Ulcers

What are ulcers?

Ulcers are open sores caused by a breakdown of the mucous membrane which fails to heal. A peptic ulcer is a small erosion (sore) in the lining of your stomach or other part of the gastro-intestinal tract. Peptic ulcers and upper middle stomach pain are common, affecting millions of Americans each year. The size of a stomach ulcer can range between 1/8 of an inch to 3-6 inches. Larger ulcers are more likely to cause severe and persistent upper middle stomach pain.

What are the types of ulcers?

Stomach Ulcer: Also known as a gastric ulcer, this is sore that develops in the stomach lining. Stomach ulcers may become malignant.

Duodenal Ulcers: Another common type of ulcer is the duodenal ulcer, which affects the first 12 inches of the small intestine. Duodenal ulcers are not cancerous nor are they contagious. People can have both a gastric and duodenal ulcer at the same time, and ulcers can re-occur.

Esophageal Ulcers: Less commonly, a peptic ulcer can develop just above the stomach in the esophagus, which is the tube that connects the mouth to the stomach. These are called esophageal ulcers.

What causes ulcers?

Years ago, it was common for doctors to think that ulcers were caused by stress or by eating food with too much acid in it. Today, we know that to be untrue. Ulcers are caused by infection from a bacteria (germ) called Helicobacter pylori, or H. pylori for short. Ulcers are also caused by an imbalance between digestive fluids in the stomach and duodenum.  Another common cause of ulcers is the use of painkillers such as anti-inflammatory drugs such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.

If your body makes too much acid, this acid can certainly aggravate the symptoms by burning the lining of your digestive tract. While physical or emotional stress does not cause an ulcer, it can aggravate it. Eating spicy foods, smoking, and drinking alcohol can also worsen ulcers and prevent healing.

Peptic ulcers are not caused by stress or eating spicy food, but both can make ulcer symptoms worse. Pain on an empty stomach is common as the stomach lining has less of a buffer against the acid. Smoking and drinking alcohol can also worsen ulcers and prevent healing.

What are the symptoms of an ulcer?

An ulcer may or may not have symptoms. The most common symptom for both duodenal and gastric ulcers is abdominal discomfort. Upper middle stomach pain is typically felt anywhere between the navel and the breastbone, and is usually characterized as a dull, gnawing, or burning pain. The symptoms tend to occur when the stomach is empty which explains pain on an empty stomach and during the night. The symptoms may be briefly relieved by eating some food, or antacids. Ulcer symptoms including upper middle stomach pain can come and go and can be confused for pancreatitis, so check through those symptoms also, or they can last for several days or even weeks.

Other symptoms may include:

• Nausea
• Vomiting
• Bloating
• Poor appetite
• Weight loss

More severe cases of ulcers, the symptoms can include:

• Weight loss
• Dark or black stool (internal bleeding)
• Severe pain in the abdomen
• Vomiting blood (can have a “coffee-grounds” appearance)

If you have any of the following symptoms, call a doctor immediately! These symptoms could be a sign of a serious problem, such as internal bleeding, perforation of the ulcer through the stomach wall, or obstruction (when the peptic ulcer blocks the path of food into the stomach):

• Bloody, black stools
• Sharp, sudden, persistent, and severe stomach pain
• Bloody vomit or vomit that looks like coffee grounds

How are ulcers diagnosed?

Your doctor will begin with a complete medical and physical history. Once he determines your symptoms, he may treat you with medication to see if the upper middle stomach pain and other symptoms subside within a week or so. If the medications are helping, you may not need tests. If you do require diagnostic exams, they most likely will include:

• Endoscopy. the doctor looks into your stomach through a thin tube; he or she may take a biopsy (a sample of the stomach lining) to test for H. pylori or malignancy.
• Urea breath test. The doctor will have you swallow a tiny capsule, or drink a clear fluid which contains radioactive carbon. After a few minutes, you will blow into a bag which is sealed. If you have H.Pylori, it will show and confirm an ulcer is most likely present.
• X-ray of your upper digestive system. This is also called upper GI series or barium swallow. You will drink the barium, which makes the ulcer more visible, and it creates a series of images of your esophagus, stomach, and small intestine.
• Blood test. A blood sample will also show the H. pylori antibodies.
• Stool antigen test. The stool sample is tested for the H. pylori antigens.

How are ulcers treated?

Sometimes ulcers will heal on their own, but you should not ignore their warning signs. Left untreated, ulcers can lead to serious health problems. The most common treatments for ulcers are lifestyle changes (quitting smoking, not drinking alcohol), medications, and surgery. If the ulcer is caused by H. pylori, this would be treated with drugs that kill the bacteria, reduce stomach acid, and protect the stomach and duodenal lining. The correct antibiotic would be determined by where a person lived, because the strains of the bacteria are very different throughout the world.

Treatments for peptic ulcer can include:

• Antibiotic medications to kill H. pylori. Eliminating the bacteria which causes the H. pylori can be difficult. Even though 80 to 90 percent of ulcers can be cured with antibiotics, it can still take time. In the US, the most common antibiotics used include amoxicillin, Biaxin, Flagyl, and tetracycline. It is crucial to finish all medicines even if you feel better and the peptic ulcer is gone. You’ll likely need to take antibiotics for two weeks. Usually your doctor may take another breath or stool test about 4 weeks after treatment. (Blood tests won’t work here because your blood can still test positive for the H. pylori bacteria, even though you have been treated.)
• Acid-reducing medicines. This type of medicine helps to reduce the amount of acid released into your digestive tract and can help relieve peptic ulcer pain and promote healing. These are called “proton pump inhibitors (PPIs)” and “histamine receptor blockers (H2) blockers”. Most are available over-the-counter, such as Zantac, Pepcid, Tagamet, Prilosec, Prevacid, Aciphex, Nexium, and Protonix. Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Discuss a calcium supplement with your doctor to reduce this risk.
• Triple Play. In the United States, standard treatment for an ulcer caused by the H. pylori bacteria is referred to as triple therapy. This involves the antibiotic clarithromycin, a PPI, and the antibiotics amoxicillin or metronidazole for 10 to 14 days. High cure rates have been reported using this triple therapy for 14 days, resulting in some doctors now prescribing triple therapy for this longer period.
• Bismuth quadruple therapy. With this treatment, the patient takes a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole for 10 to 14 days. This treatment is generally used for more severe symptoms, if the patient cannot take amoxicillin—a penicillin-like antibiotic—because of a penicillin allergy, if the patient had been treated with a macrolide antibiotic, such as clarithromycin, or if the patient is still infected with H. pylori because triple therapy failed to kill the bacteria. Both the triple and quadruple therapies can cause side effects such as headaches, diarrhea, stomach upset, metallic taste in the mouth, sensitivity to the sun, darkened tongue or stools, and/or getting flushed when drinking alcohol.

If a patient does not react favorably to any of these treatments, the doctor may decide to repeat them with a second round of medications. Generally your doctor will choose a different course of antibiotics because the bacteria could be resistant to the medicine.

Frequently Asked Questions

Can antacids or milk help a peptic ulcer heal?

People used to believe drinking milk helped peptic ulcers heal, because it gave temporary relief. Today we know that milk actually increases stomach acid, which could make the ulcer worse. The best thing to do is discuss drinking milk with your doctor.

Antacids also help provide relief, but do not kill the H. pylori bacteria. Some antacids can impede the treatment of antibiotics. It’s best to check with your doctor before using any over-the-counter antacids.

Can what I eat affect ulcers?

No, neither spicy food nor stress causes ulcers, but they can trigger symptoms. Certain foods can make the pain worse. These foods include coffee, tea, chocolate, meat extracts, alcohol, black pepper, chili powder, mustard seeds, and nutmeg. If these bother you, it’s best to avoid them. Eat a balanced diet and also try eating small, frequent meals when you’re having pain. Smoking and drinking alcohol, however, can make ulcers worse, prevent healing, and exacerbate upper middle stomach pain and other ulcer symptoms.

What is the most common symptom of an ulcer?

Dull or burning pain, most often in the upper middle abdomen and most often on an empty stomach.

How long does it take for an ulcer to cure?

With the H. pylori bacteria, the usual course of antibiotics is from 2-4 weeks.

What is best to take to relieve ulcer discomfort?

Taking antacids can provide temporary relief, but always check with your doctor before taking any medicines, even over-the-counter ones.

What causes ulcers?

The two most common causes for ulcers are the H. pylori bacteria and painkillers known as anti-inflammatory drugs or NSAIDs. A very small percentage of people have ulcers from other causes like excess stomach acid secretion.

What are some helpful tips for living with ulcers?

• Be cautious when choosing over-the-counter pain relievers.
• Don’t overdose on iron supplements. If you are anemic, check with your doctor.
• Learn to deal with stress by practicing relaxation techniques, such as deep breathing, yoga and moderate exercise.
• Eat properly prepared food.
• Drink from clean safe sources.
• Always wash hands after using the bathroom.
• Don’t smoke.
• Avoid caffeine and alcohol.
• Avoid spicy foods if they cause heartburn.