in some patients.
pain in the upper stomach area several hours after a meal
(duodenal ulcer) or dull, aching pain, often right after
a meal (gastric ulcer). Pain may radiate to the back or behind
the breastbone, resembling heartburn.
nausea, vomiting, and weight loss.
symptoms: black, tarry, or bloody stools; vomiting
of blood or material resembling coffee grounds (signs of
potentially serious bleeding). Searing abdominal pain could
indicate that an ulcer has eroded completely through the
digestive tract (perforation). Such complications require
immediate emergency medical attention.
When To Call Your Doctor
a doctor for symptoms of peptic ulcer disease.
those with ulcers, any signs of bleeding or perforation (including
vomiting blood; black, tarry stools; or severe abdominal
pain) require immediate emergency medical attention.
What Is It?
Peptic ulcers are craterlike erosions in the lining
of the stomach, the duodenum (the part of the small intestine
just past the stomach), and rarely, the esophagus. Duodenal ulcers
are about three times more common than stomach (gastric) ulcers.
Normally, glands in the stomach secrete acid and the enzyme pepsin
(hence the name peptic ulcer) that help to break down foods in
the digestive process. The stomach and duodenum meanwhile secrete
mucus to protect them against harm from pepsin and gastric acid.
In peptic ulcer disease, the digestive tracts defensive
mechanisms break down, often as a result of infection with the
bacterium Helicobacter pylori. Consequently, even small amounts
of stomach acid can cause corrosion.
Each year, about 1% of Americans develop peptic
ulcers, and overall, up to 10% of the population will have an
ulcer at some point during their lives. All ages may be affected
(including children), although ulcers most often affect those
over age 30. Although peptic ulcers are rarely a major health
threat, they sometimes lead to serious complications, such as
bleeding, obstruction of the digestive tract due to scarring,
or the creation of a hole or tear (perforation) in the digestive
tract, which can lead to severe, life-threatening infection of
the abdominal cavity (peritonitis). In addition, in a small percentage
of cases a persistent stomach ulcer may be cancerous. The same
is not true for duodenal ulcers. For most ulcers, treatment is
highly effective in controlling symptoms and preventing serious
What Causes It?
At least 80%
of ulcers are believed to be caused by infection of the digestive
tract with H. pylori bacteria. It is not known how the infection
spreads, although it may be transmitted orally or through contaminated
food or water. H. pylori infests about 60% of Americans by age
60, but most of those infected do not develop ulcers. Rather,
the bacteria merely increase the chances of developing an ulcer
by weakening the stomachs protective mechanisms and making
the lining of the digestive tract susceptible to erosion by stomach
acids. Once an ulcer has developed, various secondary factors
can aggravate it, including alcohol, caffeine, dietary factors,
smoking, and stress.
In the past,
excessive production of stomach acid was thought to be the primary
cause of ulcers. It is now recognized that many people with ulcers
actually have normal or even slightly less-than-normal amounts
of stomach acid. However, because mechanisms that protect the
digestive tract lining are weakened (in most cases by H. pylori),
even small amounts of stomach acid can cause (or delay the healing
of) ulcers. The exception is ulcers caused by certain kinds of
pancreatic or duodenal tumors, which secrete the hormone gastrin
and cause massive amounts of acid secretion (Zollinger-Ellison
of aspirin and other nonsteroidal anti-inflammatory drugs, such
as ibuprofen or naproxen, can lead to ulcers primarily in the
stomach by irritating its lining.
factors also appear to play a role. The chances of developing
an ulcer are greater if a close family member has had one.
use of aspirin or nonsteroidal anti-inflammatory drugs if possible.
Anyone who must take these drugs on a long-term basis, such as
those with arthritis, may benefit from the prescription drug
To help prevent
ulcer recurrence, carefully follow instructions for any ulcer
drugs prescribed. Do not smoke, and avoid foods or drinks that
have caused flare-ups in the past.
and physical examination are needed.
An upper gastrointestinal
series (which involves swallowing a solution containing barium
to create a clear image of the digestive tract on x-ray) may
show active ulcers or scarring caused by past ulcers.
which a flexible scope is guided down the throat and into the
stomach and duodenum) allows ulcers to be viewed directly. A
small sample of the ulcer (biopsy) may be taken at the same time
to test for cancer.
also detect the presence of H. pylori, but this method is invasive
and expensive. Quick office tests for the detection of this bacterium
are becoming available.
How To Treat It
caused by H. pylori, a combination of two antibiotics (usually
metronidazole and tetracycline) is usually taken for at least
two weeks, along with a bismuth-containing antacid (such as Pepto-Bismol).
Antacids or medications that reduce acid secretion may also be
given. Combination antibiotic regimens prevent ulcer recurrences
in about 90% of cases.
be needed for bleeding, obstruction, or perforation of the digestive
tract, or intractable pain from ulcers.
Eat a well-balanced
diet rich in fiber. Many dietary measures advocated in the pastsuch
as eating bland foods, eating many small meals a day rather than
three larger meals, or drinking milkdo not appear to help.
Indeed, milk may actually increase stomach acid production, although
one or two glasses a day is usually not harmful. Coffee, tea,
and caffeinated sodas can increase acid secretion. Avoid excessive
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