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Peptic ulcers: causes, symptoms and treatment

October 23, 2023 | Heather Shannon
man at desk holding his stomach because of  peptic ulcers pain
Stomach pain, heartburn, nausea, a feeling of fullness and an intolerance to greasy foods are hallmarks of peptic ulcer disease.

Peptic ulcers, sores on the lining of the stomach or upper intestine, often have no symptoms. But when they do, they can cause trouble, as fans of rock musician Bruce Springsteen learned when he postponed his tour because of the condition.

The most common symptom when they do arise is burning stomach pain, particularly while fasting and often at night. The symptoms ease when one consumes food or antacids that help neutralize stomach acids inflaming the ulcer.

Heartburn, nausea, a feeling of fullness and an intolerance to greasy foods are also hallmarks of peptic ulcer disease (PUD), which affects an estimated 8 million people worldwide.

“The most common causes of peptic ulcers are due to an infection by a bacteria named Helicobacter pylori or the use of anti-inflammatory drugs, including aspirin,” says UCI Health gastroenterologist Dr. Carlos Saad.

Peptic ulcer contributors

H. pylori is a bacterium that can infect the lining of the stomach and first part of the small intestine called the duodenum . Only a small portion of people with the bacteria will develop a peptic ulcer.

However, anyone with a history of untreated H. pylori is at risk for a peptic ulcer, as are individuals who continuously use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, says Saad, who sees patients at the UCI Health Digestive Health Institute.

Other behaviors such as smoking, drinking alcohol and taking anticoagulants and steroids don’t cause peptic ulcers, says Saad, but they may aggravate one.

Left untreated, peptic ulcers can result in life-threatening complications, including:

  • Internal bleeding, which can lead to shock due to acute blood loss. Signs include vomiting, vomiting blood and black or tarry stools.
  • Perforation of the stomach wall or duodenum, allowing food and digestive acid to leak into the abdominal cavity.
  • Blockages preventing food passing from the stomach into the small intestine

Populations predisposed to ulcers

Men and women are equally affected by the condition. Those considered predisposed to develop a peptic ulcer tend to:

  • Be older adults
  • Have a first-degree relative with a history of peptic ulcer
  • Have a household member infected with H. pylori
  • Have emigrated from a developed nation, where the incidence of H. pylori is higher
  • Have O or A blood type
  • Be of Black or Hispanic descent

Treatment for peptic ulcers

“The treatment of a peptic ulcer depends on what caused it,” Saad says, noting that uncomplicated ones are easier to heal.

If H. pylori is the cause, Saad prescribes a two-week course of antibiotics and a four-to-eight week course of proton pump inhibitors (PPI).

“PPIs work by reducing the amount of acid the stomach produces, preventing further damage to the ulcer as it heals naturally,” he says.

If medications are the cause of the ulcer, Saad works with the patient to try to reduce the use of NSAIDs or switch to a class of them called COX-2 inhibitors, which are easier on the stomach. Saad also prescribes medications to block or reduce acid production, promote healing and relieve pain. There are also medications to help protect the lining of the stomach.

Preventing recurrence

Ulcers can recur if the initial cause is not eradicated. In the case of H. pylori, a breath or stool test after four to six weeks will confirm whether the treatment was successful. In the case of ulcers caused by medications, Saad recommends removing or replacing as many as possible, along with making lifestyle changes.

“Contributing factors such as cigarette smoking and alcohol ingestion should be removed to prevent a recurrence of the ulcer.”

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