ULCER

Digestive health centre

What is peptic ulcer disease?

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach (gastric ulcers) or the first part of the small intestine, called the duodenum (duodenal ulcers)

What causes ulcers?

Ulcers can be caused by:

• Infection with a type of bacteria called Helicobacter pylori (H pylori). This is responsible for about 80% of stomach ulcers and about 95% of duodenal ulcers.
• Use of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen and many others. Even coated aspirin can cause ulcers.
• Very rarely, excess acid production from gastrinomas. These tumours of the acid-producing cells in the stomach - increase acid output - a phenomenon seen in Zollinger-Ellison syndrome

What are the symptoms of an ulcer?

An ulcer may or may not produce symptoms. When symptoms occur, they include:

• A gnawing or burning pain in the middle or upper stomach between meals or at night
• Bloating
• Heartburn
• Nausea or vomiting

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding)
• Vomiting blood (which may look like "coffee grounds")
• Weight loss
• Severe pain in the mid- to upper abdomen

How serious is an ulcer?

Although ulcers often heal on their own, you shouldn't ignore the warning signs. If not properly treated, ulcers can lead to serious health problems, including:

• Bleeding
• Perforation (a hole in the wall of the stomach)
• Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine.

Taking NSAIDs can cause any of the above without warning. The risk is of particular concern for the elderly and for people with a prior history of peptic ulcer disease.

Who is more likely to get ulcers?

You may be more likely to develop ulcers if you:

• Are infected with the H pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen naproxen
• Have a family history of ulcers
• Have another illness, such as liver, kidney or lung disease
• Drink alcohol regularly
• Smoke
• Are 50 or over

How are ulcers diagnosed?

Your doctor may suspect an ulcer diagnosis just by talking with you about your symptoms. To confirm the diagnosis, however, you will need to have one or more tests:

• A urea breath test - your breath is tested for carbon dioxide after drinking a special solution containing a chemical that is digested by H pylori
• A stool antigen test - to look for H pylori excreted in faeces
• A blood test to look for antibodies to H pylori
• An upper endoscopy. This involves inserting a small, illuminated tube (endoscope) through the throat and into the stomach and duodenum to look for abnormalities. A biopsy of a suspected ulcer site or other abnormal area may be taken at the same time, and the tissue sample can also be tested for H pylori.

  What is peptic ulcer disease?

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  How are ulcers treated?

  If tests show that you have H Pylori infection, you will need treatment to get rid of it. If tests do not show H Pylori infection, then you will probably be given treatment to reduce the amount of stomach acid you produce, to give the ulcer time to heal.
  In addition, if your ulcer is believed to be due to NSAID use, you will be advised to stop taking these if possible. Your GP may be able to suggest an alternative analgesic, such as paracetamol. If you have a condition such as arthritis and need to take an NSAID, you GP may add another medicine to protect your intestinal lining while you are taking the NSAID.
  Your symptoms may also be improved more quickly if you stop smoking or drinking alcohol.
  

  Ulcer medications

  Ulcer medications can include
• Proton pump medications (PPI). Proton pump inhibitors reduce acid levels and allow the ulcer to heal. They include omeprazole, esomeprazole, lansoprazole and rabeprazole.
• Antibiotics. If you have H Pylori infection, then antibiotics are used.  Usually you will be prescribed a combination of two antibiotics along with a PPI treatment known as "triple therapy". You need to take these for a week and then have another test to make sure that the H Pylori has cleared up. If tests are still positive, you may need another course of treatment with different antibiotics.

Other treatment
Upper endoscopy Some bleeding ulcers can be treated through an endoscope.
Surgery Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach or if there is serious bleeding.

Will drinking milk help cure an ulcer?

No. Milk can make your ulcer worse. Milk provides brief relief from ulcer pain because it coats the stomach lining. But milk can also stimulate your stomach to produce more acid and digestive juices, which can aggravate ulcers.

How can I prevent ulcers?

To try and prevent ulcers from developing:

• Don't smoke.
• Avoid alcohol.
• Don't overuse aspirin and/or NSAIDs.
• If you have symptoms of an ulcer, seek medical advice.

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