Peptic Ulcer Disease

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine (duodenum). Ulcers develop when the intestine or stomach's protective layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. These strong juices, which contain hydrochloric acid and an enzyme called pepsin, also can injure the esophagus. The esophagus is the tube that leads from your throat to your stomach.

Peptic ulcers are no longer a condition that most people have to live with their entire lives. Treatment cures most ulcers, and symptoms go away quickly.

Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say “doo-uh-DEE-nul” or “doo-AW-duh-nul”) ulcers.

See a picture of the stomach and duodenum.

What causes peptic ulcers?

The two most common causes of peptic ulcers are:

• Infection with Helicobacter pylori (H. pylori) bacteria.
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs).

H. pylori and NSAIDs break down the stomach or intestine’s protective mucus layer. The mucus layer prevents digestive juices from damaging the stomach and intestine.

What are the symptoms?

Symptoms include:

• A burning, aching, gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks.
• Pain that usually goes away for a while after you take an antacid or acid reducer.
• Loss of appetite and weight loss.
• Bloating or nausea after eating.
• Vomiting.
• Vomiting blood or material that looks like coffee grounds.
• Passing black stools that look like tar or stools that have streaks of dark red blood.

Different people have different symptoms, and some people have no symptoms at all.

How are peptic ulcers diagnosed?

Your doctor will ask you questions about your symptoms and your general health, and he or she will do a physical exam.

Sometimes, if your doctor thinks you might have an ulcer or another problem (like indigestion or irritation of the stomach lining) that causes the same symptoms as an ulcer, he or she may try to treat your symptoms with medicine before you have any tests.

If your symptoms are not severe and you are younger than 55, your doctor may do some simple tests (using your blood, breath, or stool) to look for signs of H. pylori infection.

The only way for you and your doctor to know for sure if you have an ulcer is to do a more complicated test, called an endoscopy, to look for an ulcer and to test for H. pylori infection. An endoscopy allows the doctor to look inside your esophagus, stomach and small intestine. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases.

You may also have an endoscopy if your doctor thinks that your symptoms could be caused by stomach cancer, rather than by an ulcer. This does not happen very often. During this test, your doctor may remove small pieces of tissue (biopsy). This tissue may be tested for cancer.

How are they treated?

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics. If your doctor prescribes antibiotics to treat your infection, you need to take all the pills. It is much more likely that the infection will be cured if you take all the antibiotics.

You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.

Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.