Peptic ulcer disease

WEB EXCLUSIVE / OCTOBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in March 1999

Download this Patient Note in PDF format

You've been experiencing pain between your breastbone and navel. It seems worse in the middle of the night or between meals but improves when you eat. A visit to your doctor has confirmed that you have peptic ulcer disease.

What are peptic ulcers?

Peptic ulcers are sores or holes in the inner lining of the esophagus, stomach, or first part of the small intestine (duodenum). Duodenal ulcers are the most common type. People of any age can get ulcers, and women and men are affected equally. One in 10 Americans develops an ulcer at some time in his or her life.

What causes peptic ulcers?

Most ulcers are caused by a bacterium called Helicobacter pylori that lives on the lining of the stomach. H pylori is common everywhere in the world, although it does not always cause ulcers. Exactly how H pylori infection is acquired is not known, but it may be transmitted by person-to-person contact.

Another cause of peptic ulcers is frequent use of nonsteroidal antiinflammatory drugs (NSAIDs), such as aspirin or ibuprofen. NSAIDs can block the production of substances that protect the stomach lining from acid.

Although peptic ulcers are not caused by stress, spicy foods, excessive alcohol use, or smoking, all of these can make ulcers worse.

What are the symptoms?

Regardless of location, ulcers can cause a great deal of discomfort. Some people with peptic ulcers describe a burning pain in the gut, while others call it a dull ache. The pain often occurs when the stomach is empty, such as between meals and in the middle of the night or early morning, but it can occur at any time. It can last from a few minutes to many hours and is usually relieved by eating food or taking antacids.

Less common symptoms are nausea, vomiting, and loss of appetite. In severe cases, ulcers can bleed and cause anemia, with its symptoms of weakness and fatigue.

What tests should I have?

Your doctor has several tests to help determine if you have peptic ulcers.

• Endoscopy uses a small, flexible fiber-optic tube that is attached to a camera. The tube is inserted through your mouth and into your stomach to look for ulcers.
• An upper gastrointestinal x-ray can reveal peptic ulcers. You drink liquid barium before the procedure so the ulcers can be visualized.

Tests can also tell whether you have H pylori infection.

• During endoscopy, small samples of your stomach lining may be obtained for testing for the presence of H pylori.
• A blood test can confirm exposure to H pylori, although it can't tell you if you are currently infected.
• A breath test can detect active H pylori infection. After drinking a special solution and waiting about an hour, a sample of your breath is tested for by-products produced by H pylori bacteria.
• A stool sample test can also detect active H pylori infection.

How are peptic ulcers treated?

If your ulcers are caused by NSAID use, you may need to limit or stop use of these medications. If testing shows your ulcers are a result of H pylori infection, your doctor may prescribe 2 weeks of treatment with a combination of antibiotics and a drug that blocks acid production in the stomach. For most people, this treatment eliminates the ulcers for good.

One of the most important things you can do if you are given antibiotics for ulcers is to make sure you follow your doctor's directions exactly. You should take each dose as directed until all the medication is gone, even if you feel better right away. If you have side effects that make it hard to take the medicines, call your doctor. There probably is another drug that can be used.

When to call your doctor immediately Peptic ulcers can worsen if they aren't treated. Call your doctor immediately if you experience any of these symptoms: Intense or sharp stomach pain that comes on suddenly and doesn't go away Black or bloody stools Vomit that is bloody or looks like coffee grounds

This information is not a substitute for medical treatment.

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