Peptic ulcer

Definition
A peptic ulcer is a sore that develops in the lining of the gastrointestinal tract. Peptic ulcers are classified according to their location. For example, the most common type of peptic ulcers, duodenal ulcers, are found in the duodenum (the part of the small intestine closest to the stomach). Ulcers that develop in the stomach are called gastric ulcers. Sometimes, ulcers develop in the esophagus (the tube that connects the throat and stomach).

Causes/associated factors
Spicy foods and stress do not cause peptic ulcers. In some cases, peptic ulcer disease (PUD) may be caused by long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. (These medications can irritate the lining of the gastrointestinal tract.)
In other cases, 80 to 95 percent of peptic ulcers are associated with a bacterium called Helicobacter pylori (H. pylori). Researchers think you may become infected with H. pylori through poorly prepared food or contaminated food and water early in life. The infection persists without treatment, and may also spread to others through contact with infected saliva. (Sometimes the bacteria are found in the saliva of people infected with H. pylori, who may spread it by kissing someone else.) Although the reason is unclear, most people infected with H. pylori don't develop ulcers.

For a small percentage of people, peptic ulcers are caused by tumors in the stomach or pancreas (the gland that produces enzymes the body needs to digest food).

Risk factors for developing a peptic ulcer include smoking and possibly genetic factors.


Signs/symptoms
For many people, the symptoms of a peptic ulcer are mild or barely noticeable. The most common symptom is a dull or burning epigastric pain that comes and goes for days or weeks. The discomfort typically starts two to three hours after eating or in the middle of the night. Eating may help the pain go away for a while. Other symptoms may include:
bloating
burping
decreased appetite
nausea
vomiting
weight loss
Severe symptoms of a peptic ulcer include:

sudden, sharp, constant abdominal pain with possible spread to the right shoulder
black or bloody stools
vomit that looks bloody or resembles coffee grounds

Diagnosis
Your doctor will ask about your medical history and do a physical exam. If a peptic ulcer is suspected, you may need an upper GI series (an X-ray of your esophagus, stomach and small intestine). Before the X-ray, you'll be asked to drink a glass of barium, a white, chalky liquid that helps ulcers appear more clearly on the X-ray.
Your doctor may also suggest an endoscopy, the standard for confirming peptic ulcer disease. With this procedure, the doctor examines the lining of your esophagus, stomach and small intestine through an endoscope (a thin, flexible tube equipped with a camera lens and light). With the endoscope, the doctor can take pictures of any ulcers and remove a small tissue sample for analysis.

If your doctor finds an ulcer on endoscopy or other testing (or often if an ulcer is suspected), it's important to find out if H. pylori is the cause. Your doctor may send a blood sample for lab analysis or do a urea breath test, in which you drink a solution containing a special carbon atom. The breath test can be up to 96 to 98 percent accurate for detecting H. pylori. If you've had an endoscopy and tissue samples were collected, they will also be examined in a lab and cultured for H. pylori.


Treatment
If your ulcer is caused by H. pylori, you may placed on a medication regimen known as triple therapy or eradication therapy, which is a combination of two antibiotics and another medication that either reduces stomach acid or protects the lining of your stomach. With this treatment, you may need to take up to 20 pills a day for two weeks. When you've completed the course of medication, your doctor may recommend a follow-up breath test to make sure the treatment was successful. Side effects of these medication can include nausea, vomiting, diarrhea, dizziness, headaches, a metallic taste in your mouth and, for women, vaginal yeast infection.
Peptic ulcers with other causes are typically treated with medication. Medications such as acid blockers and proton pump inhibitors can decrease the amount of acid produced in your stomach.

If your ulcer is caused by NSAIDs, your doctor may have you stop taking these medications or switch to the newer, more selective NSAID products that were developed to reduce the risk of ulcer complications. If this isn't not possible, you may be given another medication to counteract the effects of these medications.

Surgery may be needed in severe cases of peptic ulcer disease or when conservative therapy is unsuccessful.


Complications
If left untreated, a peptic ulcer can lead to serious complications, including:
a hole in the wall of the stomach or intestine (This condition is considered a medical emergency that requires surgery and hospitalization.)
heavy bleeding if stomach acid or the ulcer causes a blood vessel to break
obstruction, if the ulcer causes inflammation or results in scarring that blocks food from passing through the gastrointestinal tract
If left untreated, an H. pylori infection increases the risk of developing gastric cancer or mucosal-associated, lymphoid-type lymphoma. However, these types of cancer are uncommon in the United States.


Pregnancy-specific information
Active peptic ulcer disease is not a common problem during pregnancy. In fact, most women who have a history of symptoms from peptic ulcer disease usually notice improvement during pregnancy. When antibiotics are needed to treat H. pylori during pregnancy, your doctor will select a medication that does not contain tetracycline.

Senior-specific information
Peptic ulcers are more likely to be "silent" in older people. They're also associated with an increased risk of complications, as well as a potentially longer healing time.

Prevention
It's unclear how to prevent the spread of H. pylori. Here are some recommendations from the Centers for Disease Control and Prevention.
Wash your hands often and thoroughly.
Eat foods that are properly prepared.
Drink water from clean, safe sources.
Successful treatment of H. pylori reduces ulcer recurrence rates to less than 5 percent per year. Limiting the long-term use of NSAIDs may also help prevent the development of peptic ulcers not caused by H. pylori. If you smoke, quit.