A peptic ulcer is a sore in the inner lining of the stomach or upper minor intestine.
Ulcers form when the intestine or stomach'due south protective layer is broken downwards. When this happens, digestive juices—which contain hydrochloric acid and an enzyme chosen pepsin—can damage the intestine or stomach tissue.
Treatment cures most ulcers. And symptoms ordinarily go away quickly.
Peptic ulcers that form in the tummy are called gastric ulcers. Those that grade in the upper small intestine are chosen duodenal (say "doo-uh-DEE-nul" or "doo-AW-duh-nul") ulcers.
What causes peptic ulcers?
The two near common causes of peptic ulcers are:
Infection with Helicobacter pylori ( H. pylori) bacteria.
Apply of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.
H. pylori and NSAIDs break down the breadbasket or intestine's protective mucus layer.
What are the symptoms?
Symptoms include:
A burning, aching, or gnawing pain between the abdomen button (navel) and the breastbone. Some people also have back hurting. The pain can concluding from a few minutes to a few hours and may come and go for weeks.
Pain that normally goes away for a while later y'all 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 wait like tar, or stools that contain nighttime carmine claret.
Unlike people have different symptoms, and some people accept no symptoms at all.
How are peptic ulcers diagnosed?
Your doctor volition ask you questions about your symptoms and your general wellness, and he or she will do a concrete exam.
If your symptoms aren't severe and you are younger than 55, your doctor may exercise some uncomplicated tests (using your claret, breath, or stool) to look for signs of H. pylori infection.
The only manner for you lot and your doctor to know for sure if you have an ulcer is to practice a more than complicated test, called an endoscopy, to wait for an ulcer and to exam for H. pylori infection. An endoscopy allows the doctor to look within your esophagus, stomach, and small intestine. An endoscopy is normally done by a gastroenterologist, a doctor who specializes in digestive diseases.
How are they treated?
To treat peptic ulcers, most people need to have medicines that reduce the amount of acrid in the tummy. If y'all have an H. pylori infection, y'all will also demand to accept antibiotics.
You can help speed the healing of your ulcer and forestall it from coming back if yous quit smoking and limit alcohol. Continued apply of medicines such as aspirin, ibuprofen, or naproxen may increase the risk of your ulcer coming back.
Ignoring symptoms of an ulcer is non a good thought. This condition needs to be treated. While symptoms can go away for a short time, you may yet have an ulcer. Left untreated, an ulcer can cause life-threatening bug. Even with handling, some ulcers may come back and may demand more treatment.
Cause
The ii most common causes of peptic ulcers are:
Infection withHelicobacter pylori(H. pylori) bacteria. Although many people are infected with H. pylori bacteria, just a few get ulcers.
Nonsteroidal anti-inflammatory drugs (NSAIDs). When used for weeks or months, NSAIDs can impairment the lining of the digestive tract, causing an ulcer or making an existing ulcer worse. NSAIDs include aspirin, ibuprofen, and naproxen.
A rare crusade of peptic ulcers is Zollinger-Ellison syndrome. In this status, the stomach makes likewise much acid, damaging the tummy lining.
Symptoms
Common symptoms
Common ulcer symptoms include:
A burning, aching hurting—or a pain that feels like hunger—between the belly button and the breastbone. The hurting sometimes extends to the back.
Belly pain that can final from a few minutes to a few hours and that usually goes away for a while after yous have an antacid or acid reducer.
Weeks of pain that comes and goes and may alternating with pain-free periods.
Loss of ambition and weight loss.
Bloating or nausea afterwards eating.
Less mutual symptoms
Less common just more serious symptoms of ulcers include:
Airsickness after meals.
Airsickness claret and/or cloth that looks similar coffee grounds.
Black stools that look like tar, or stools that incorporate dark red claret.
Ulcers and pains
Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the tummy (gastric ulcers) are similar, except for when pain occurs.
Hurting from a duodenal ulcer may occur several hours after you eat (when the tum is empty) and may improve after y'all eat. Hurting as well may wake y'all in the middle of the night.
Pain from a gastric ulcer may occur shortly later on yous eat (when food is however in your stomach).
Silent ulcers
Some ulcers don't crusade symptoms. These are known as silent ulcers. Silent ulcers are more common in:
Older adults.
People who have diabetes.
People who use nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such equally Advil), and naproxen (such every bit Aleve).
Symptoms in children
In children, symptoms vary with age:
Toddlers and young children may complain of full general stomach hurting.
Teenagers may have symptoms more like those of adults.
The symptoms of an ulcer often can be confused with other intestinal conditions, such equally dyspepsia or gastroesophageal reflux disease (GERD).
What Happens
Many people who accept peptic ulcers may non meet a md when their symptoms brainstorm. Their symptoms, such as belly hurting, may come up and become. Even without treatment, some ulcers will heal by themselves.
And even with treatment, ulcers sometimes come back. Sure factors such as cigarette smoking and continued use of nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of ulcers coming back.
Sometimes ulcers can crusade complications, such as bleeding, perforation, penetration, or obstacle. That's why it'south important to care for an ulcer, even if you have i that isn't causing any symptoms.
Most peptic ulcers without complications heal, regardless of the cause. But an ulcer is likely to come back if you have an H. pylori infection that is not successfully treated. Recurring ulcers caused past reinfection with H. pylori are non common in the United States, except in areas that are overcrowded or have poor sanitation.
Ulcers in the tum (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).
What Increases Your Risk
Take chances factors you can command
The post-obit things tin can increase your hazard of getting a peptic ulcer and may irksome the healing of an ulcer you already have:
Taking nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
Smoking.
Drinking too much alcohol. This is more than 2 drinks a day for men and more than i drink a day for women.
In the past, spicy foods, caffeine, and moderate amounts of alcohol were idea to increment ulcer risk. This is no longer believed to be truthful.
Run a risk factors you cannot command
Some things that you lot cannot control may increment your gamble of getting an ulcer. These include:
A Helicobacter pylori ( H. pylori) infection, the nigh common crusade of ulcers.
Physical stress caused by a serious illness or injury (such as a major trauma, surgery, or the need to be on a ventilator to aid breathing).
Hypersecretory condition, in which your stomach produces as well much acid.
A personal or family history of ulcers.
When should you telephone call your physician?
If you take been diagnosed with a peptic ulcer, call 911 or other emergency services immediately if yous accept:
Symptoms that could indicate a center attack or stupor.
Sudden severe, continuous abdomen pain or vomiting.
Call your md or seek medical attention right abroad if you have:
Frequent feelings of dizziness or lightheadedness, especially when moving from lying down to a seated or standing position.
Claret in your vomit or something that looks like coffee grounds (partially digested blood) in your vomit.
Stools that are blackness or that look like tar, or stools that contain dark red or maroon claret.
Call your doctor if you have been diagnosed with a peptic ulcer and:
Your symptoms continue or become worse afterward 10 to 14 days of treatment.
You begin to lose weight without trying.
Y'all are vomiting.
You take new belly pain or belly pain that does not become away.
Watchful waiting
If yous have been diagnosed with a peptic ulcer and medical treatment is not helping, telephone call your doc. Waiting until your symptoms get worse can be serious.
If you lot don't know if you lot take a peptic ulcer and y'all don't have whatsoever of the emergency symptoms listed above, yous may try taking an antacid or nonprescription acid reducer and other abode treatment, such every bit making changes to your diet.
If your symptoms don't get meliorate after 10 to 14 days, phone call your physician.
If your symptoms get away later you take antacids or acid reducers and try home treatment, just and then the symptoms come back, telephone call your doctor.
Who to see
To evaluate your symptoms, see your:
Family medicine doctor.
Internist.
Full general practitioner.
Nurse practitioner.
Md banana.
Pediatrician (for children and teens).
If further testing or treatment is needed, you may need to see someone who specializes in the handling of diseases of the digestive tract (gastroenterologist).
If surgery is needed, your md may refer y'all to a general surgeon. But surgery is rarely needed to treat ulcers.
Exams and Tests
Although not all peptic ulcers are caused by bacteria, it's getting more common to do a exam forHelicobacter pylori whenever someone has ulcer symptoms. This includes testing your claret, breath, stool, or a sample of tissue from your digestive tract (biopsy).
An endoscopy may be washed so that a medico can:
Look at the inside of your stomach and your upper small intestine to check for an ulcer.
Collect a tissue sample (biopsy) that can be tested for H. pylori or cancer.
If you are older than 55, you may need an endoscopy considering of a higher hazard for stomach cancer. This is especially true if you accept:
Ulcer symptoms for the first time.
Ulcer symptoms that render before or subsequently treatment is completed.
A family history of tum cancer.
Other symptoms that may signal to a more serious problem, such as stomach cancer. These include:
Blood in the stool.
Weight loss of more than x% of body weight.
Difficulty swallowing (dysphagia).
Jaundice.
Abdominal mass.
Other tests that may be done include:
Fecal occult claret test (FOBT). This test may exist done to observe claret in the stool, which may exist caused by a peptic ulcer or another serious problem, such as colon cancer. By itself, an FOBT cannot diagnose peptic ulcer disease, but it may show if an ulcer is haemorrhage.
Complete blood count (CBC). This claret exam may be done to look for anemia, which may exist caused by a bleeding ulcer.
Upper GI series. This Ten-ray exam of the esophagus and tum may exist used to diagnose peptic ulcer disease, although this test is being used less frequently.
Treatment Overview
Left untreated, many ulcers eventually heal. But ulcers often recur if the cause of the ulcer is not eliminated or treated. If ulcers go along coming back, you have an increased take chances of developing a serious complication, such every bit bleeding or a hole in the wall of your tum or intestine.
Virtually of the time, handling means taking medicines—such as H2 blockers and proton pump inhibitors (PPIs)—and making lifestyle changes, including:
Not taking nonsteroidal anti-inflammatory drugs (NSAIDs), if possible. These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
Quitting smoking.
Not drinking too much alcohol (no more 2 drinks a day for men and one drink a twenty-four hours for women).
H. pylori infection
If your ulcer is caused by Helicobacter pylori ( H. pylori) leaner, treatment usually involves a combination of medicines, including antibiotics.
If treatment isn't working, you may demand more than tests to look for bacteria. If yous even so have an H. pylori infection, your doctor will likely effort a different combination of medicines. He or she may likewise suggest that you see a gastroenterologist. This specialist will do an endoscopy to look at your ulcer and to take a tissue sample (biopsy).
Handling if ulcers get worse
If you take serious complications from a peptic ulcer, such as bleeding or obstacle, you may need an endoscopy, even if you have already had ane.
If your stomach or intestine has a perforation or your ulcer continues to bleed despite treatment, you may need surgery. Only surgery is rarely used to treat an ulcer.
Prevention
You can greatly reduce the chance that y'all will become a peptic ulcer if you lot:
Don't fume. Smokers are much more than probable than nonsmokers to get ulcers. For ways to quit smoking, run into the topic Quitting Smoking.
Avert NSAIDs. Avert taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) for longer than a few days at a time. If yous are taking one of these medicines daily, for example taking aspirin for heart problems, ask your doc near taking medicine to help protect your stomach and intestines from ulcers.
Drink alcohol but in moderation. Limit alcohol to ii drinks a day for men and i drink a 24-hour interval for women.
Home Treatment
Many people who take mild ulcer symptoms first try home treatment for a curt time without seeing a doctor.
Simply encounter your doc if your symptoms don't get ameliorate after x to 14 days of home treatment, or if yous have other symptoms such equally weight loss, nausea after eating, or consistent pain. This is even more of import if you are middle-anile or older, considering the gamble for cancer or other illnesses that cause symptoms similar to peptic ulcer disease increases with age.
Endeavor these dwelling handling steps to stop symptoms and help an ulcer heal:
Terminate smoking.
Effort nonprescription medicines that reduce stomach acid. Brand sure yous tell your md virtually any medicines you are taking.
Make changes to your diet, such as eating smaller, more than frequent meals. (These changes may improve your symptoms, but they won't assistance your ulcer heal.)
Drink booze only in moderation, or non at all. Limit alcohol to 2 drinks a solar day for men and 1 drink a day for women. Drinking also much alcohol may make an ulcer heal more than slowly and may make your symptoms worse.
Medications
Medicines are used to:
Treat peptic ulcers past reducing the amount of acrid produced by the tum.
Impale Helicobacter pylori ( H. pylori) bacteria if they are infecting the stomach lining.
Protect the lining of the stomach and upper small intestine from injury caused past nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen (such every bit Advil), and naproxen (such as Aleve).
Medicine choices
Medicines to reduce tummy acrid
Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.
Antacids (such every bit Tums)
Acrid reducers
H2 blockers (such every bit Pepcid). Some H2 blockers are available without a prescription.
Proton pump inhibitors (PPIs) (such equally Prilosec). Some PPIs are bachelor without a prescription.
Be careful when you accept over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that y'all are not taking more than than the recommended dose. Also much aspirin tin can be harmful.
Medicines to kill H. pylori bacteria
Doctors prescribe combination drug therapy to cure infection with H. pylori bacteria. This normally includes at to the lowest degree ii antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.
Medicines to protect the stomach
Medicines used to protect the stomach from damage acquired past frequent use of aspirin or other NSAIDs include:
Acid reducers. These include:
H2 blockers (such as Tagamet).
Proton pump inhibitors (PPIs) (such every bit Prilosec).
Prostaglandin analogs (such as Cytotec).
You lot tin can get some H2 blockers and PPIs without a prescription (over the counter or OTC). If y'all are using OTC acid reducers (such as Prilosec or Pepcid) to assistance with your symptoms for more than than 10 to 14 days at a time, or if your symptoms are very bad, be certain to see your doctor.
Surgery
Surgery is rare, but it is needed sometimes to treat:
Ulcers that don't heal (intractable peptic ulcers).
Life-threatening complications of an ulcer, such as severe bleeding, perforation, or obstruction.
If surgery is suggested, y'all may desire to:
Seek a second opinion and ask whether all medicine treatment options have been tried.
Compare the cost of long-term medicine handling to the one-time price of surgery.
Recall that no surgery can completely prevent ulcers from returning.
Observe a surgeon who has a lot of experience with surgery for ulcers.
Surgery choices
When surgery is washed, it usually involves one or more than of the following:
Cutting one or more of the nerves to the tummy (vagotomy).
Widening the opening of the lesser of the breadbasket (pyloroplasty).
Removing office of the stomach (partial gastrectomy).
References
Other Works Consulted
Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and adventure of hip fracture. JAMA, 296(24): 2947–2953.
Credits
Electric current every bit of: Apr 15, 2020
Writer: Healthwise Staff Medical Review: East. Gregory Thompson Physician - Internal Medicine Adam Husney MD - Family Medicine
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