Peptic ulcers are small open sores in the stomach or upper intestine. Sores occur when the lining of the stomach or intestine breaks down and exposes tissue underneath. Ulcers may be gastric (stomach) or duodenal (first 12 inches of the small intestine). Duodenal ulcers occur four times more often than gastric ulcers. Peptic ulcer disease (PUD) is common. About 15 million people in the United States have peptic ulcer disease.
Three things cause most peptic ulcers: infection with a bacteria named Helicobacter pylori (H. pylori), taking aspirin or similar medicines (nonsteroidal antiinflammatory drugs, or NSAIDs, such as ibuprofen), and too much acid secretion. Ulcers aren’t contagious but may run in families. Smoking and alcohol increase the risk of stomach ulcers.
The main symptom is stomach pain that may feel like heartburn, indigestion, or hunger. A burning, boring, or gnawing feeling can last from 30 minutes to 3 hours. It’s usually felt in the upper stomach area, but it sometimes occurs below the breastbone. Pain usually happens when the stomach is empty. It can also occur right after eating or hours later, depending on the location of the ulcer.
Complications include bleeding and perforation (hole in the stomach or duodenum). Black, tarry stools and vomiting with blood or with what looks like “coffee grounds” material (blood mixed with stomach acid) indicate bleeding ulcers.
The health care provider will suspect PUD from the medical history and physical examination. The health care provider may order blood and stool tests. Endoscopy or barium x-rays may be done. For endoscopy, the better test, the doctor uses a lighted tube to see into the stomach and take a tissue sample for study. Tests will be done to see whether the stomach or duodenum has H. pylori infection.
Treatment heals the ulcer, helps symptoms, stops relapses, and avoids complications. With treatment, people usually start to feel better in about 2 weeks. Relapses can occur if the risk factors persist.
Two treatment options are drugs and surgery. Medicines to reduce stomach acid include antacids, histamine-2 blockers such as ranitidine or famotidine, and proton pump inhibitors such as omeprazole. Sucralfate is another medication that can form a protective coating on the ulcer to help it heal. Antibiotics, proton pump inhibitors, and bismuth can be used for H. pylori infection.
Surgery is used when drugs don’t work or serious complications occur. Today, surgery is rarely needed.
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