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19
Apr

Peptic Ulcer

Peptic Ulcer is a sore in the lining of the stomach or the first part of the small intestine (called the duodenum). Ulcers in the stomach are often called gastric ulcers. Ulcers in the duodenum are called duodenal ulcers.

Causes

Most Peptic Ulcers are caused by the bacteria Helicobacter pylori or by using nonsteroidal anti-inflammatory drugs (NSAIDs). People infected with H. pylori and people who take NSAIDs do not all develop ulcers, though.
Anything that upsets the balance of stomach acid and digestive juices can lead to an ulcer, including:
  • H. pylori bacteria
  • NSAIDs, which hinder the body's ability to protect the stomach lining
  • Diseases that cause an increase in acid production, such as Zollinger-Ellison syndrome
  • Rare causes include radiation therapy, bacterial or viral infections, alcohol abuse, injury, and burns.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.
Risk factors for ulcer from H. pylori infection:
  • Age: 60 or older
  • Race: Black and Hispanic
  • Lower socio-economic group
  • A crowded and unsanitary living environment
  • Cigarette smoking
  • Stress
  • Excess coffee drinking
  • Family history of ulcer disease
  • Type O blood
Risk factors for ulcer from anti-inflammatory drugs:
  • Age: 60 or older
  • Sex: Male
  • History of stomach upset from NSAIDs
  • Prior peptic ulcer disease
  • Cigarette smoking
  • Alcohol abuse
  • Stress

Symptoms

Peptic Ulcers do not always cause symptoms. Symptoms may come and go. Food may increase gastric ulcer pain, but food usually relieves duodenal ulcer pain.
Symptoms include:
  • Gnawing pain
    • May awaken you from sleep
    • May change when you eat
    • Pain may last for a few minutes or several hours
  • Hunger
  • Nausea
  • Vomiting
  • Loss of appetite
  • Bloating
  • Burping
Ulcers can result in serious complications and severe abdominal pain. Complications include:
  • Bleeding, which may occur with no other symptoms. Symptoms of bleeding include:
    • Black, tarry stools
    • Vomiting up what looks like coffee grounds
    • Weakness
    • Dizziness
    • Anemia
  • Breaking through the wall of the stomach or duodenum. Symptoms of breakthrough include:
    • Sudden, severe pain
  • Scar tissue that narrows and eventually closes off the outlet of the stomach to the intestines. This blocks the passage of food through the digestive system. Symptoms of scar tissue blockage include:
    • Vomiting
    • Weight loss
    • Intense pain

Symptoms

Symptoms of PMR often develop within two weeks. They may include:
  • Muscle pain and/or stiffness in the hip, shoulder, or neck areas
  • Stiffness in the morning
  • Fever
  • Unexplained weight loss
  • Anemia
  • Fatigue
  • Mood changes
Symptoms of GCA may include:
  • All PMR symptoms
  • Headache
  • Pain or tenderness in the temple
  • Changes in vision
  • Pain in the jaw or tongue with chewing
If you suspect GCA, contact a doctor immediately. Without treatment, this condition may lead to permanent blindness.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tell your doctor all medications that you are taking.
Tests may include:
Rectal exam, stool guiac test – to test for hidden blood
Blood Test or Breath Test – to check for H. pylori infection. It can also test for gastrin levels if Zollinger-Ellison syndrome is suspected.
Upper GI Series – a series of x-rays of the upper digestive system taken after drinking a barium solution
Endoscopy – a thin, lighted tube inserted down the throat to look inside the digestive tract. During the procedure, the doctor can take tissue samples to test for H. pylori infection or for cancer.

Treatment

The goals of treatment are to eliminate the source of the problem and heal the ulcer. Gastric ulcers may take longer to heal than duodenal ulcers.
Treatments include:
Medication
Some medications block or reduce acid production and some coat the ulcer, protecting it. If H. pylori caused the ulcer, you will need to take a combination of drugs to eliminate the bacteria. This is usually two antibiotics and either a bismuth-containing drug or a proton-pump inhibitor. It is very important to take these drugs exactly as directed. The doctor will order tests 6 to 12 months after treatment to verify that the bacteria are gone.
Medications may include:
  • Antacids (Don't heal ulcers, but may provide some relief from heartburn.)
  • Antibiotics (Amoxicillin, tetracycline, clarithromycin)
  • Bismuth-containing drug (Pepto-Bismol)
  • Proton pump inhibitors [Used to decrease stomach acid production (Omeprazole, lansoprazole).]
  • H2 blockers [Used to decrease stomach acid production (Famotidine, ranitidine, cimetidine, nizatidine).]
  • Medications to protectively coat ulcer (Sulcrafate)
  • Medications to protect stomach against NSAID damage (Misoprostol)
Lifestyle Changes
  • If you smoke, quit. Smoking interferes with ulcer healing.
  • Do not drink alcoholic beverages.
  • Avoid NSAIDS, including over-the-counter drugs like aspirin and ibuprofen.
  • If spicy or fatty foods increase symptoms, you can temporarily stop eating them. Keep in mind they did not cause the ulcer and do not affect healing.
  • If stress increases ulcer pain, learn and practice stress-management techniques.
Endoscopic Surgery
A thin, lighted tube can be inserted down the throat into the stomach or intestine to treat bleeding or open a blockage.

Prevention

To decrease risk of ulcer from H. pylori infection:
  • Wash your hands after using the bathroom and before eating or preparing food.
  • Drink water from a safe source.
  • Don't smoke. Cigarette smoking increases the chances of getting an ulcer.
To decrease the risk of ulcer from NSAIDs:
  • Use other drugs when possible for managing pain.
  • Take the lowest possible dose.
  • Do not take longer than needed.
  • Do not drink alcohol while taking the drugs.
  • Ask your doctor about switching to a newer NSAID that is less likely to cause ulcers or taking other drugs to protect your stomach and intestine lining.
  • Don't smoke. Cigarette smoking increases the chances of getting an ulcer.