AMITA Health Endoscopy Center Lincoln Park

Peptic Ulcer Disease

Overview

Peptic ulcers are open sores that exist in the inner lining of the stomach and the uppermost part of the small intestine called the duodenum. Peptic ulcer disease (PUD) is diagnosed when a patient has chronic peptic ulcers. Gastric ulcers occur in the stomach and duodenal ulcers in the duodenum.

A normal and healthy digestive tract has a layer of mucus on the inner surface or lining. This mucus layer protects the digestive lining from deterioration due to acid. An ulcer can result when the balance between mucus and acid is upset.

There are two very common causes of peptic ulcers. Helicobacter pylori or H pylori usually lives in the gut’s mucus layer and is a very common infection worldwide. Most of the time, it causes no symptoms, but sometimes it can increase inflammation in the gut lining enough to cause an ulcer. The other major cause of PUD is long-term use of anti-inflammatory medications such as ibuprofen, naproxen and aspirin.

Other risk factors include alcohol-use and smoking. And as for spicy foods? Most people think they can cause peptic ulcers, but they can’t. They can certainly worsen the symptoms of PUD, however.

Diagnosis can be made for H pylori as a potential cause of PUD by blood, breath and stool tests. An x-ray with barium swallowed can help, as can an upper gastrointestinal (GI) endoscopy. An endoscopy involves a tube with a camera that is lowered down into the esophagus to view the gut’s inner lining and take a tissue sample (biopsy).

Untreated PUD can lead to some quite unpleasant complications. These complications include internal bleeding and anemia, and even a hole in the stomach and upper small intestine. With a hole, abdominal cavity infection (peritonitis) is a serious risk. Untreated PUD may also result in obstruction that blocks food passage, makes you feel full after only small amounts of food, and can cause vomiting and weight loss. Finally, stomach (gastric) cancer may result with untreated PUD.

Symptoms

  • Burning upper abdominal pain
  • Nausea
  • Heartburn and chest pain
  • *Please seek immediate medical attention with chest pain, especially with arm pain or shortness of breath
  • Bloating and a feeling of fullness in the abdomen
  • In more severe cases, vomiting and possible vomiting of blood which may appear red or black
  • In more severe cases, dark and tarry stools indicating GI blood
  • In more severe cases, appetite changes and weight loss, feeling faint or trouble breathing

Treatments

Antibiotics. For H pylori, usually a combination of 2 antibiotics is used to treat the bacteria. The entire course of antibiotics should be completed.

Acid suppressors. Acid-reducing medication will likely be prescribed by your provider. Stomach acid can irritate your stomach and intestinal lining. The most common medications to reduce acid are proton pump inhibitors or PPIs. Lansoprazole (Prevacid) is an example of a PPI. Others include H-2 blockers such as nizatidine (Axid).

Gut-protective medicines. Cytoprotective medications such as misoprostol (Cytotec) and sucralfate (Carafate) can help protect the cells that line the stomach and duodenum.

Prevention

Hygiene. Good handwashing, especially with food preparation. Only eating foods that have been cooked completely.

Better lifestyle choices. Stop smoking and drinking alcohol. Eat more food with probiotics such as yogurt. Eat more fruits, vegetables and whole grains. Eat less meat, salt, fat and sugar. Avoid processed foods, junk food and fried foods.

Anti-inflammatories. Use caution with non-steroidal anti-inflammatory drugs (NSAIDs, like naproxen and ibuprofen) and aspirin. Consult with your provider to safely reduce aspirin, especially if taking for heart or arterial disease.