What is Peptic Ulcer Disease?

Stomach pain can stem from many different causes. A burning pain in the middle to upper abdomen can be triggered by sores in the stomach lining called peptic ulcers (among other possible causes). While spicy and acidic foods can worsen this pain, dietary choices are not the cause of peptic ulcer disease.

What do peptic ulcers feel like?

Although it’s possible not to experience any symptoms, the most common peptic ulcer symptom is a burning sensation or pain in your belly between your breastbone and belly button. This pain usually happens before or after meals, at night, lasting a few minutes to hours, and may temporarily go away if you eat something or take an antacid.

Less common but more severe ulcer symptoms include:

• bloody or black stool (a sign of internal bleeding)
• excessive burping
• bloating
• feeling full after eating a small amount of food
• not feeling hungry at all for several days
• nausea
• vomiting
• vomiting blood
• losing weight without trying

Left untreated, peptic ulcers can lead to:

• internal bleeding
• a hole (perforation) in the stomach wall (increases the risk of serious infection)
• digestive tract obstruction (blocks the passage of food during digestion)
• gastric cancer (a result of untreated H. pylori infection)

What causes peptic ulcer disease?

The burning sensation triggered by this disease comes from the ulcer itself, which is a gastrointestinal wound caused by damage from digestive acids. These wounds can develop in the lining of your stomach (called a gastric ulcer) or the first part of the small intestine (duodenal ulcer).

Why would normal digestive acids damage the walls of your stomach or small intestine?

Peptic ulcers can be caused by:

Bacterial infection called Helicobacter pylori (H. pylori)

“H. pylori bacteria is common and often acquired in childhood. Almost 50% of the world has H. pylori,” says Shria Kumar, M.D., M.S.C.E., a gastroenterologist with the University of Miami Health System.

If these bacteria multiply in your digestive tract, they can cause inflammation that breaks down the gastrointestinal walls. When this protective lining is weakened, digestive acids can further erode the lining and cause wounds (ulcers).

Long-term use of certain pain relievers

NSAIDs are nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen (such as Advil or Motrin), and naproxen sodium (such as Aleve, Midol or Anaprox).

These can be over-the-counter or prescription strength.

They are typically used to relieve muscle pain, arthritis, headaches and fever. This type of medication, which can wear away at the mucus layer in the digestive tract, is different from pain and fever relievers like acetaminophen (Tylenol).

Less common causes of peptic ulcers include:

• serious illness from infections or diseases
• surgery
• steroid medications (taken for autoimmune diseases or viral infections)
• Zollinger-Ellison syndrome (gastrinoma)

The following can increase the risk of developing peptic ulcers:

• peptic ulcers run in your family
• liver, kidney or lung disease
• regularly drinking alcohol
• tobacco smoking

How are stomach ulcers diagnosed?

If you are experiencing stomach pain, there are many possible causes. Visit a gastroenterologist for an exam, testing and imaging to get an accurate diagnosis and effective treatment plan.

Your doctor may recommend the following diagnostics:

• H. Pylori tests (breath or stool test or biopsy taken during endoscopy)
• upper endoscopy (doctors uses a small, lighted tube with a camera to examine the inside of your throat, esophagus and stomach)
• imaging tests (such as X-rays and CT scans)

How to relieve the pain from peptic ulcers

To reduce the burning pain caused by digestive acids interacting with your stomach ulcer, you can take one or more of the following over-the-counter or prescription strength medications.

These symptom-management medications may help you feel better temporarily, but will not address the cause of your peptic ulcers. “Check with your doctor to see if it’s okay to begin these medications,” Dr. Kumar says. “You’ll want to treat peptic ulcer disease in conjunction with them.”

• Histamine receptor blockers and antacids: These drugs (like Tagamet and Pepcid) reduce the body’s production of gastric acid, and they can be taken as needed for mild symptoms.
• Proton pump inhibitors (PPIs): These drugs (like Prilosec, Prevacid and Nexium) also reduce the body’s production of digestive acids. However, PPIs should be taken daily and are typically recommended for persistent or chronic GI issues.
• Protective medications: These sucralfate and bismuth medications (like Pepto-Bismol and Carafate) coat the ulcer temporarily, protecting the wound from further damage from digestive acids.

You may also find that avoiding spicy and acidic foods can help reduce acid production, and drinking milk can help temporarily coat or soothe the ulcer.

Peptic ulcers are curable.

“While it’s called peptic ulcer disease, this condition does not have to be chronic and is very curable,” Dr. Kumar says.

If you are diagnosed with peptic ulcer disease, your treatment will be based on the underlying cause and severity of your ulcers. Treatment may resolve the cause and allow the ulcer wound to heal completely.

If your ulcers were caused by H. pylori bacteria, your treatment would include antibiotics (for one to two weeks) to kill the harmful bacteria. The ulcer(s) may take a few more weeks to heal, but they can reoccur if H. pylori is not fully cleared from your system with the first round of antibiotics.

“Your doctor will check to ensure the H. pylori are fully treated,” says Dr. Kumar.

If your doctor thinks your peptic ulcers were caused by NSAID use, you will need to stop taking that type of medication and use another form of pain reliever or fever reducer. This is also recommended when peptic ulcers have another cause, as NSAID use can continue to weaken the gastrointestinal lining.

If your ulcer is bleeding, your doctor may perform an endoscopy to inject medications into the ulcer and/or clamp or cauterize the wound to stop the bleeding.

To promote peptic ulcer healing, you shouldn’t smoke.

If you are experiencing stomach pain, the University of Miami Health System offers a motility lab in South Florida to conveniently dia gnose GI conditions. Our gastroenterology clinic provides a variety of therapeutic procedures to keep your stomach, digestive system and organs healthy.

To schedule an appointment, call 305-243-2910 or request an appointment online.

Dana Kantrowitz is a contributing writer for UHealth’s news service.

Tags: amounts of acid, Dr. Shria Kumar, nonsteroidal anti inflammatory drugs nsaids, spicy foods