A peptic ulcer is a craterlike sore in the stomach or duodenal lining. It’s called a gastric ulcer when it occurs in the stomach, and a duodenal ulcer when it occurs in the first 12 inches of the small intestine. Symptoms of the two are similar. (Peptic refers to pepsin, an enzyme in the area of the digestive system where ulcers develop.)
Peptic ulcers affect about 4.5 million Americans a year. Sixty percent of them are over age 60, and 20 percent are over 80. Ulcers may be more prevalent in older adults because of heavy use of aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) for managing pain, especially from arthritis. In the U.S. and other Western countries, peptic ulcers were once more common in men, but that’s changed over the decades, with incidence now comparable in men and women. The overall ulcer complication rates are also falling in developed countries.
Although most ulcers occur in people over 30, children may get them as well. Even after pain has subsided and an ulcer has healed, it’s common for it to recur. Fortunately, the high rate of ulcer recurrence has been significantly reduced since the introduction of short-term drug regimens that combat the bacterium H. pylori in the digestive tract (see below).
Symptoms of an ulcer
• Pain is the distinguishing ulcer characteristic. In most instances there is a burning or gnawing feeling in the upper abdomen, sometimes below the breastbone. The pain is usually mild to moderate in severity and can last from 30 minutes to several hours.
• Often the pain occurs immediately after meals in the case of gastric ulcers, or 2 or more hours later for duodenal ulcers, and may be relieved by eating. In some people with gastric ulcers, eating food aggravates the pain. The pain of an ulcer may also awaken you at night or early in the morning. It may come and go for no apparent reason; many people experience multiple-week cycles of pain and freedom from pain.
• Other symptoms include belching after eating, a feeling of fullness, and nausea.
• Less common symptoms include vomiting, loss of appetite and weight.
About 70 percent of people with peptic ulcers have no symptoms, particularly those who are older.
What causes ulcers?
For years a stressful lifestyle and a high-fat or spicy diet were blamed for ulcers. Then, in 1982, two Australian researchers discovered that a bacterium called Helicobacter pylori (H. pylori) was present in more than 90 percent of duodenal ulcers and more than 73 percent of gastric ulcers. They received a Nobel prize for their work.
H. pylori is considered a major contributor to both gastric and duodenal ulcers. The bacterium can have many physiological effects that affect peptic ulcer risk, including causing inflammation in the gastric lining. In addition, H. pylori impairs the natural alkaline environment in the duodenum and makes the tissues more susceptible to injury from stomach acids. In people who already have ulcers, H. pylori can worsen the severity.
Researchers know that H. pylori is transmitted orally, often during childhood. Though everyone with H. pylori has evidence of a sudden inflammation of the stomach lining, only some people develop the signs and symptoms of ulcers.
Aside from H. pylori infection, most cases of peptic ulcers can also be linked to long-term or heavy NSAID use. NSAIDs exert many effects on the stomach and duodenum that result in an increased risk of ulcers, such as irritating the lining and impairing the ability to protect and repair injuries.
Heredity and smoking are also involved with the development of peptic ulcers. Indeed, more than 20 percent of people with duodenal ulcers have a family history of the condition, compared with 5 to 10 percent of people who don’t have duodenal ulcers. Cigarette smoking is a risk factor for several reasons. It harms the lining of the stomach and duodenum, and it’s been linked with a reduction in the natural alkalinity in the duodenum. Some foods—namely coffee, tea, cola beverages, and spicy foods, as well as alcohol—have also been implicated. But no food or beverage has ever been shown to cause ulcers.
Extreme or poorly tolerated psychological stress, as well as physiological stress such as surgery, have been associated with peptic ulcers. That doesn’t mean stress alone causes ulcers, but it may have physiological effects that exacerbate them, such as an increase in acid production.
What if you do nothing?
Ulcers that go untreated can sometimes progress and lead to serious complications such as bleeding. In severe cases an ulcer eats a hole in the wall of the stomach or duodenum, and bacteria can spill through this perforation into the abdominal cavity. This causes a serious condition known as peritonitis, an inflammation of the abdominal cavity and wall that usually requires surgery. In addition, untreated H. pylori has been associated with anincreased risk of stomach cancer.
Therefore, you should always see a doctor if you suspect you have an ulcer.
Are there any home remedies for an ulcer?
Ulcer symptoms should be evaluated by a doctor. Prescription medications are the most effective form of treatment.
How to prevent ulcers
The following measures can help you avoid ulcers, or at least reduce the risk of them.
• Be careful with NSAIDs. If you must take aspirin, ibuprofen, or other NSAIDs regularly, take the smallest possible dose and always take it with food. If you are prone to ulcers and you must take NSAIDs, your doctor may recommend you take the prescription COX-2 inhibitor celecoxib (Celebrex) along with an acid-suppressing heartburn medication called a proton pump inhibitor (PPI), such as omeprazole (Prilosec) or esomeprazole (Nexium). The combination appears to reverse the negative impact of NSAIDs on ulcers and help prevent complications or the recurrence of NSAID-induced ulcers.
• Quit smoking, if you smoke. Cigarettes can negatively affect the lining of the stomach and duodenum. When combined with H. pylori infection, smoking may increase the risk of a relapse of peptic ulcers. Smoking also slows the healing of existing ulcers.
• Drink in moderation. If you drink alcohol, drink moderately (no more than two drinks a day for men and one a day for women) and never on an empty stomach. Although alcohol consumption and ulcers are not directly linked, alcohol abuse has been shown to impair ulcer healing.
• Reduce stress in your life. Stress has not been proven to be a direct cause of ulcers, but it can increase the risk or exacerbate existing ulcers.
When to call your doctor
Call your doctor if you develop symptoms of a peptic ulcer.
Contact your doctor or a hospital immediately if you vomit blood, if you feel faint or cold, or if you do faint; these are signs of potentially serious blood loss. Also contact your physician if your stools are black, tarry, or bloody, which are signs of internal bleeding.
Call for advice if you develop ulcer symptoms combined with back pain; the ulcer may have perforated into your pancreas. Also contact your physician if you’ve been diagnosed with an ulcer and now have a pallid complexion and begin to feel fatigued; these are signs of anemia.
What your doctor will do
A careful history will be taken and other medical conditions will be eliminated as primary causes of your problem. Diagnosing and treating an ulcer can be complex, and your doctor may refer you to a gastroenterologist. The definitive method of determining that someone has an ulcer, and that the cause is H. pylori, is to perform an endoscopy, which involves inserting a tubelike instrument down the throat into the stomach and duodenum. This allows the doctor to view tissue and also biopsy samples to test for the presence of H. pylori or other problems. A barium swallow, visible on an x-ray, is a less precise but noninvasive tool that can detect an ulcer. But it’s used much less frequently.
In addition to endoscopy, there are less expensive noninvasive tests, including a stool sample test and an in-office breath test that can be used in initially detecting H. pylori and to monitor the effects of treatment. Blood tests are also available, but they may be less reliable.
For most cases of peptic ulcer, drug therapy will be recommended. If H. pylori is present, your doctor will prescribe a course of antibiotics, in combination with a PPI. Treatment with antibiotics greatly reduces the chance of an ulcer recurring. (Never take antibiotics just because you have gastric symptoms, however, unless you’re sure you have an ulcer.) If H. pylori isn’t present, your doctor will likely prescribe either a PPI or another heartburn medication called an H2 receptor antagonist, such as ranitidine (Zantac) or famotidine (Pepcid).
Consult your doctor before using any heartburn medication on your own to treat ulcer symptoms. Some of these medications are available in over-the-counter formulations, but the OTC versions are only half the strength of the prescription drugs and may be ineffective for ulcers. Antacids (such as Tums) are not usually recommended as an ulcer treatment, given that PPIs are so much more effective.
Surgery is infrequently used to treat severe peptic ulcers.
For more information
Also see Flatulence (Gas): Causes and Treatments.