Peptic ulcers are open sores that develop on the inside lining of your stomach, upper small intestine or esophagus. The most prominent symptom is pain. Too much stress, too much spicy food, and you may be headed for one or so the thinking used to go. Not long ago, the common belief was that a result of lifestyle was the main culprit. A great deal has changed. Doctors now know that a bacterial infection or medications, not stress or diet, cause most ulcers (ULs) of the stomach and upper part of the small intestine. Most ulcers of the esophagus are associated with the reflux of stomach acid.
Depending on their location, they have different names:
- A peptic ulcer that occurs in your stomach is called a gastric UL.
- An ulcer that develops in your small intestine is named for the section of the intestine where it develops. The most common is a duodenal ulcer, which develops in the duodenum, the first part of the small intestine.
- An esophageal ulcer is usually located in the lower section of your esophagus. It’s often associated with chronic gastroesophageal reflux disease (GERD).
Peptic ULs are common. About one in 10 Americans experience one at some point in their lives. The good news is that, oftentimes, successful treatment can take just a few weeks.
Gnawing pain is the most common symptom of a peptic ulcer. The pain is caused both by the ulcer and by stomach acid coming in contact with the ulcerated area. The pain typically may:
- Be felt anywhere from your navel to your breastbon
- Last from a few minutes to many hours
- Be worse when your stomach is empty
- Flare at night
- Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
Less often, ULs may cause severe signs or symptoms such as:
- The vomiting of blood, which may appear red or black
- Dark blood in stools or stools that are black or tarry
- Nausea or vomiting
- Unexplained weight loss
- Pain in your upper back
Although stress and spicy foods were once thought to be the main causes of peptic ULs, doctors now know that many are caused by the corkscrew-shaped bacterium Helicobacter pylori (H. pylori). This bacterium was discovered in the early 1980s in biopsy specimens of people who had ULs and persistent stomach inflammation (gastritis).
H. pylori lives and multiplies within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame and erode digestive tissues, producing an ulcer. Approximately one in six people infected with H. pylori get an ulcer. One reason may be that these people already have damage to the lining of the stomach or small intestine, making it easier for bacteria to invade and inflame tissues.
H. pylori is a common gastrointestinal infection around the world. In the United States, 20 percent of people younger than 40 and half of people older than 60 are infected. In developing countries, it’s even more common. Although it’s not clear exactly how H. pylori spreads, it appears to be transmitted from person to person by close contact.
H. pylori is the most common, but not the only, cause of peptic ULs. H. pylori accounts for about half of all peptic ULs in the United States. Besides H. pylori, other causes of peptic ULs, or factors that may aggravate them, include:
- Regular use of pain relievers.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. The medications are available both by prescription and over-the-counter. Nonprescription NSAIDs include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve) and ketoprofen (Orudis KT). To help avoid digestive upset, take NSAIDs with meals.
About 20 percent of people who regularly take NSAIDs develop ULs. The drugs inhibit production of an enzyme (cyclooxygenase) that produces prostaglandins. These hormone-like substances help protect your stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining, causing bleeding and ULs.
It’s uncertain, but seems possible, that regular use of NSAIDs may also increase the risk of ULs in people infected with H. pylori.
Nicotine in tobacco increases the volume and concentration of stomach acid, increasing your risk. Smoking also may slow healing during treatment.
- Excessive alcohol consumption.
Alcohol can irritate and erode the mucous lining of your stomach and intestines, causing inflammation and bleeding. It’s uncertain, however, whether this alone can progress into an ulcer or whether other contributing factors must be present, such as H. pylori bacteria or ulcer-causing medications such as NSAIDs.
Although stress isn’t a cause, it’s a contributing factor. Stress may aggravate symptoms nd, in some cases, delay healing. You may undergo stress for a number of reasons, an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury.
Because most ULs stem from H. pylori bacteria, doctors use a two-pronged approach:
- Kill the bacteria.
- Reduce the level of acid in your digestive system to relieve pain and encourage healing.
Accomplishing these two steps requires the use of at least two, and sometimes three or four, of the following medications:
- Antibiotics – Several combinations of antibiotics kill H. pylori. Most of the medications are equally effective. However, for the treatment to work, it’s essential that you follow your doctor’s instructions precisely. Antibiotics most commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil, Wymox), clarithromycin (Biaxin), metronidazole (Flagyl) or tetracycline (Achromycin V). Some pharmaceutical companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent specifically for treatment of H. pylori infection. These combination treatments are sold under the names Prevpac and Helidac. You’ll need to take antibiotics for only 1 to 2 weeks, depending on their type and number. Other medications prescribed in conjunction with antibiotics generally are taken for a longer period.
- Acid blockers — also called histamine (H-2) blockers, reduce the amount of hydrochloric acid released into your digestive tract, which relieves ulcer pain and encourages healing. Acid blockers work by keeping histamine from reaching histamine receptors. Histamine is a substance normally present in your body. When it reacts with histamine receptors, the receptors signal acid-secreting cells in your stomach to release hydrochloric acid. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) and cimetidine (Tagamet). For treatment of ULs, prescription-strength acid blockers are more effective.
- Antacids – Your doctor may include an antacid in your drug regimen. An antacid may be taken in addition to an acid blocker or in place of one. Instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief.
- Proton pump inhibitors – A more effective way to reduce stomach acid is to shut down the “pumps” within acid-secreting cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. They include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). Another drug, pantoprozole (Protonix), can be taken orally or administered intravenously in the hospital. Proton pump inhibitors also appear to inhibit H. pylori. However, the drugs cost almost twice as much as acid blockers. Uncommon side effects include stomach pain, diarrhea and headache.
- Cytoprotective agents – These medications help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). The drugs cause some side effects. Sucralfate may cause constipation. Misoprostol may cause diarrhea and uterine bleeding. Misoprostol shouldn’t be taken by pregnant women because it can cause miscarriage. Another nonprescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol). In addition to protecting the lining of your stomach and intestines, bismuth preparations appear to inhibit H. pylori activity.
Fail to heal
Most peptics heal within 1 to 3 months. Those that don’t are called refractory ULs. There are many reasons why one may fail to heal. Not taking medications according to directions is one reason. Another is that some types of H. pylori are resistant to antibiotics. Other factors that can interfere with the healing process include regular use of tobacco, alcohol or nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes the problem is accidental: People are unaware that a medication they’re taking contains an NSAID.
In rare cases refractory ULs may be a result of extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome, an infection other than H. pylori, or other digestive diseases, including Crohn’s disease or cancer.
Treatment generally involves eliminating factors that may interfere with healing, along with stronger doses of medications. Sometimes, additional medications may be included. Surgery to help heal is necessary only when the ulcer doesn’t respond to aggressive drug treatment.
Below is a link that provides documentation to what we believe to be a safe and effective method to treating ulcers.
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