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Disease & Condition

Peptic Ulcer Disease

Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.

Peptic ulcers include:

  • Gastric ulcers that occur on the inside of the stomach
  • Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)
  • Esophageal ulcers that occur inside the hollow tube (esophagus) that carries food from your throat to your stomach

Symptoms

Pain is the most common symptom

Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

  • Be felt anywhere from your navel up to your breastbone
  • Be worse when your stomach is empty
  • Flare at night
  • Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
  • Disappear and then return for a few days or weeks

Other signs and symptoms

Less often, ulcers may cause severe signs or symptoms such as:

  • The vomiting of blood — which may appear red or black
  • Dark blood in stools or stools that are black or tarry
  • Nausea or vomiting
  • Unexplained weight loss
  • Appetite changes

When to see a doctor

See your doctor if you have persistent signs and symptoms that worry you. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If your pain persists, see your doctor.

Causes

Common causes include:

  • A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer.
  • Regular use of certain pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen, naproxen, ketoprofen and others.
  • Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates and potassium supplements.

Risk factors

You may have an increased risk of peptic ulcers if you:

  • Smoking
  • Drink alcohol

Complications

Left untreated, peptic ulcers can result in:

  • Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  • Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  • Scar tissue. Peptic ulcers can also produce scar tissue that can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

Tests and diagnosis

Tests for H. pylori

Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. Tests can test for H. pylori using your:

  • Blood
  • Breath
  • Stool

Which type of test you undergo depends on your situation.

For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you’re infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide.

Other test includes:

  • Endoscopy of your upper digestive system
  • X-ray of your upper digestive system

Treatments and drugs

Treatment for peptic ulcers depends on the cause. Treatments can include:

  • Antibiotic medications to kill H. pylori. Your doctor may recommend a combination of antibiotics to kill the bacterium. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid.
  • Medications that block acid production and promote healing.
    • Proton pump inhibitors. These drugs include the prescription and over-the-counter medications omeprazole ,lansoprazole rabeprazole , esomeprazole and pantoprazole.
    • Acid blockers — also called histamine (H-2) blockers. Available by prescription or over-the-counter, acid blockers include the medications ranitidine , famotidine , cimetidine and nizatidine.
  • Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief.
  • Cytoprotective agents. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Options include the prescription medications sucralfate and misoprostol . Another nonprescription cytoprotective agent is bismuth subsalicylate.

Lifestyle and home remedies

You may find relief from the pain of a stomach ulcer if you:

  • Choose a healthy diet
  • Consider switching pain relievers
  • Control stress
  • Don’t smoke
  • Limit or avoid alcohol

Prevention

You may reduce your risk of peptic ulcer if you:

  • Protect yourself from infections. You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
  • Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.

Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.

 

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