Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.
What Causes Ulcers?
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:
- Infection with a type of bacteria called Helicobacter pylori (H. pylori)
- Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
- Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.
What Are the Symptoms of an Ulcer?
An ulcer may or may not have symptoms. When symptoms occur, they include:
- A gnawing or burning pain in the middle or upper stomach between meals or at night
- Nausea or vomiting
In severe cases, symptoms can include:
- Dark or black stool (due to bleeding)
- Vomiting blood (can have a "coffee-grounds" appearance)
- Weight loss
- Severe pain in the mid to upper abdomen
How Serious Is an Ulcer?
Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:
- Perforation (a hole through the wall of the stomach)
- Gastric outlet obstruction from swelling or scarring that blocksv the passageway leading from the stomach to the small intestine.
Taking NSAIDs can cause any of the above without warning. The risk is especially concerning for the elderly and for those with a prior history of having 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, and many others
- Have a family history of ulcers
- Have another illness, such as liver, kidney, or lung disease
- Drink alcohol regularly
- Are 50 years old or older
How Are Ulcers Diagnosed?
Your doctor may be able to make an ulcer diagnosis just by talking with you about your symptoms. However, to confirm the diagnosis one of several tests should be taken. First, your doctor may ask you to take an acid-blocking medication such as those used to treat heartburn for a short period of time to see if your symptoms improve.
If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe symptoms of ulcers.
Often, doctors will frequently treat without confirming the diagnosis using endoscopy. If the cause is not likely to be from NSAIDs, then it is very likely to be from H. pylori. Most doctors will now test for H. pylori and will treat specifically for that in addition to giving medications to reduce the symptoms.