Peptic (stomach) ulcers

A peptic or stomach ulcer is an open sore or raw area in the lining of the stomach or intestine. The digestive tract has a layer of mucous that protects it from acids, but if the layer is worn away or if there is too much acid, an ulcer can develop in the stomach, esophagus or small intestine. Ulcers in the small intestine are called duodenal ulcers.

Symptoms of peptic (stomach) ulcers

A peptic (stomach) ulcer doesn’t always cause symptoms. If it does, common symptoms may include any of the following:

• Belching
• Bloating
• Feeling full very quickly while eating a meal
• Feeling uncomfortably full after eating a meal
• Nausea and vomiting
• Heartburn or indigestion

Pain can occur anywhere from the belly button to the breastbone and may feel worse at night and when you’re hungry. More severe symptoms include unexplained weight loss, nausea, vomiting blood or dark material, dark blood in the stool or black, tarry stool.

In the most severe cases, a hole can form in the stomach, or a blockage could develop in the stomach or small intestine.

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Risk factors for peptic ulcer disease

The following factors can increase your risk for developing peptic ulcer disease:

• Regular use or overuse of aspirin, ibuprofen, naproxen or other nonsteroidal anti-inflammatory drugs (NSAIDs)

• Radiation treatments or surgery on your stomach or small intestine

Causes of peptic (stomach) ulcer disease

The most common causes of peptic (stomach) ulcers are Helicobacter pylori (H. pylori) bacteria and NSAIDs. Doctors and researchers once believed that peptic (stomach) ulcers were caused by stress or spicy foods. There is no evidence to support this theory, although these factors can irritate existing ulcers and worsen symptoms.

How H. pylori can cause ulcers

H. pylori is a common cause of peptic (stomach) ulcers. About two-thirds of the world’s population is infected with H. pylori, but only 20% of those who are infected have symptoms. The H. pylori bacteria may spread from person to person through contact with an infected person’s vomit, stool or saliva.

When H. pylori enters your body, it attacks the mucous lining of your stomach, which protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. The ulcers may bleed, cause infections or keep food from moving through your digestive tract. Untreated H. pylori can also lead to stomach cancer.

Having good health habits can help keep you safe from getting H. pylori. These habits include:

• Washing your hands with soap and water especially after using the bathroom and before eating
• Making sure all food you eat has been cleaned and cooked safely
• Making sure that your drinking water is safe and clean

How NSAIDs can cause ulcers

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen is another common cause of peptic ulcers. NSAIDs relieve pain, but they also make the stomach lining more prone to damage and ulcers. You have a higher chance of developing a peptic (stomach) ulcer due to NSAIDs if you:

• Take them for a long time
• Take large doses of an NSAID
• Use more than one type of NSAID
• Consume NSAIDs along with other medicines such as those used to treat low bone mass, corticosteroids and some antidepressants, which can increase the risk for ulcers

Less common causes of peptic (stomach) ulcers

• Infections caused by certain viruses, fungi or bacteria other than H. pylori
• Surgery or medical procedures, including radiation, that affect the stomach or small intestine

Getting a peptic (stomach) ulcer diagnosis

Your doctor may ask about your medical and family history, perform a physical exam and order tests to diagnose a peptic (stomach) ulcer, find its cause and check for complications. Your doctor may also order tests, such as:

• Upper gastrointestinal series: Sometimes called a barium swallow, this series of X-rays creates images of your esophagus, stomach and small intestine. You swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.
• Stool culture: This test looks for any abnormal bacteria in your digestive tract that may cause diarrhea and other problems. A small stool sample is collected and sent to a lab. The test results will show if you have any abnormal bacteria.
• Capsule endoscopy: You swallow a capsule that contains a tiny light and camera that takes pictures inside your esophagus, stomach and small intestine.
• Blood test or breath test: These tests check for H. pylori or other bacteria in your digestive system.

Peptic (stomach) ulcer services & treatments

If you have a peptic ulcer, your Aurora health care team will work with you to determine the best course of treatment, which may include:

• Antacids
• Antibiotics to kill the H. pylori bacteria
• H-2 receptor blockers to reduce acid levels in the stomach
• Medications called cytoprotective agents that protect the tissue in the stomach lining
• Proton pump inhibitors

If a peptic ulcer bleeds, medicine or heat therapy may need to be applied directly to the ulcer. Surgery may be needed if the bleeding won’t stop or if the ulcer has caused a tear in the stomach or small intestine.

Surgical treatment for peptic (stomach) ulcers

• Antrectomy: This procedure removes the lower part of the stomach that produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes, an adjacent part of the stomach that secretes pepsin and acid may be removed. A vagotomy is usually done along with an antrectomy.
• Gastrectomy: This procedure removes the diseased part of the stomach.
• Pyloroplasty: The openings into the duodenum and small intestine are enlarged, enabling contents to pass from the stomach. This procedure may be performed along with a vagotomy.
• Vagotomy: The surgeon cuts the vagus nerve to reduce acid secretion.

Diet and lifestyle changes to reduce symptoms

If you have peptic (stomach) ulcers, here are some things you can do to help reduce irritation, pain and other symptoms:

• Ask your physician about foods or supplements that may help balance the bacteria in your digestive system such as berries, broccoli, fermented foods, honey and probiotics.
• Avoid chocolate, coffee, excessive spices and other foods that cause irritation.
• Limit use of NSAIDs.
• Reduce alcohol consumption.
• Stop using tobacco.