Peptic Ulcer Disease

What is it?

Ulcers, or open sores, can form on the inside of your GI tract: the esophagus, stomach, and first portion of the small intestine, the duodenum. These open areas are called ulcers. Ulcerations form as acid irritates the protective lining of the GI tract.

Risk factors for developing an ulcer include:

Bacterial infection. A common cause of ulcers is an infection with Helicobacter pylori.
Regular use of nonsteroidal anti-inflammatory medications. These are things such as aspirin, ibuprofen and naproxen. These medications decrease the protective lining and irritate the stomach tissue.
Other medications can be linked to the formation of ulcers.
Smoking and alcohol use. This can weaken the stomach lining allowing irritants to cause more damage.
Significant stress such as major surgery, injury, or severe infection.

What are the symptoms?

Abdominal pain. Often this is burning, gnawing, and aching in nature. It can be worse depending on if your stomach is empty or full; it may flare at night and can be relieved by foods that neutralize the acid in the stomach.
If an ulcer is bleeding, you may vomit blood or have dark black, tar-like stools.
Nausea.
Unexplained weight loss.
Changes in appetite.
Bloating.
Feeling full after just several bites.

How is it diagnosed?

Several tests may be performed. You may be tested for an infection with H. pylori which can be done with a blood, stool, or breath test. An upper endoscopy may be performed to actually look with a camera in your esophagus, stomach, and small intestine. Small tissue samples can be taken and examined under a microscope. Sometimes x-rays of the upper GI tract will be obtained.

How is it treated?

If ulceration is not treated, it can cause bleeding, infection, perforation, or scarring.

Treatment is directed at the cause of the ulceration. For example, if there is a medication that can lead to damage to the lining of your stomach this will be stopped or if you have an infection with H.pylori this will be killed with antibiotics.

In general, medicines are used to decrease the levels of stomach acid to help with your symptoms and create an environment more likely for the stomach tissue to heal. This can be accomplished with medicines that block the production of acid (proton pump inhibitors), reduce acid production (histamine blockers), and/or neutralize the acid already present in the stomach (antacids). Medications to protect the lining of the small intestine may also be given such as sucralfate, misoprostol, or bismuth subsalicylate.

After about two months of treatment often another upper endoscopy to confirm that the ulcer has healed will be performed.

What can I do?

Stop smoking
Avoid alcohol
Avoid spicy, acidic, fried or fatty foods
Avoid coffee and caffeinated beverages
Avoid NSAID (non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, Aleve, Naproxen and Celebrex) if possible.
Manage your stress level, as stress can make the inflammation worse.