By Chris Woolston, M.S.
What is a peptic ulcer?
The digestive juices that churn in our stomachs are great for dissolving dinner, but they can also be hard on our bodies. Under certain circumstances, the brew of acid and enzymes can eat away at the lining of the stomach or the duodenum (the upper part of the small intestine), creating an open sore that is commonly called a peptic ulcer. Estimates vary, but government sources say that about 1 in 8 Americans will develop an ulcer at some point.
What are the symptoms of a peptic ulcer?
Many people with ulcers never notice any symptoms. The rest typically feel a gnawing, burning ache in the abdomen that comes and goes. Other symptoms may include weight loss, bloating, nausea, vomiting, and poor appetite.
Symptoms also vary depending on the type of ulcer someone has. If a sore forms in the duodenum, for example, the pain usually arrives between meals and goes away after a few bites of food or a glass of milk. But if the ulcer is in the stomach, the discomfort usually flares up during a meal. Both kinds of ulcers can also cause nausea and a loss of appetite.
Although most ulcers are harmless, a few can cause serious complications, particularly in older people. Some ulcers bleed slowly and steadily, leading to fatigue or anemia. In severe cases, an ulcer can break through (perforate) the wall of the stomach or duodenum, a potentially life-threatening problem that requires immediate surgery. An ulcer may also penetrate the pancreas and cause a sharp, "boring" pain that radiates to the back.
Call your doctor immediately if you have any of the following symptoms: a burning or a sharp, sudden, long-lasting stomach pain; bloody or black stools; vomit that is bloody or looks like coffee grounds; and a sharp, severe pain that spreads to the back and does not respond to painkillers or ulcer medications. These could signal a serious and even life-threatening emergency, such as internal bleeding, obstruction, or a perforated ulcer.
What causes ulcers?
For many years, doctors had little idea what might trigger the problem. Many believed that they were caused by spicy foods, alcohol, or stress -- theories that have since been overturned. (Scientists still believe that stress or alcohol may exacerbate ulcers, but that they don't cause them.) Recent breakthroughs have shown that two factors give rise to almost all ulcers: infection by a common bacterium called Helicobacter pylori and the use of aspirin, ibuprofen, and similar painkillers called nonsteroidal anti-inflammatory agents (NSAIDS).
As recently as the 1980s, the idea that a bacteria could cause ulcers seemed laughable. But two Australian scientists -- Barry Marshall and Robin Warren -- were so convinced that the H. pylori bacteria caused stomach ulcers that Marshall actually swallowed a teaspoonful of H. pylori germs to prove his point. He woke up the next day with unmistakable symptoms of gastritis (stomach inflammation), which he was finally able to reverse with antibiotics.
Today, about 90 percent of all duodenal ulcers and 70 percent of stomach ulcers are due to H. pylori, according to the Mayo Clinic. H. pylori sets up camp in the protective mucus coating of the stomach and duodenum, secreting an enzyme that neutralizes any stomach acid that still manages to reach it. Once there, the spiral-shaped bacterium causes a series of events that lead to the development of an ulcer. Among other things, it weakens the protective mucus by burrowing downwards into the stomach lining, where it can cause infections. People who carry H. pylori also seem to produce more acid than normal, perhaps enough to overwhelm the body's natural defenses.
Infections of H. pylori are extremely common, but for some reason, most people who harbor the germ never develop ulcers. It's possible that only particular strains of the bug cause ulcers or that some stomachs are simply more sensitive to an infection.
The other major source of ulcers is the class of drugs called NSAIDs, which includes aspirin, ibuprofen, naproxen sodium, and other common pain relievers. Some people can take these medications for years without problems, but others may develop ulcers from just a few pills. The drugs damage the protective lining in the digestive system, and they also hamper healing by slowing the flow of blood to the stomach.
Ulcers triggered by NSAIDs often cause little discomfort and generally go away if the NSAIDs are stopped or reduced. In older people and smokers, these ulcers are likely to be more painful and slower to heal. And though most side effects are minor, stomach bleeding and other injuries caused by NSAIDs cause 100,000 hospitalizations a year and are the 15th most common cause of death in the country, according to a report in Postgraduate Medicine.
What can I do to ease the pain?
First of all, consult your doctor. If NSAIDs are causing your ulcer, he or she may suggest that you switch to a different pain reliever (such as acetaminophen, the active ingredient in Tylenol). You'll need to read labels carefully. NSAIDs can show up in indigestion tablets and other places you might not expect. (If you normally drink three or more glasses of alcohol a day, check with your doctor before taking Tylenol; you may be vulnerable to liver damage.) Your doctor may also prescribe various medications, including a proton pump inhibitor, a drug that blocks the enzyme in the stomach wall that produces acid.
If you smoke, you should quit immediately. People who smoke are more likely to develop ulcers, and their sores are slower to heal. Avoiding excessive alcohol can also help. While alcohol in itself doesn't cause ulcers, it can irritate the stomach lining and hinder the healing of existing ulcers. When the pain strikes, an antacid tablet or two will usually bring quick relief. But if the pain keeps coming back, you'll need a doctor's help to get to the root of the problem.
What can my doctor do to help?
Most people with ulcers won't find long-term relief until they rid their bodies of H. pylori. If tests show you carry the germ, your doctor will probably give you antibiotics along with medicine that suppresses the production of acid in the stomach. The antibiotics won't speed the healing of an existing ulcer, but they will help prevent future flare-ups.
Sometimes antibiotics and other medications aren't enough. In severe cases, doctors may need to perform surgery to slow acid production in the stomach.
But for most patients, getting rid of the bacteria is enough to get rid of the ulcers. According to the National Institutes of Health, two weeks of triple therapy (treatment with two antibiotics and either an acid blocker or a stomach-lining shield) usually prevents ulcers from coming back.
National Digestive Diseases Information Clearinghouse H. pylori and Peptic Ulcers. April 2010. www.niddk.nih.gov/health/digest/pubs/hpylori/hpylori.htm
Centers for Disease Control and Prevention. Helicobacter Pylori and Peptic Ulcer Disease. September 2005. http://www.cdc.gov/ulcer/
Mayo Clinic. Peptic Ulcer. January 2009. http://www.mayoclinic.com/health/peptic-ulcer/DS00242
American College of Gastroenterology. The Danger of Aspirin and NSAIDs. http://www.acg.gi.org/patients/women/asprin.asp