Peptic Ulcers

A peptic ulcer is a sore that is caused by stomach acid, and can occur either in the stomach (gastric ulcer) or the upper portion of the small intestine (duodenal). While they initially cause minor discomfort, peptic ulcers can become medical emergencies if they form perforations, which are holes that eat all the way through the stomach or duodenum lining.

Causes

There are a few causes associated with peptic ulcers. Even though it is a common belief that stress causes ulcers, it is not believed that this is one of the primary factors.

One of the two leading causes of peptic ulcers is a bacteria known as Helicobacter pylori, which is found in the gastrointestinal tracts of infected patients, but doesn’t always cause ulcers when it is present. The second leading cause is regular use of a group of drugs known as NSAIDs. NSAIDs are most often common drugs used to manage pain, and can include aspirin, ibuprofen or naproxen. These drugs interfere with the stomach and duodenum’s resistance to stomach acid, leading to damage through prolonged use.

Symptoms

There aren’t many obvious symptoms with peptic ulcers, and the intensity can differ from patient to patient. Here are some of the more notable symptoms:

  • Abdominal pain
  • Feeling full without eating/drinking much or hungry 1-3 hours after a meal
  • Mild nausea

The more serious symptoms are related to rapidly bleeding ulcers, and are considered a medical emergency:

  • Black, sticky stool
  • Blood in the stool
  • Vomiting blood or substance that looks like coffee grounds
  • Feeling light-headed or passing out

Testing

The preferred method for testing for peptic ulcers is an EGD, or EsophagoGastroDuodenoscopy, sometimes known as an upper endoscopy for short. An upper endoscopy is performed by inserting a flexible tube with a camera on the end into the mouth, down the esophagus and into the stomach and beginning of the small intestine. The flexible camera means the gastroenterologist can look in the most likely spots for ulcers. Bleeding ulcers can even be treated during an EGD.

Another method to test for ulcers is an upper GI series. In this test, the patient drinks a chalky substance known as barium. The barium settles in the stomach in a way that an X-ray can search for abnormalities.

It is also necessary to test for H. pylori by way of a hemoglobin blood test to check for anemia and a stool occult blood test to look for blood in a patient’s stool.

Treatment

Treatment for a peptic ulcer depends on the cause of the ulcers. In the case of H. pylori, the bacterial infection must be treated with antibiotics before the ulcers can begin to heal. If the cause of the ulcer is an NSAID, then the patient should consult their healthcare professional about moving away from those drugs.

Most often, peptic ulcers are treated with proton pump inhibitors (PPI), which are extremely effective at blocking acids. These drugs need to be taken around an hour before a meal, which will then activate the drug in the stomach. Another useful medication for blocking acid is an H2 blocker, typically used for duodenal ulcers.


If you think you are experiencing symptoms of a gastric or duodenal ulcer, please contact your doctor. To read more about peptic ulcers online, please visit The American College of Gastroenterology.