Peptic ulcer (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
A peptic ulcer is a sore on the lining of the stomach or duodenum, which is the beginning of the small intestine. Peptic ulcers are common: One in 10 Americans develops an ulcer at some time in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are not caused by stress or eating spicy food, but these can make ulcers worse.

What are the symptoms of a Peptic ulcer?
Abdominal discomfort is the most common symptom. This discomfort usually
 * Is a dull, gnawing ache
 * Comes and goes for several days or weeks
 * Occurs 2 to 3 hours after a meal
 * Occurs in the middle of the night—when the stomach is empty
 * Is relieved by eating
 * Is relieved by antacid medications

Other symptoms include
 * Weight loss
 * Poor appetite
 * Bloating
 * Burping
 * Nausea
 * Vomiting

Some people experience only very mild symptoms, or none at all.

Emergency Symptoms

If you have any of these symptoms, call your doctor right away:
 * Sharp, sudden, persistent stomach pain
 * Bloody or black stools
 * Bloody vomit or vomit that looks like coffee grounds

They could be signs of a serious problem, such as
 * Perforation—when the ulcer burrows through the stomach or duodenal wall
 * Bleeding—when acid or the ulcer breaks a blood vessel
 * Obstruction—when the ulcer blocks the path of food trying to leave the stomach

What are the causes of Peptic ulcers?
Peptic ulcers are caused by:
 * Bacteria called Helicobacter pylori, or H. pylori for short
 * Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
 * Other diseases

Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.

H. pylori causes almost two-thirds of all ulcers. Many people have H. pylori infections. But not everyone who has an infection will develop a peptic ulcer.

Most other ulcers are caused by NSAIDs. Only rarely do other diseases cause ulcers.

Who is at risk for Peptic ulcers?
You're more likely to develop a peptic ulcer if you:
 * Have an H. pylori infection
 * Use NSAIDs often
 * Smoke cigarettes
 * Drink alcohol
 * Have relatives who have peptic ulcers
 * Are 50 years old or older

How to know you have a Peptic ulcer?
If you have symptoms, see your doctor. Your doctor may Doctor talking to a woman Peptic ulcers can show up on x rays.


 * take x rays of your stomach and duodenum, called an upper GI series. You'll drink a liquid called barium to make your stomach and duodenum show up clearly on the x rays.


 * use a thin lighted tube with a tiny camera on the end to look at the inside of your stomach and duodenum. This procedure is called an endoscopy. You'll take some medicine to relax you so your doctor can pass the thin tube through your mouth to your stomach and duodenum. Your doctor may also remove a tiny piece of your stomach to view under a microscope. This procedure is called a biopsy.

If you do have a peptic ulcer, your doctor may test your breath, blood, or tissue to see whether bacteria caused the ulcer.

When to seek urgent medical care
Call 911 if you:
 * Develop sudden, sharp abdominal pain
 * Have a rigid, hard abdomen that is tender to touch
 * Have symptoms of shock such as fainting, excessive sweating, or confusion
 * Vomit blood or have blood in your stool (especially if it's maroon or dark, tarry black)

Call your doctor if:
 * You feel dizzy or lightheaded
 * You have ulcer symptoms

Treatment options
Peptic ulcers can be cured. Medicines for peptic ulcers are
 * Proton pump inhibitors or histamine receptor blockers to stop your stomach from making acids
 * Antibiotics to kill the bacteria

Depending on your symptoms, you may take one or more of these medicines for a few weeks. They'll stop the pain and help heal your stomach or duodenum.

Ulcers take time to heal. Take your medicines even if the pain goes away. If these medicines make you feel sick or dizzy, or cause diarrhea or headaches, your doctor can change your medicines.

If NSAIDs caused your peptic ulcer, you'll need to stop taking them. If you smoke, quit. Smoking slows healing of ulcers.

In many cases, medicine heals ulcers. You may need surgery if your ulcers
 * Don't heal
 * Keep coming back
 * Perforate, bleed, or obstruct the stomach orduodenum

Surgery can:
 * Remove the ulcers
 * Reduce the amount of acid your stomach makes

Diseases with similar symptoms

 * Nonulcer dyspepsia
 * Gallstones
 * Gastroesophageal reflux disease
 * Irritable bowel syndrome
 * Chrohn's disease
 * Pancreatitis
 * Stomach cancer
 * Lymphoma
 * Celiac disease

Where to find medical care for Peptic ulcers
Directions to Hospitals Treating Peptic ulcer

Prevention of Peptic ulcers
Lifestyle changes may help prevent peptic ulcers:

Tips include:
 * Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first.
 * Don't smoke or chew tobacco.
 * Limit alcohol to no more than two drinks per day.

What to expect (Outlook/Prognosis)
Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will be cured and you'll be much less likely to get another ulcer.

Possible Complications

 * Bleeding inside the body (internal bleeding)
 * Gastric outlet obstruction
 * Inflammation of the tissue that lines the wall of the abdomen (peritonitis)
 * Perforation of the stomach and intestines