Peptic Ulcer

Peptic ulcers are sores that occur on the inner lining of the esophagus, stomach and upper a part of the intestines (duodenum).

The most common symptom of peptic ulcer is abdominal pain that tends to get better with food intake.

Bacterial infections and certain medications have been shown to cause peptic ulcers.

The most common symptom of peptic ulcer is burning pain that can occur anywhere from the breastbone to the navel. This pain tends to get worse before meals when the stomach is empty.

Eating tends to relieve pain. Pain can also be relieved by taking acid-reducing medication. In some patients, pain may disappear and then return for a few days or weeks.

Other signs and symptoms of ulcers include:

• Vomiting blood, which may appear red or black
• Dark blood in stool or stools that are black or tarry
• Nausea or vomiting
• Unexplained weight loss
• Changes in appetite

Common causes of the peptic ulcer include:

• Helicobacter pylori infection. This bacteria invades and lives in the mucous layer that covers and protects the lining of the stomach and small intestines.
• H. pylori can cause inflammation of the inner lining of the stomach which leads to the formation of an ulcer. H. pylori can be spread from person to person by close contacts, such as kissing and also through contaminated food and water.
• Regular use of certain over-the-counter painkillers, such as aspirin, ibuprofen( Advil, Motrin IB), naproxen (Aleve, Anaprox) and ketoprofen.
• Medications used to treat osteoporosis, such as bisphosphonates (Actonel, Fosamax) and potassium supplements.

A peptic ulcer can occur as a result of hypersecretion of gastric acid, insufficient production of mucous which normally coats the lining of the stomach or a combination of both.

In peptic ulcer, the gastric acid eats away at the inner surface of the esophagus, stomach or small intestines. This can lead to the formation of a painful open sore that may bleed.

The following tests are used for diagnosing peptic ulcers:

• Tests for H. pylori using blood, breath or stool samples. The type of test used depends on the state of the patient.
• In a breath test, a patient is asked to drink or ear something that contains radioactive carbon. H. pylori break down substances. Later, a patient is asked to breathe into a bag which is then sealed.
• If he or she is infected with H. pylori, the breath sample with containing the radioactive carbon in the form of carbon dioxide.
• Endoscopy of the upper digestive tract to look for ulcers. During endoscopy, a biopsy can be taken for lab examination.
• X-ray of the upper digestive tract using a barium swallow, a liquid containing barium that a patient swallows before X-rays are taken. This coats the digestive tract and makes an ulcer more visible.

Treatment depends on the cause of peptic ulcer. Treatments may include the following:

• Antibiotic if H. pylori are found in the digestive tract. Antibiotics are usually taken for two weeks. In addition to antibiotics, doctors may also prescribe medications that reduce stomach acid. Medications that block acid production and promote healing.
• Proton pump inhibitors, such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix) which reduce stomach acid by blocking the action of the parts of cells that produce acid.
• Medications to reduce acid production, histamine (H-2) blockers which reduce the amount of stomach acid released into the digestive tract, which relieves ulcer pain and encourages healing.
• Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).
• Antacids that neutralize stomach acid may also be included in the drug regimen of a patient. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.
• Medications that protect the lining of the stomach and small intestine. These medications known as cytoprotective agents help to protect the tissues that line the stomach and small intestine. Examples of cytoprotective agents include sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth sub-salicylate (Pepto-Bismol). Treatment for peptic ulcers is often successful, leading to ulcer healing. But if symptoms are severe or if they continue despite treatment, endoscopy may be recommended to rule out other possible causes for symptoms.

If an ulcer is detected during endoscopy, another endoscopy may be recommended after treatment to make sure the ulcer has healed. Ulcers that fail to heal despite treatment are known as refractory ulcers.

Reasons, why an ulcer may fail to heal, include:

• Not taking medications according to directions.
• The fact that some types of H. pylori are resistant to antibiotics.
• Regular use of tobacco.
• Regular use of pain relievers that increase the risk of ulcers.

Less often, refractory ulcers may be a result of:

• Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
• An infection other than H. pylori
• Stomach cancer
• Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics

The risk of having peptic ulcers can be reduced by preventing H. pylori infections.

This can be achieved by frequently washing the hands with soap and water and eating properly cooked foods.

Avoiding regular use or reducing the dose of pain relievers can also reduce the risk of peptic ulcer.

Alcohol should not be taken with these medications, as the two can combine to increase the risk of peptic ulcer.

Following lifestyle modifications can help to relieve pain in peptic ulcers:

• Eating a healthy diet full of fruits, vegetables, and whole grains and avoiding vitamin-rich foods that may make it difficult for the ulcers to heal.
• Avoiding painkillers, such as aspirin which may make pain worse. Patients with peptic ulcer can use acetaminophen (Tylenol).
• Avoiding or managing stress, as stress can worsen pain.
• Avoiding excessive consumption of alcohol.

There are several risks and complications associated with peptic ulcers.

People who smoke have an increased risk of having peptic ulcers. Excessive alcohol consumption can lead to peptic ulcers since alcohol can irritate and erode the mucous lining stomach.

Alcohol also increases the amount of gastric acid produced by the stomach. Complications usually occur when the peptic ulcer is left untreated.

Complications may include:

• Internal bleeding which can lead to anemia or severe blood loss which may require hospitalization or blood transfusion. Patients may also vomit blood or have blood in the stools.
• If a peptic ulcer ruptures, it can lead to a serious infection of the abdominal cavity (peritonitis).
• Formation of scar tissue in the stomach. This scar tissue can block the passage of food through the digestive tract, causing a person to become full easily, to vomit and lose weight.