A peptic ulcer is a round or oval sore that forms when stomach acid and digestive juices eat away at the lining of the stomach or duodenum. Peptic ulcers are caused by Helicobacter pylori infection or medicines that weaken the stomach or duodenum lining. Ulcer pain comes and goes, and it usually happens after meals since stomach acid is created in reaction to eating. The symptoms of stomach pain and the results of a flexible viewing tube examination of the stomach are used to diagnose peptic ulcer disease (upper endoscopy). Antibiotics are given to eradicate Helicobacter pylori, while antacids and other medications are given to lower acid in the stomach.
Ulcers are wounds in the stomach or duodenal lining (the first part of the small intestine). Ulcers can be anywhere from a few millimeters to several centimeters in length. Ulcers can strike at any age, including infancy and youth, but they are most frequent in adults in their forties and fifties. Ulcer illness can arise from gastroenteritis (stomach inflammation).
Specific ulcer names refer to their anatomic sites or the conditions in which they formed.
The most frequent type of peptic ulcer is a duodenal ulcer, which occurs in the first few inches of the duodenum.
Gastric ulcers (also known as stomach ulcers) are less prevalent and mainly arise in the lower stomach.
When a portion of the stomach is surgically removed and the remaining stomach is attached to the intestine, marginal ulcers can develop.
Stress ulcers, similar to those seen in acute stress gastritis, can develop as a result of the stress of a serious illness, skin burns, or injury. Ulcers in the stomach and duodenum are caused by stress.
Ulcers form when the stomach or duodenum’s regular defense and repair processes are impaired, making the lining more vulnerable to stomach acid injury.
Peptic ulcers are caused by two factors that are far and away from the most common.
- Infection of the stomach with Helicobacter pylori
- Nonsteroidal anti-inflammatory medication (NSAID) use (NSAIDs)
- Infection with H. pylori is shown in 50 to 70% of persons with duodenal ulcers and people with stomach ulcers.
More than half of all peptic ulcers are caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Most persons who take NSAIDs, on the other hand, do not develop peptic ulcers.
Smokers are more prone than nonsmokers to acquire a peptic ulcer, and their ulcers heal more slowly and are more likely to recur. Although alcohol increases stomach acid production, it does not appear to cause ulcers or prolong their healing when consumed in moderation. Ulcers can be caused by psychological stress. Doctors discovered an increased frequency of ulcer disease in Japan following an earthquake and in New York following the 9/11 terrorist attacks.
A form of cancer that generates a hormone called gastrin, which promotes excessive acid production, is an uncommon cause of peptic ulcers (see Zollinger-Ellison Syndrome). Cancerous ulcers have symptoms that are remarkably similar to noncancerous ulcers. Cancerous ulcers, on the other hand, rarely react well to noncancerous ulcer therapies.
A family history of peptic ulcer disease affects 50 to 60% of children with duodenal ulcers. According to recent evidence, this is because H. pylori infection is passed down through the family. Doctors are skeptical that people are born with a higher risk of infection.
The symptoms of peptic ulcer disease vary depending on where the ulcer is located and how old the person is. Children, the elderly, and adults whose ulcers were induced by NSAIDs, for example, may not have the clinical manifestation ms or may have none at all. Ulcers are only discovered when complications arise in these cases.
A peptic ulcer’s most prevalent symptom is indigestion.
Upper abdominal pain ranges from mild to moderate.
The pain is commonly described as gnawing, burning, hurting, or discomfort, or as a hungry sensation, and it occurs in the upper abdomen, right behind the breastbone. Food or antacids are commonly used to ease it. The usual ulcer heals and reappears. As a result, discomfort may last for days or weeks before fading or disappearing, only to reappear when the ulcer returns. Only around half of the population experiences typical symptoms.
The symptoms of a duodenal ulcer usually follow a pattern. When people first wake up, they are normally pain-free, but by mid-morning, discomfort has set in. The discomfort is usually relieved by drinking milk, eating (which buffers stomach acid), or taking antacids, but it returns 2 or 3 hours later. Pain that wakes a person up in the middle of the night is typical. The discomfort usually flares up once or twice a day for one to many weeks before disappearing without medication. Pain, on the other hand, frequently returns within the first two years, and possibly after several years. People create patterns and often learn when a repeat is probable through experience (commonly in spring and fall and during periods of stress).
Unlike duodenal ulcers, the symptoms of stomach ulcers, marginal ulcers, and stress ulcers do not follow a pattern. Eating can either momentarily reduce pain or exacerbate discomfort rather than alleviate it. Gastric ulcers can induce scarring and swelling of the tissues leading to the small intestine (edema), which can make it difficult for food to pass through the stomach. After eating, this blockage may produce bloating, nausea, or vomiting.
The majority of peptic ulcers may be treated without causing complications. Peptic ulcers, on the other hand, can sometimes lead to life-threatening consequences, such as cancer.
- obstructive action (blockage)
When a patient complains of stomach pain, a doctor suspects an ulcer. The doctor may merely treat the patient for an ulcer to see whether the symptoms improve (called empiric therapy). If the symptoms go away, it’s very likely that the person has an ulcer.
Tests may be required to confirm the diagnosis, particularly if symptoms persist after a few weeks of treatment, or if they first present in a person over the age of 45 or who has additional symptoms such as weight loss, as stomach cancer can cause similar symptoms. A doctor may suspect an underlying illness that causes the stomach to overproduce acid if serious ulcers defy therapy, especially if a person has numerous ulcers or the ulcers are in unexpected spots.
The doctor performs an upper endoscopy to assist detect ulcers and pinpointing their origin (a procedure done using a flexible viewing tube called an endoscope).
A biopsy (removal of a tissue sample for examination under a microscope) can be performed during an endoscopy to assess if a stomach ulcer is malignant and to help identify the presence of Helicobacter pylori bacteria. An endoscope can also be used to stop active bleeding and reduce the risk of recurrent ulcer bleeding.
Only 10% of those who have successfully treated their Helicobacter pylori infection will develop peptic ulcer disease again. Peptic ulcer disease, on the other hand, returns in 70% of infected persons who are merely treated with acid-suppressing medicines.
- Acid-reducing medicines
- Antacids are sometimes used in conjunction with surgery.
Because H. pylori infection is a leading cause of ulcers, when the infection is detected, it is treated with two antibiotics, bismuth subsalicylate, and a proton pump inhibitor (known as quadruple therapy). Amoxicillin, clarithromycin, metronidazole, and tetracycline are some of the antibiotics that can be employed. Two antibiotics and a proton pump inhibitor without bismuth subsalicylate are among the treatments (called triple therapy).
Acid-blocking medications prevent stomach acid from being produced. Proton pump inhibitors and histamine-2 (H2) blockers are the most often prescribed acid-reducing medications (see also Drug Treatment of Stomach Acid). Proton pump inhibitors heal ulcers in a higher percentage of persons in a shorter amount of time than H2 blockers and are consequently often favored for treating ulcers over H2 blockers.
Antacids, such as calcium carbonate or similar liquids or tablets, neutralize stomach acid but do not prevent it from being produced.
Regardless of the origin, neutralizing or lowering stomach acid aids in the healing of peptic ulcers. Treatment usually lasts 4 to 8 weeks for most patients. While bland foods may help lower acid, there is little proof that they expedite healing or prevent ulcers from recurring. Nonetheless, it is reasonable for people to avoid meals that appear to aggravate pain and bloating. It’s also crucial to avoid stomach irritants such as NSAIDs, alcohol, and tobacco.
Because medications are so good at healing peptic ulcers and endoscopy is so effective at stopping active bleeding, surgery for ulcers is no longer necessary. Surgery is generally used to treat peptic ulcer problems such as bleeding.
- A hole or a perforation
- A blockage that does not respond to medication or recurs.
- Two or more major bleeding ulcer episodes
- A malignant gastric ulcer is suspected.
- Peptic ulcer recurrences that are severe and frequent
To treat these issues, a variety of surgical treatments may be used. Surgery can be used to minimize acid production and ensure that the stomach drains properly. Ulcers can reoccur following surgery, and each technique has its own set of complications, such as weight loss, poor digestion, frequent bowel movements (dumping syndrome), and anemia.