Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers; Bleeding ulcer; Gastrointestinal bleeding - peptic ulcer; Gastrointestinal hemorrhage - peptic ulcer; G.I. bleed - peptic ulcer; H. pylori - peptic ulcer; Helicobacter pylori - peptic ulcer A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine. There are two types of peptic ulcers: Peptic ulcers may lead to emergency situations. Severe abdominal pain with or without
evidence of bleeding may indicate a perforation of the ulcer through the stomach or duodenum. Vomiting of a substance that resembles coffee grounds, or the presence of black tarry stools, may indicate serious bleeding. The procedure called gastroscopy involves the placing of an endoscope (a small flexible tube with a camera and light) into the stomach and duodenum to search for abnormalities. Tissue samples may be obtained to check for H pylori bacteria, a cause of many peptic ulcers. An actively bleeding ulcer may also be cauterized (blood vessels are
sealed with a burning tool) during a gastroscopy procedure. A peptic ulcer is an open sore or raw area in the lining of the stomach (gastric) or the
upper part of the small intestine (duodenal). A major cause of peptic ulcer, although far less common than H.pylori or NSAIDS, is Zollinger-Ellison
syndrome. A large amount of excess acid is produced in response to the overproduction of the hormone gastrin, which in turn is caused by tumors on the pancreas or duodenum. These tumors are usually malignant, must be removed and acid production suppressed to relieve the recurrence of the ulcers. An ulcer is a crater-like lesion on the skin or mucous membrane caused by an inflammatory, infectious, or malignant condition. To avoid irritating an ulcer a person can try eliminating certain substances from their diet such as caffeine, alcohol, aspirin, and avoid smoking. Patients can take certain medicines to suppress the acid in the
stomach causing the the erosion of the stomach lining. Endoscopic therapy can be used to stop bleeding from the ulcer.
If you've got stomach pain and nausea, any number of gastrointestinal problems could be to blame. When these symptoms don't go away, one possibility is that you have a peptic ulcer. Let's talk about peptic ulcers. A peptic ulcer is a defect in the lining of your stomach or the first part of your small intestine, the duodenum. When the defect is in your stomach, it's called a gastric ulcer. A defect in your duodenum is called a duodenal ulcer. Your stomach is filled with strong acid, which breaks down and digests the foods you eat. If you've ever seen a strong acid at work, you know that it starts to burn away anything it touches. That's why your stomach and intestines are equipped with a special lining to protect them. But if that lining breaks down for any reason, acids can start eating their way through. When acids burn a hole all the way through the stomach or duodenum, it's called a perforation, and that's a medical emergency. You may joke that your boss is giving you an ulcer, and it's possible that stress does play some part in ulcers. More likely, your ulcer is caused by a stomach infection with a type of bacteria called H. pylori. Other common ulcer risks include smoking cigarettes, drinking a lot of alcohol, or regularly using NSAID pain relievers like aspirin and ibuprofen. If the ulcer is small, you may have no idea that you have it because there are no symptoms. Larger ulcers can cause abdominal pain, a feeling of fullness in the stomach, and nausea. If you have any of these ongoing symptoms, your doctor will look inside your GI tract to see what's going on. One way to do this is with an upper endoscopy, a thin tube with a camera on one end that takes pictures as it moves through your stomach and small intestine. A lower GI is a series of x-rays that are taken after you drink a radioactive substance called barium. Your doctor will also test you for the H. pylori bacteria that may be causing your ulcer. Treatment for peptic ulcers works in two ways. If you have an H. pylori infection, you'll have a medication regimen to kill the bacteria. You'll also get a medicine called a proton pump inhibitor, such as Prilosec or Prevacid, which reduces the amount of acid in your stomach. Try to avoid taking NSAID pain relievers for long periods of time, especially if you have a problem with H. pylori. Use Tylenol instead. If you do have to take NSAIDs, also take an acid-blocking drug to protect your sensitive stomach. Also avoid tobacco smile and excess alcohol. Follow your doctor's instructions carefully for treating a peptic ulcer. If you don't follow your treatment as directed, your ulcer could come back. Call your doctor right away if you have sharp stomach pain, you're sweating a lot or feeling confused, or your stomach feels hard to the touch. These could be signs of a serious ulcer complication that needs immediate medical help. CausesNormally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:
Most ulcers occur in the first layer of the inner lining. A hole in the stomach or duodenum is called a perforation. This is a medical emergency. The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer. The following factors raise your risk for peptic ulcers:
A rare condition, called Zollinger-Ellison syndrome, causes stomach and duodenal ulcers. SymptomsSmall ulcers may not cause any symptoms. Some ulcers can cause serious bleeding. Abdominal pain (often in the upper mid-abdomen) is a common symptom. The pain can differ from person to person. Some people have no pain. Pain occurs:
Other symptoms include:
Exams and TestsTo detect an ulcer, you may need a test called an upper endoscopy (EGD).
EGD is done on most people when peptic ulcers are suspected or when you have:
Testing for H pylori is also needed. This may be done by biopsy of the stomach during endoscopy, with a stool test, or by a urea breath test. Other tests you may have include:
Sometimes, you may need a test called an upper GI series. A series of x-rays are taken after you drink a thick substance called barium. This does not require sedation. TreatmentYour health care provider will recommend medicines to heal your ulcer and prevent a relapse. The medicines will:
Take all of your medicines as you have been told. Other changes in your lifestyle can also help. If you have a peptic ulcer with an H pylori infection, the standard treatment uses different combinations of the following medicines for 7 to 14 days:
You will likely need to take a PPI for 8 weeks if:
Your provider may also prescribe this type of medicine regularly if you continue taking aspirin or NSAIDs for other health conditions. Other medicines used for ulcers are:
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:
Surgery may be needed if:
Outlook (Prognosis)Peptic ulcers tend to come back if untreated. There is a good chance that the H pylori infection will be cured if you take your medicines and follow your provider's advice. You will be much less likely to get another ulcer. Possible ComplicationsComplications may include:
When to Contact a Medical Professional
Get medical help right away if you:
Contact your provider if:
PreventionAvoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first. Your provider may:
The following lifestyle changes may help prevent peptic ulcers:
ReferencesChan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 53. Cover TL, Blaser MJ. Helicobacter pylori and other gastric Helicobacter species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 217. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613-624. PMID: 28242110 pubmed.ncbi.nlm.nih.gov/28242110/. Version InfoLast reviewed on: 5/27/2020 Reviewed by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Internal review and update on 08/26/2021 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Which findings are commonly associated with peptic ulcer disease?A history of episodic or epigastric pain, relief of pain after food intake, and nighttime awakening because of pain with relief following food intake are the most specific findings for peptic ulcer and help rule in the diagnosis.
What are the clinical signs and symptoms of peptic ulceration?These symptoms include epigastric pain that worsens with eating, postprandial belching and epigastric fullness, early satiety, fatty food intolerance, nausea, and occasional vomiting [2,5].
What is the diagnosis of peptic ulcer?Your doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.
What the three main symptoms associate with stomach ulcer?The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the tummy (abdomen). But stomach ulcers aren't always painful and some people may experience other symptoms, such as indigestion, heartburn and acid reflux and feeling sick.
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