Diseases

Peptic Ulcer Disease (Ulcers)


Acid

Acid is produced by cells of the stomach. Acid aids in digestion, helps the intestine with digestion and absorption of minerals and helps to kill food borne bacteria from entering the digestive system. Your stomach lining is a remarkably resilient membrane. A layer of mucus protects the stomach from its own acids. Similar mechanisms protect the duodenum (the first part of the small intestine). Some of the gastric juices involved in the digestive process are as toxic as car battery acid, so a healthy stomach and intestinal lining play a key role in your overall health.

Peptic ulcer disease

Peptic ulcer disease occurs when the stomach acid penetrates the stomach or intestinal lining and causes ulcers, an often painful sore in the lining. An estimated 4 million Americans have peptic ulcer disease, and one in 10 patients will experience the disease during his or her lifetime.

When a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach lining by living in or on it, it can cause an ulcer in the stomach or duodenum. The ulcer can cause abdominal pain and, in some cases, bleeding.

Untreated, the ulcer can literally create a hole in the stomach or intestinal lining (perforation). Chronic inflammation from an ulcer can cause stomach tissue swelling and scarring. Over time, this scarring may close the outlet of the stomach, preventing food from passing into the small intestine and causing vomiting and weight loss. In severe cases, ulcer complications can lead to death.

Most ulcers are associated with an infection with a bacteria called H. pylori. Ulcers are not caused by eating spicy foods or stress. It is not known how the H. pylori bacteria is transmitted, but it may spread from person to person through fecal-oral or oral-oral routes. It may also be transmitted by contaminated water sources.

Another common cause of peptic ulcer disease is the regular use of pain medications called non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen, naproxen, ketoprofen, meloxicam and celecoxib. People typically take NSAIDs to reduce pain and inflammation. Frequent or long-term use of NSAIDs, especially among older persons, can increase a person’s risk of developing an ulcer. Rarely, ulcers can form as a result of over secretion of acid.

The most common symptom of an ulcer is a burning pain in your stomach between your breastbone and your belly button.

  • You will often feel this pain when your stomach is empty, between meals generally, but it can occur at any time.
  • The pain will last anywhere from a few minutes to several hours and may sometimes wake you in the middle of the night.
  • Stomach pain is often reduced by food, fluids or taking antacids.

While not as common as stomach pain, other symptoms include:

  • Nausea
  • Vomiting
  • Vomiting blood
  • Blood in the stool
  • Loss of appetite

Tests for Peptic Ulcers

If you have symptoms of peptic ulcer disease, one of several tests can be done to determine if you are infected with H. pylori. An upper endoscopy (EGD) with biopsy of the stomach lining is the most accurate test to determine if you have an H. pylori infection.

An upper endoscopy (EGD) of the stomach lining is the most accurate test to determine if you have an ulcer. This procedure involves passing a small flexible tube through your mouth and into the stomach. The tube has a camera inside that can detect ulcers and allows biopsies to be taken to check for the presence of the infection. The procedure is performed under propofol sedation, so it is painless.

Treatment for Ulcers

Treatment for H. pylori infection usually consists of taking two antibiotics (such as amoxicillin, tetracycline, metronidazole or clarithromycin), a medication that contains bismuth, and another medicine that reduces the acid in the stomach. Generally, the antibiotic therapy is given for ten to fourteen days.

During the treatment, alcoholic beverages and cigarettes should be avoided, as they inhibit ulcer healing. Once the medicine has eliminated the ulcer, there is a 90% chance that the disease is completely cured.  Confirmation of the eradication of the bacteria will be done via a simple breath test, called a Urease Breath Test, which is done six weeks after completing treatment.

When is Surgery Necessary?

With proper treatment, surgery is usually not necessary. However, if an ulcer fails to heal, if there are bleeding complications, or if a perforation (hole) or obstruction in the stomach develops, surgery is usually indicated. Fortunately, surgical therapy is rarely needed because of the efficacy of medical treatment.