Peptic ulcers: Symptoms, causes, and treatments (original) (raw)

A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. It may occur in the lining of the stomach or duodenum.

A peptic ulcer can affect several areas of the digestive tract. Therefore, it goes by different names, including a gastric ulcer in the stomach or a duodenal ulcer in the duodenum, the first part of the small intestine.

Potential causes of peptic ulcers include Helicobacter pylori (H. pylori) bacteria infection and the long-term use of nonsteroidal anti-inflammatory drugs.

Peptic ulcers may not cause any noticeable symptoms. Some people may have mild discomfort, while others may experience a dull, burning pain in their stomach.

Other symptoms can include:

• nausea
• vomiting
• feeling bloated or full

In some cases, ulcers can cause severe signs and symptoms and bleeding. Signs the ulcer is bleeding include:

• vomiting blood
• black and tarry stools, or stools with dark red blood
• nausea and vomiting that is especially persistent and severe

These symptoms indicate a medical emergency. The affected person should contact a doctor immediately or call 911.

According to a 2022 study, around 8.09% of people globally had at least one peptic ulcer in 2019. This was around a 25% increase from 1990.

The same study reported that cases in the United States had decreased since the first half of the 20th century. They started to increase globally between 1990 and 2019.

H. pylori

Although many people naturally carry H. pylori bacteria, it is unclear why these bacteria only cause ulcers in some people.

H. pylori bacteria spread through food and water. They live in the mucus that coats the lining of the stomach and duodenum, and they produce urease, an enzyme that neutralizes stomach acid by making it less acidic.

To compensate for this, the stomach produces more acid, which irritates the stomach lining. The bacteria also weaken the stomach’s defense system and cause inflammation.

Patients with peptic ulcers due to H. pylori need antibiotic treatment to remove the bacterium from the stomach and prevent them from returning.

NSAIDs

NSAIDs are a type of medication people may use for headaches, period pains, and other pains. They can also help reduce fever and inflammation. Examples include aspirin and ibuprofen. Many NSAIDs are available without a prescription.

These medications lower the stomach’s ability to make a protective layer of mucus, making it more susceptible to damage by stomach acid. NSAIDs can also affect blood flow to the stomach, reducing the body’s ability to repair cells.

Other causes of peptic ulcers

Other types of infections and medications can also cause peptic ulcers. Other potential causes may include:

• medical procedures affecting the stomach or duodenum
• conditions affecting the stomach or duodenum, including Crohn’s disease or cancer
• Zollinger-Ellison syndrome
• cirrhosis
• chronic obstructive pulmonary disease
• injuries or blockages affecting the stomach or duodenum

In some cases, doctors may be unable to find any apparent cause.

Doctors will ask about a person’s symptoms and perform a physical exam. Other tests that can confirm a diagnosis include:

• a blood test to check for H. pylori, though a positive test does not always mean there is an active infection
• a breath test, which uses a radioactive carbon atom to detect H. pylori
• a stool antigen test to detect H. pylori in the feces
• an upper gastrointestinal X-ray to identify ulcers

The most common tool doctors use for diagnosis is EsophagoGastroDuodenoscopy or upper endoscopy. It involves inserting a tube through the mouth to look for an ulcer in the stomach and upper intestine.

If the test detects an ulcer, the doctor may take a biopsy for examination under a microscope. A biopsy can test for H. pylori and look for evidence of cancer.

A person may need to repeat an endoscopy a few months later to determine whether the ulcer is healing.

Treatment will focus on helping the ulcer heal and targeting the underlying cause. Doctors may recommend the following treatment options:

• Antisecretory agents: These include H2 receptor antagonists and proton pump inhibitors to help block stomach acid production.
• Quadruple therapy: This involves using two antibiotics, a proton pump inhibitor, and bismuth subsalicylate to eradicate H. pylori.
• Avoidance of NSAIDs: Doctors may recommend stopping or limiting the use of NSAIDs if the person uses them frequently.
• Surgery: In cases of bleeding, a doctor may recommend surgical intervention, which typically requires 8 to 12 weeks for recovery

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Doctors currently do not recommend certain diets to prevent or treat peptic ulcers.

However, some people may find that certain foods worsen their symptoms and may wish to adjust their diet accordingly.

What to eat

• oats
• flax seeds
• legumes
• nuts
• barley
• certain fruits and vegetables

People may also benefit from including foods rich in flavonoids and vitamin A.

What to avoid

If certain foods worsen a person’s symptoms, they may benefit from limiting or avoiding that food. Potential dietary triggers of symptoms include:

• alcohol
• caffeine
• citrus fruits
• spicy foods

However, it is worth noting that there is little evidence to suggest these factors can cause peptic ulcers.

People may not be able to prevent all ulcers from forming.

However, they can limit their use of NSAIDs to help prevent new ulcers from forming. People with chronic pain conditions can talk with their doctor about alternatives to NSAIDs that may be safer for their stomachs.

Another step to help prevent ulcers is to finish a full antibiotic regimen. People should see their doctor for a follow-up to ensure the bacteria is under control.

Peptic ulcers can sometimes lead to complications that require additional treatment. The three most common complications include:

• internal bleeding
• bowel obstruction
• perforation, which is when the ulcer bores a hole through the wall of the stomach or small intestine

Peptic ulcers can recur. Having the first ulcer increases the risk of developing another one later.

One study suggests peptic ulcers affect about 8% of the world population. Though they decreased in the later 20th century, they have since started to increase in frequency again globally.

Peptic ulcers are holes or lesions that form due to too much acid. Gastroesophageal reflux disease (GERD) occurs when a person’s stomach acid repeatedly backs up into the esophagus. Gastritis is a group of conditions that cause inflammation in the stomach.

While all of these conditions affect the stomach, they are not the same and require different treatments.

If the cause of the peptic ulcer is NSAID use, stopping the medication may help the ulcer clear. However, a bacterial infection requires treatment with antibiotics.

Peptic ulcers are a type of sore that occur in the digestive tract. They are most often due to H. pylori infection or chronic use of NSAIDs.

These ulcers can be painful and debilitating, but treatment can help the ulcer heal and alleviate the person’s symptoms. Treating the underlying cause and limiting NSAID use can help ensure the problem does not recur.

People can speak with a healthcare professional if they have symptoms of peptic ulcers, including persistent stomach pain, nausea, or vomiting.