle changes may also help ulcers heal and may keep them from coming back. Eating high fiber, balanced meals at regular intervals would be one change. Another would be to avoid aspirin and other NSAIDs that irritate the stomach. Even though food and spices have been ruled out as the cause of ulcers, it is important to avoid specific foods that upset the stomach. This may include coffee, both caffeinated and decaffeinated. Alcohol and smoking should be stopped if possible. A healthcare provider can give information on how to eat well and have a healthy lifestyle.

Go to the emergency department if the following symptoms develop:

vomiting blood or coffee ground type material
passing black tarry stools or
severe abdominal pain occurs

Call the emergency medical system 911 if all these symptoms develop:

upper abdominal pain with shortness of breath
sweating
weakness and
chest, arm, or back pain

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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