Understanding Ulcers

Most of us know what it’s like to have a mouth sore. It’s open, it hurts and acidic and certain foods make it hurt more. A mouth sore is a type of ulcer. Normally, a layer of mucus protects the mouth from ulcers but they hurt until they heal. Now, imagine that same kind of open sore in your digestive system. Ouch! That’s generally what people mean when they talk about “ulcers.”

For a gastroenterologist, who specializes in your digestive tract, “ulcers” is a broad term since there are various conditions that differ according to where they occur in your digestive system. Some of these are gastritis, peptic ulcers, stomach ulcers and duodenal ulcers.

Let’s take a look at the biology of the digestive system to understand what territory we’re talking about.


Most of us are unfamiliar with how our digestive system works. We like it to feel good, to behave appropriately and then we can forget about it. But when the system has problems, it helps to be able to understand what’s causing the pain and where it’s coming from. This is partly the work of your gastroenterologist, but it’s helpful to understand what may be happening.

Is it Gastritis or an Ulcer?

People sometimes use the word “gastritis” when they have a stomach ache. The actual meaning of gastritis is “inflammation of the stomach.” Most people with sore stomachs don’t actually have gastritis. True gastritis causes significant pain and discomfort and should lead you to a visit with a gastroenterologist to make sure it isn’t anything more serious – like ulcers which we’ll go into in greater depth below. Gastritis is not too difficult to cure, with some lifestyle changes and perhaps some medication, your stomach should be back to normal. If you do have pain, remember, you don’t have to put up with it, help is available.

What are the different types of ulcers?

Ulcers can occur in different parts of the digestive system:

  • Esophageal ulcers: ulcers that develop inside the esophagus.
  • Gastric ulcers: ulcers that develop inside the stomach.
  • Duodenal ulcers: ulcers that develop in the upper section of the small intestine, called the duodenum.

Collectively, gastric and duodenal ulcers are known as peptic ulcers.

In a healthy digestive system a thick layer of mucus protects the stomach lining from the acidic effect of its own digestive juices. However, there are many factors that can reduce this protective layer and this allows ulcers to develop.

Do I have an ulcer?

If you think you may have an ulcer, you are not alone. Over 4 million Americans suffer from active peptic ulcers and each year 300,000 new cases are diagnosed. Although not all ulcers show symptoms, frequent symptoms include:

  • Burning pain usually in the abdominal region from your neck down, particularly between meals, early in the morning
  • Bloating
  • Heartburn
  • Nausea or vomiting

More severe symptoms can include:

  • Dark or black stool (due to bleeding)
  • Vomiting
  • Weight loss
  • Severe pain in the mid- to upper abdomen  

What causes ulcers?

As yet there is no single cause that has been found for ulcers. However, research has made it clear that an ulcer is caused by an imbalance or unevenness, between two digestive fluids (hydrochloric acid and the digestive enzyme pepsin) in the stomach and duodenum

treatment for ulcers
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Possible triggers for ulcers

  • Infection with a type of bacteria called Helicobacter pylori (H. pylori).
  • Use of aspirin, ibuprofen (Motrin®, Advil®, Midol®, and others), naproxen (Aleve®, Anaprox®, Naprosyn and others) other non-steroidal anti-inflammatory drugs (NSAIDs), and many prescription drugs. Coated aspirin can still cause ulcers.
  • Excessive production of acid. This may be caused by a condition called Zollinger-Ellison syndrome (gastrinoma). A gastrinoma is a tumor of the acid-producing cells of the stomach that increases acid output.

How are ulcers diagnosed?

If you think you might have an ulcer, or even a painful case of gastritis, your first step is to make an appointment with a gastroenterologist. You may be asked to take an acid-blocking medication for a short period of time to see if your symptoms improve.

If you are having severe ulcer symptoms, your doctor may recommend a procedure called an upper endoscopy which allows a small lighted tube called an endoscope to be inserted through the throat and stomach to look for abnormalities. If you have been taking NSAIDs, that may very likely be the cause of your ulcers, if you haven’t, then it is very likely to be from H. pylori.

At Premier Medical Group, our gastroenterologists can now test for H. pylori and will treat specifically for it, in addition to giving you medications to reduce the symptoms. H. pylori can be discovered either directly by taking a sample during an upper endoscopy, or indirectly, with a blood test or a breath test.

Lifestyle changes that can ease or cure an ulcer

While stress and eating spicy food are sometimes thought to cause ulcers, they don’t, but they can irritate an already unbalanced digestive system. If you have an ulcer, you need to eliminate the substances that may be causing it. Good rules to live by – with or without an ulcer – include:

  • DON’T drink more than two alcoholic beverages a day
  • DON’T mixing alcohol with medication
  • DO wash your hands frequently to avoid infections
  • DO limit your use of ibuprofen, aspirin, and naproxen.
  • DON’T use tobacco
  • DO eat a balanced diet rich in fruits, vegetables, and whole grains

Taking medication when necessary

Your doctor can suggest or prescribe helpful medications depending on the cause of your ulcer:

  • Proton pump inhibitors (PPI): Proton pump inhibitors reduce acid and allow the ulcer to heal.
  • Antibiotics: Antibiotics are used to treat H. pylori. There are multiple combinations of antibiotics that are taken for two weeks, along with a PPI.

It is important that you have a diagnosis before you take any medications.

Treatment procedures

Some bleeding ulcers can be treated through an endoscope, while others require an operation if the ulcer has created a hole in the wall of the stomach or if there is serious bleeding.

Last but not least: is milk a good cure for an ulcer?

No, in fact, milk can make your ulcer worse. It may offer brief relief as it coats the stomach lining, but it also makes your stomach produce more acid and digestive juices, which can aggravate symptoms and make ulcers worse.

Good science and good medicine has produced effective diagnosis and treatment for ulcers. Don’t put up with consistent stomach pain, heartburn or other symptoms, call and make an appointment with Premier Medical Group’s Gastroenterology Division at 845-471-9410 today.