Peptic Ulcer Disease
A peptic ulcer is an open sore on the inner lining of the stomach (gastric ulcer) or upper small intestine/duodenum (duodenal ulcer). It is a common condition that affects one in 10 Americans at some point in their lives. Peptic ulcers develop when the protective barrier of the stomach or intestine breaks down, often due to a bacterium called Helicobacter pylori (H. pylori). This breach allows digestive fluids, which contain strong chemicals like hydrochloric acid and an enzyme called pepsin, to damage the sensitive underlying tissues.
Peptic ulcers can lead to serious complications if left untreated, including internal bleeding, perforation (when the ulcer eats a hole through the stomach wall or intestine), and narrowing and obstruction (when the ulcer occurs where the stomach and duodenum meet and blocks food from leaving the stomach).
A burning abdominal pain, located anywhere from the breastbone to the navel, is the most common symptom of peptic ulcers. This pain may last for minutes or for hours, and is usually experienced a few hours after a meal or during the night when the stomach is empty. The pain can usually be calmed through eating or taking an antacid. You may find that the pain comes and goes over the course of several days or weeks.
Other symptoms include bloating or nausea after eating, vomiting, weight loss, and appetite loss. If you experience bloody vomit, vomit that looks like coffee grounds, or black or bloody stools, seek medical treatment immediately as these could signal a serious condition.
Causes and Risk Factors
Long thought to be caused by stress or spicy food, peptic ulcers are most commonly the result of an H. pylori infection; 80-90% of all ulcer cases can be attributed to this bacterium. Long-term use of anti-inflammatory medications also accounts for some ulcer cases. Smoking, alcohol consumption, and stress can all contribute to the development of ulcers and slow healing, although they are unlikely to cause ulcers on their own.
In addition to a medical history and symptom interview, diagnostic tests for peptic ulcer disease might include:
- Upper GI, or gastrointestinal, series (also known as a barium swallow)
- Endoscopy (which will sometimes include a biopsy)
Once an ulcer has been discovered, it is important for your physician to pinpoint its underlying cause in order to determine the best course of treatment. Testing the blood, breath, or biopsied stomach tissue can detect presence of H. pylori
If H. pylori is found to be contributing to your ulcers, your doctor will prescribe a combination of two antibiotics found to be effective in eradicating the organism. It generally takes about two weeks for the antibiotics to get rid of the infection. It is important that you follow dosing instructions precisely in order for the treatment to work.
Medications such as H2 blockers, proton pump inhibitors, and antacids, are another component of treatment. They will help lower the levels of stomach acids and promote healing of the affected area. For those patients who have ulcers without the presence of H. pylori, you doctor will advise you to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and naproxen, which can sometimes cause ulcers with prolonged use. All people will ulcers should consider lifestyle changes that will promote healing, such as quitting smoking, limiting caffeine and alcohol, and avoiding stress.
While most ulcers respond to medication quickly and heal completely, some ulcers resist initial treatment. If your condition fails to heal, your physician may increase your dosage or try new medications. In extreme cases, surgery is sometimes necessary if the ulcers resist aggressive drug treatments.
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