Peptic Ulcer Disease

What is Peptic Ulcer Disease?
An ulcer is an open sore in the lining of the stomach or the intestine. Ulcers can occur in the stomach (gastric ulcers) or they can occur in the first portion of the intestine (duodenal ulcers).

An ulcer is simply the result of stomach acid and pepsin eating away at the lining of the stomach and intestine and the delicate tissues underneath. While acid is generally the final cause of the injury, it is now recognized that there are other factors that permit acid to cause damage.

What Causes Ulcers?

Helicobacter pylori – the ulcer bacteria
In the past, ulcers were believed to be caused by too much stress or by eating too many spicy foods. It is now known that ulcers are most commonly caused by a bacterial infection in the stomach, called Helicobacter pylori (H. pylori). Helicobacter pylori accounts for over 80% of stomach (gastric) and 90% of duodenal ulcer cases. This bacteria is highly resistant to the acid in the stomach and small intestine and does not spread elsewhere in the body. H. pylori is curable with antibiotics.

Aspirin and many other arthritis pain medications can also cause ulcers. These medications damage the protective mucosal layer of the digestive tract, allowing the stomach acid to come in contact with the delicate tissue underneath. Medications that can harm your stomach are: Aspirin, ibuprofen, Advil, Motrin, Aleve, Naprosyn, Indocin, Feldene, Orudis, Relafen, Torodol, and Voltaren. Tylenol does not cause ulcers and may be safely used in patients with ulcers.

In rare cases, patients may produce excessive amounts of acid and develop ulcers. This is called Zollinger-Ellison syndrome, and is it is very unusual. Although stress is no longer believed to cause ulcers, extreme physical stress, such as major trauma, burns, major surgery or a prolonged hospitalization can lead to the formation of ulcers.

Symptoms
Ulcers can cause a gnawing or burning pain in the upper abdomen. The discomfort may be worse on an empty stomach or it may be worse several hours following a meal. The burning sensation may be so severe that it wakes you up at night. The pain may be temporarily relieved by foods or antacids. Some patients do not experience any pain, but will have nausea, anemia (low blood count), or the presence of blood in the stool (black tarry stools or a positive hemoccult test). A bleeding ulcer can require emergency treatment, you should call your doctor immediately if you vomit “coffee grounds” material or have black tarry stools.

Diagnosis
An upper endoscopy is the most accurate way to test for the presence of ulcers. It is performed by a specially trained physician called a Gastroenterologist. An endoscopy allows your doctor to directly examine the lining of your stomach and small intestine. Your doctor may take a biopsy of your stomach lining to test you for the H.pylori bacteria.

An upper G.I. x-ray is sometimes also ordered to check for the presence of ulcers but it is not as accurate as an endoscopy.


Treatment
Therapy for Peptic Ulcer Disease is aimed at fighting the cause of the ulcer. If the Helicobacter pylori bacteria is present, an antibiotic and acid supression regimen will be prescribed. If aspirin or other arthritis medications are to be blamed then they should be avoided.

Acid suppressing medications are dramatically effective in both relieving symptoms and allowing ulcers to heal. Your doctor may prescribe one of the following: Zantac, Tagamet, Prilosec, Prevacid, Aciphex, Nexium, Protonix.

It was once believed that diet was an important factor in ulcer formation. We now know that these dietary restrictions are not necessary for most patients. The patient is the best judge of which foods to avoid, if a patient knows of a certain trigger food, it should be avoided. However, many substances are known to stimulate acid production and should be avoided by anyone with ulcers; caffeine, alcohol and nicotine can all delay the healing of an ulcer.