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Digestive Disorders

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Peptic Ulcer

Symptoms

No symptoms in some patients.

Gnawing 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.

Indigestion, nausea, vomiting, and weight loss.

Emergency 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

Call a doctor for symptoms of peptic ulcer disease.

Emergency: For 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 tract’s 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 complications.

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 stomach’s 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 syndrome).

Long-term use 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.

Hereditary factors also appear to play a role. The chances of developing an ulcer are greater if a close family member has had one.

Prevention

Avoid long-term 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 misoprostol.

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.

Diagnosis

Patient history 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.

Endoscopy (in 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.

Biopsies can 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

For ulcers 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.

Surgery may 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 past—such as eating bland foods, eating many small meals a day rather than three larger meals, or drinking milk—do 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 alcohol consumption.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.

 

 


 


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2005
WHITE PAPERS
Digestive Disorders

The Digestive Disorders White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.

 

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