GASTRIC ULCER

Gastric ulcers are sores in the lining of the stomach.  It is a type of peptic ulcer, and occurs when the organs are corroded by acidic digestive juices, known as pepsin.  Other type of peptic ulcers are the esophageal ulcer and the duodenal ulcer.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Common causes include:

  • A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer, it can cause inflammation of the stomach’s inner layer, producing an ulcer.
  • Regular use of certain pain relievers. Certain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, Anaprox, others), ketoprofen and others.
  • Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others) and potassium supplements.

An ulcer may or may not have symptoms. When symptoms occur, they may include:

  • A gnawing or burning pain in the middle or upper stomach during meals
  • Bloating
  • Heartburn
  • Nausea or vomiting
  • Appetite changes

In severe cases, symptoms can include:

  • Dark or black stool (due to bleeding)
  • Vomiting blood (that can look like “coffee-grounds”)
  • Weight loss
  • Severe pain in the mid to upper abdomen

DIAGNOSIS

Your doctor may suspect you have an ulcer just by talking with you about your symptoms. However, to confirm the diagnosis one of several tests should be taken. First, your doctor may ask you to take an acid-blocking medication, such as those used to treat heartburn, for a short period of time to see if symptoms improve.

If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe or recurring symptoms of ulcers.

Doctors sometimes treat for ulcers without confirming the diagnosis using endoscopy.

 

RECOMMENDED MEDICATIONS

Ulcer medications can include:

  • Proton pump inhibitors (PPI). Proton pump medications reduce acid levels and allow the ulcer to heal. They include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), and omeprazole/sodium bicarbonate (Zegerid).
  • Antibiotics. If you have H. pylori infection, then antibiotics are also used. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Bismuth is also part of some treatment regimens.
  • Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.
Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).
  • Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.
Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.
  • Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.
Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).
  • Upper endoscopy. Some bleeding ulcers can be treated through an endoscope.
  • Surgery. Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach, or if there is serious bleeding that can’t be controlled with an endoscope.

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