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Jai Ganesh

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Registered: 2005-06-28

Posts: 53,747

Ulcer

Ulcer

Gist

The most common causes of peptic ulcers are Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs). Other causes of peptic ulcers are uncommon or rare. People with certain risk factors are more likely to develop ulcers.

Mouth ulcers typically heal on their own within 1 to 2 weeks, though larger ones can last up to 6 weeks. Stomach ulcers usually heal within 4 to 8 weeks with proper treatment, though severe cases may take over 12 weeks. See a doctor if mouth ulcers last over 3 weeks.

Summary:

What is an ulcer?

Ulcers are sores on the lining of your stomach or small intestine. Sores also could be on your esophagus (throat). Most ulcers are located in the small intestine. These ulcers are called duodenal ulcers. Stomach ulcers are called gastric ulcers. Ulcers in the throat are called esophageal ulcers.

Ulcer symptoms:

Common ulcer symptoms

* 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

Bleeding ulcer symptoms

If your ulcer becomes perforated (torn), it becomes a bleeding ulcer. This can cause the following symptoms:

* Nausea
* Vomiting blood
* Unexpected weight loss
* Blood in your stool or dark stools
* Pain in your back

What causes ulcers?

A bacterial infection called Heliocobacter pylori (H. pylori) is typcially what causes ulcers. Acids from the foods we eat can make the pain and discomfort worse. Long-term use of aspirin or anti-inflammatory medicines (ibuprofen) are also a common cause of ulcers. Stress and spicy foods can make an ulcer worse.

How is an ulcer diagnosed?

Your doctor will ask you about your symptoms. They may do an endoscopy. This procedure involves inserting a thin, flexible tube attached to a camera down your throat and into your stomach. Your doctor will test your blood, breath, or stool for H. pylori. They also can test a sample of your stomach lining. Your doctor also will ask you if you regularly take aspirin or anti-inflammatory medicines.

Details:

What Are Stomach Ulcers?

Stomach ulcers, also known as peptic ulcers, are open sores in the lining of your stomach or the upper part of your small intestine. The ulcer forms when stomach acid eats away at the mucus that protects the lining of your digestive tract.

Types of peptic ulcers

Gastric ulcer: It occurs when a sore forms in the lining of your stomach.
Duodenal ulcer: This happens when a sore develops in the upper part of your intestine.
Esophageal ulcer: This is when a sore forms in the lining of your esophagus, which is the tube that carries food and liquid from your throat to your stomach.

Causes of Stomach Ulcers

Until the mid-1980s, the conventional wisdom was that ulcers form as a result of stress, being prone to excessive stomach acid secretion because of genetics, and poor lifestyle habits (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was believed that such factors could lead to a buildup of stomach acids that could erode the protective lining of the stomach, duodenum, or esophagus.

While too much stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Research since the mid-1980s has shown that the bacterium Helicobacter pylori(H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers. However, more recent figures indicate those percentages are declining.

Most people infected with H. pylori do not get ulcers. But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how an H. pylori infection spreads. They think it may pass from person to person through close contact, such as kissing. You may also get it from unclean food and water.

Other factors also seem to contribute to ulcer formation, especially in someone with an H. pylori infection, including:

* Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen). If you’ve been taking aspirin often and for a long time, you’re more likely to get a peptic ulcer. The same is true for other nonsteroidal anti-inflammatory drugs (NSAIDs). They include ibuprofen and naproxen. NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid. Other types of pain meds, such as acetaminophen, won’t lead to peptic ulcers.
* Heavy alcohol use
* Psychological stress
* Smoking

Your risk for peptic ulcers also increases if you:

* Use steroids and have high calcium levels. If you use steroids often and have high levels of calcium in your blood, known as hypercalcemia, you can be more prone to ulcers.
* Are older. Studies show that stomach ulcers are more likely to develop in older people. This may be because arthritis is prevalent in older people, and easing arthritis pain can mean taking daily doses of aspirin or ibuprofen. Also, with advancing age, the pylorus (the valve between the stomach and duodenum) relaxes and allows extra bile (a compound produced in the liver to aid in digestion) to seep up into the stomach and erode the stomach lining.
* Have type A blood. For an unknown reason, people with type A blood are more likely to develop cancerous stomach ulcers.
* Have type O blood. Duodenal ulcers tend to appear in people with type O blood, possibly because they do not produce the substance on the surface of blood cells that may protect the lining of the duodenum.
* Have Zollinger-Ellison syndrome. If you have Zollinger-Ellison syndrome, which is a rare condition where tumors in your pancreas or duodenum (called gastrinomas) cause your stomach to make too much acid, you are at a greater risk of developing peptic ulcers.

Additional Information:

Definition

A peptic ulcer is an open sore or raw area in the lining of the stomach (gastric ulcer) or in the first part of the small intestine (duodenal ulcer).

There are two types of peptic ulcers:

Gastric ulcer -- occurs in the stomach
Duodenal ulcer -- occurs in the first part of the small intestine

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:

* Swollen and inflamed tissue (gastritis)
* An ulcer

Most ulcers occur in the first, inner surface, layer of the inner lining. A hole in the stomach or duodenum is called a perforation. This is a medical emergency.

The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following factors raise your risk for peptic ulcers:

* Drinking too much alcohol
* Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)
* Smoking cigarettes or chewing tobacco
* Being very ill, such as being on a breathing machine
* Radiation treatments
* Stress

A rare condition, called Zollinger-Ellison syndrome, causes the stomach to produce too much acid, leading to stomach and duodenal ulcers.

Symptoms

Small ulcers may not cause any symptoms and may heal without treatment. Some ulcers can cause serious bleeding.

Abdominal pain (often in the upper mid-abdomen) is a common symptom. The pain can differ from person to person. Some people have no pain.

Pain occurs:

* In the upper abdomen
* At night and wakes you up
* When you feel an empty stomach, often 1 to 3 hours after a meal

Other symptoms may include:

* Feeling of fullness and problems drinking as much fluid as usual
* Nausea
* Vomiting
* Bloody or dark, tarry stools
* Chest pain
* Fatigue
* Vomiting, possibly bloody
* Weight loss
* Ongoing heartburn

Exams and Tests

To detect an ulcer, you may need a test called an upper endoscopy (esophagogastroduodenoscopy or EGD).

This is a test to check the lining of the esophagus (food pipe), stomach, and first part of the small intestine.

It is done with a small camera (flexible endoscope) that is inserted down the throat.

This test most often requires sedation given through a vein (IV).

In some cases, a smaller endoscope may be used that is passed into the stomach through the nose. This does not require sedation.

EGD is done on most people when peptic ulcers are suspected or when you have:

* Low blood count (anemia)
* Trouble swallowing
* Bloody vomit
* Bloody or dark and tarry-looking stools
* Lost weight without trying

Other findings that raise a concern for cancer in the stomach

Testing for H pylori is also needed. This may be done by biopsy of the stomach during endoscopy, with a stool test, or by a urea breath test.

Other tests you may have include:

* Hemoglobin blood test to check for anemia
* Stool occult blood test to test for blood in your stool

Sometimes, you may need a test called an upper GI series. A series of x-rays are taken after you drink a thick substance that contains barium. This does not require sedation.

Treatment

Your health care provider will recommend medicines to heal your ulcer and prevent a relapse. The medicines will:

* Kill the H pylori bacteria, if present.
* Reduce acid levels in the stomach. These include H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid AC), and nizatidine (Axid), or a proton pump inhibitor (PPI) such as omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole (AcipHex) or pantoprazole (Protonix).

Take all of your medicines as you have been told. Other changes in your lifestyle can also help.

If you have a peptic ulcer with an H pylori infection, the standard treatment uses different combinations of the following medicines for 7 to 14 days:

* Two different antibiotics to kill H pylori.
* PPIs such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium).
* Bismuth subsalicylate (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria.

You will likely need to take a PPI for 8 weeks if:

* You have an ulcer without an H pylori infection.
* Your ulcer is caused by taking aspirin or NSAIDs.
* Your provider may also prescribe this type of medicine regularly if you continue taking aspirin or NSAIDs for other health conditions.

Other medicines used for ulcers are:

* Misoprostol, a medicine that may help prevent ulcers in people who take NSAIDs on a regular basis
* Medicines that protect the tissue lining, such as sucralfate

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:

* Injecting medicine in the ulcer
* Applying metal clips or heat therapy to the ulcer

If bleeding cannot be stopped during an EGD, you make need to have a procedure in radiology, called embolization, where the radiologist can put a coil in the bleeding blood vessel to block it and stop the bleeding.

Surgery may be needed if:

* Bleeding cannot be stopped with an EGD or by the radiologist
* The ulcer has caused a tear (perforation) in the stomach or duodenum.

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