ULCERS

Overview & Facts

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.

Causes of Ulcers

  • No single cause has been found
  • End result of an imbalance between digestive fluids in the stomach and duodenum
  • Most ulcers are caused by Helicobacter pylori (H. pylori) bacterial infection

Factors that can increase your risk for ulcers include:

  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of Midol, and others)
  • Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)
  • Excessive Alchohol intak
  • Smoking or chewing tobacco
  • Serious illness
  • Radiation treatment to the area

Types & Symptoms

  • May be present even without symptoms
  • Usual symptoms include:
    • A gnawing or burning pain in the middle or upper stomach between meals or at night
    • Bloating
    • Heartburn
    • Nausea or vomiting
  • 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
  • May heal on their own but if untreated, they may lead to:
    • Bleeding
    • Perforation of the stomach
    • Gastric outlet obstruction due to scarring or inflammation

NSAID use can lead to ulcers without any warning therefore this risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.

Diagnosis & Medications

DIAGNOSIS

  • Physician may do/request:
    • History & Physical Exam
      • Interview regarding symptoms
    • Upper endoscopy
      • Insertion a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities

 

RECOMMENDED MEDICATIONS

  • Medications include:
    • Proton pump inhibitors (PPI)
      • 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
      • For H. Pylori infection 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.
    • Upper endoscopy
      • Some bleeding ulcers can be treated through an endoscope
    • Surgery
    • Usually 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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