Peptic Ulcers

Common ulcer symptoms include:

Discomfort between meals or during the night (duodenal ulcer)
Discomfort when you eat or drink (gastric ulcer)
Stomach pain that wakes you up at night
Feel full fast
Bloating, burning, or dull pain in your stomach
Comes and goes days or weeks at a time
The discomfort lasts for minutes or hour

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)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stress and spicy foods do not cause peptic ulcers however they can make your symptoms worse.

The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.

Many people with peptic ulcers don't even have symptoms.

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

Vomiting or vomiting blood — which may appear red or black
Dark blood in stools, or stools that are black or tarry
Trouble breathing
Feeling faint
Nausea or vomiting
Unexplained weight loss
Appetite changes

Risk factors

In addition to having risks related to taking NSAIDs, you may have an increased risk of peptic ulcers if you:

Smoke: Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
Drink alcohol: Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.
Have untreated stress
Eat spicy foods

Prevention

You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers. It also may be helpful to protect yourself from infections. It's not clear just how H. pylori spreads, but there is some evidence that it could be transmitted from person to person or through food and water.

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.

To detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:

Laboratory tests for H. pylori. Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. He or she may look for H. pylori using a blood, stool or breath test. The breath test is the most accurate

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.
If you are taking an antacid prior to the testing for H. pylori, make sure to let your doctor know. Depending on which test is used, you may need to discontinue the medication for a period of time because antacids can lead to false-negative results.

Endoscopy. Your doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.

Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium if present, eliminating or reducing use of NSAIDs if possible, and helping your ulcer to heal with medication.

Medications may include: Antibiotic medications to kill H. pylori.

If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline and levofloxacin.

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You'll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

Medications that block acid production and promote healing

Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.
Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. Available by prescription or over the counter, acid blockers include the medications famotidine (Pepcid AC), cimetidine (Tagamet HB) and nizatidine (Axid AR).
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. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief but generally aren't used to heal your ulcer.
Medications that protect the lining of your stomach and small intestine. 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 (Carafate) and misoprostol (Cytotec).

Follow-up after initial treatment

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

Ulcers that fail to heal

Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:

Not taking medications according to directions
The fact that some types of H. pylori are resistant to antibiotics
Regular use of tobacco
Regular use of pain relievers — such as NSAIDs— that increase the risk of ulcers

Less often, refractory ulcers may be a result of:

Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
An infection other than H. pylori
Stomach cancer
Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics.

If you have a serious complication from an ulcer, such as acute bleeding or a perforation, you may require surgery. However, surgery is needed far less often now than previously because of the many effective medications available.

Lifestyle and home remedies

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

Consider switching pain relievers. If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you.
Control stress. Stress may worsen the signs and symptoms of a peptic ulcer. Consider the sources of your stress and do what you can to address the causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal.
Don't smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid.
Limit or avoid alcohol. Excessiveuse of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.

Preparing for your appointment

Make an appointment with your regular doctor if you have signs or symptoms that worry you. Your doctor may refer you to a specialist in the digestive system (gastroenterologist).

It's a good idea to be well prepared for your appointment. Here's some information to help you get ready, and what you can expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. Certain medications can affect peptic ulcer tests, so your doctor may want you to stop taking them. He or she may be able to suggest alternatives to these drugs.
Write down any symptoms you're experiencing, as well as the food you're eating. People with peptic ulcers often experience more symptoms when their stomachs are empty.
Write down key personal information, including any other medical problems, major stresses or recent life changes.
Make a list of all medications, including over-the-counter medications, vitamins or supplements that you're taking. It's especially important to note any pain reliever use and the usual dose that you take.
Write down questions to ask your doctor.

For peptic ulcers, some questions you might want to ask your doctor include:

What's the most likely cause of my symptoms?
What kinds of tests do I need, and how do I need to prepare for them?
Is my condition likely temporary or chronic?
Am I at risk of complications related to this condition?
What treatment do you recommend?
If the initial treatment doesn't work, what will you recommend next?
Are there any dietary restrictions that I need to follow?
I have other medical problems. How can I manage these along with ulcers?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to cover. Your doctor may ask:

When did you first begin experiencing symptoms?
Have your symptoms been continuous or intermittent?
How severe are your symptoms?
Are your symptoms worse when you're hungry?
What, if anything, have you been taking to relieve your symptoms?
Does anything seem to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Do you take pain relievers or aspirin? If yes, how often?
Do you feel nauseated or have you been vomiting?
Have you ever vomited blood or black material?
Have you noticed blood in your stool or black stools?

What you can do in the meantime

While you're waiting to see your doctor, avoiding tobacco, alcohol, spicy foods and stress may help lessen your discomfort.

Here is to your good health

Cathy