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Peptic Ulcer

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(PUD; Duodenal Ulcer; Ulcer, Peptic; Ulcer, Duodenal)

Definition

A peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. This area of the small intestine is called the duodenum. Peptic ulcers may be named by their location:
Treatment may include antibiotics, medications that heal the ulcer and protect the stomach, and lifestyle changes. Surgery may be needed for ulcers that bleed, obstruct, perforate, or don't heal with other treatments.
Gastric Ulcer
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Causes

Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:
  • Helicobacter pylori (H. pylori) infection
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Less common causes include:

Risk Factors

Factors that increase your chances of peptic ulcer include:
  • H. pylori infection
  • Taking NSAIDs for a long time and at higher doses
  • Prior peptic ulcer disease
  • Cigarette smoking
  • Alcohol abuse

Symptoms

Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food or fluids sometimes make symptoms better. Having an empty stomach may make symptoms worse. However, symptoms can occur at any time.
Symptoms may include:
  • Gnawing pain:
    • May awaken you from sleep
    • May change when you eat
    • May last for a few minutes or several hours
    • Feels like unusually strong hunger pangs
    • May be relieved by taking antacids
  • Nausea
  • Vomiting
  • Loss of appetite
  • Bloating
  • Burping
  • Weight loss
Ulcers can cause serious problems and severe abdominal pain. One problem is bleeding. Bleeding symptoms may include:
  • Bloody or black, tarry stools
  • Vomiting what looks like coffee grounds or blood
  • Weakness
  • Lightheadedness
A perforated ulcer is a break through the wall of the stomach or duodenum. It causes sudden and severe pain.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:

Treatment

Talk to your doctor about the best treatment plan for you. Treatment options may include one or more of the following:

Medication

Your doctor may recommend:
  • Antibiotics if an infection is present or possible
  • Over-the-counter antacids
  • Proton pump inhibitors
  • H-2 blockers
  • Medications to coat ulcer
  • Medications to protect stomach against NSAID damage

Lifestyle Changes

You and your doctor will discuss lifestyle changes. These may include:
  • Quit smoking. Smoking worsens symptoms and slows healing.
  • Limit alcohol intake.
  • Avoid NSAIDs. This includes over-the-counter drugs like aspirin and ibuprofen.

Surgery and Endoscopy

Surgery and/or endoscopy may be recommended for:
  • An ulcer that won't heal
  • Recurring ulcers
  • A bleeding ulcer
  • A perforated ulcer
  • Problems with food passing out of stomach
Endoscopy
This may be done to stop bleeding. A thin, lighted tube is inserted down the throat into the stomach or intestine. Heat, electricity, epinephrine, or a substance called fibrin glue can then be applied to the area. This should stop the blood flow.
Surgery
Surgery for peptic ulcers is rare, but it can greatly reduce acid production. Common procedures include:
  • Removal of the ulcer
  • Removal of part of the stomach or small intestine
  • Tying off the bleeding blood vessel
  • Taking tissue from another part of the intestine and oversewing the ulcer
  • Cutting part of the nerve that goes to the stomach to reduce acid production

Prevention

To reduce your chance of getting 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 reduce your chance of getting a peptic ulcer from NSAIDs:
  • Use other drugs when possible for managing pain.
  • Take the lowest possible dose.
  • Don't take drugs longer than needed.
  • Don't drink alcohol while taking the drugs.
  • Ask your doctor about switching to medicines less likely to cause ulcers. Talk to your doctor about taking other drugs to protect your stomach and intestine lining.
  • Don't smoke. Cigarette smoking increases the chances of getting an ulcer.

RESOURCES

The American College of Gastroenterology http://gi.org

American Gastroenterological Association http://www.gastro.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology http://cag-acg.org

Health Canada http://www.hc-sc.gc.ca

References

H. pylori and peptic ulcers. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.aspx. Updated April 30, 2012. Accessed April 29, 2013.

Meurer LN, Bower DJ. Management of helicobacter pylori infection. Am Fam Physician. 2002;65(7):1327-36.

Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed April 29, 2013.

Peptic ulcer disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 22, 2013. Accessed April 29, 2013.

Understanding peptic ulcer disease. American Gastroenterological Association website. Available at: http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease. Published April 23, 2010. Accessed April 29, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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