Peptic (or stomach) ulcers are sores that develop in the lining of the bowel, stomach or upper area of the small intestine (better known as the duodenum). According to the Canadian Digestive Health Foundation, these sores can become inflamed and cause pain or discomfort when they come in contact with the enzymes and digestive acids used to dissolve food. Common forms of peptic ulcers include gastric ulcers (those that form inside the stomach) and duodenum ulcers (inside the upper area of the small intestine).
Symptoms of a peptic ulcer
Contrary to conventional wisdom, peptic ulcers are not caused by stress or spicy foods but both of these factors are known to exacerbate symptoms. The most common culprits of peptic ulcers, according to the Mayo Clinic, are infection by a bacterium known as Helicobacter pylori (H. pylori) or the extended use of nonsteroidal anti-inflammatory drugs, such as ibuprofen (found in Advil and Motrin IB) and naproxen sodium (Aleve).
While many people with peptic ulcers experience no symptoms, the most frequently reported among those who do is burning stomach pain. This pain may worsen on an empty stomach because food acts as a buffer between digestive acids and an inflamed ulcer. Because of this, stomach ulcers often hurt more at night or between meals. Other common symptoms of peptic ulcers include: intolerance to fatty foods, nausea, heartburn or a feeling of fullness, bloating or belching.
Although less common, some ulcers can produce more extreme symptoms and a doctor should be consulted immediately if any of the following are experienced: vomiting or vomiting blood; stools that are bloody, black or tarry; difficulty breathing or feeling faint; and appetite changes or unexplained weight loss.
How is a peptic ulcer diagnosed?
Doctors typically diagnose an ulcer by inquiring about symptoms and conducting a physical exam. To determine the presence of an ulcer, one of the following procedures may be used:
- Endoscopy and biopsy – The most accurate test for diagnosing an ulcer, an endoscopy involves inserting a flexible tube with a light and camera into the mouth and through the stomach and duodenum. This allows doctors to get a real-time view of the area and take any tissue samples needed to confirm diagnosis.
- Upper gastrointestinal X-ray – Patients are required to drink a solution containing barium that coats the digestive tract and allows for detailed X-rays of the stomach, esophagus and small intestine.
There are also a number of tests doctors can use to determine if the bacterium H. pylori is present in the body. These include:
- Urea breath test – Patients are required to consume a drink or tablet containing urea. If the bacterium is present in the body, it will break down the urea, producing ammonia and carbon dioxide that can be detected and measured when a patient exhales.
- Antibody test – Patients who have H. pylori in their system will also have the antibodies the body creates to fight the infection. However, because these antibodies survive for years after an infection has passed, this test cannot determine the presence of a new infection or how long it has been there.
Treatment for a peptic ulcer
Although antacids can provide relief from symptoms, the best way to treat an ulcer and prevent its return is to remove the H. pylori infection from the body. Aside from leading to painful ulcers, H. pylori is considered a carcinogen by the World Health Organization and has been linked to stomach cancer. Historically, doctors have used a combination of two antibiotics and an acid-supressing drug (known as a proton-pump inhibitor) to remove an infection but H. pylori has become more difficult to treat over time. New treatment recommendations have added a third antibiotic to the mix and the length of treatment has been extended to 14 days. Recent research has cast doubt on the wisdom of using proton-pump inhibitors, however, finding the medication can have a damaging effect on kidneys.
Preventing a peptic ulcer
Peptic ulcers are particularly challenging to prevent because no one is sure what causes them and there are currently no effective vaccines available. Some encouraging research has focused on a specific protein that makes the stomach acidic, a development that increases the likelihood of developing better anti-ulcer drugs in the future.
Prevalence of peptic ulcers
H. pylori is the most common bacterial infection in humans, affecting 50 to 80 per cent of the world’s population, according to one study. Its prevalence is declining in industrialized nations, however, and is estimated to affect around 20 to 30 per cent of Canadians.
Support for peptic ulcers
The Canadian Digestive Health Foundation is one source of information on peptic ulcers and what to expect if you think you or someone you know might be affected. You can also connect with others who have experienced peptic ulcers through the GERD/Stomach Ulcer Support Group.
Dave Yasvinski is a Toronto-based writer.