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What are peptic ulcers?
A peptic ulcer is a sore or break in the lining of any area in the digestive tract that contains concentrated gastric juice. These can occur in the lower end of the esophagus, the stomach, or most commonly, in first part of the small intestine below the stomach (duodenum). The main components of gastric juice are digestive enzymes (pepsin and rennin), hydrochloric acid, and mucus. About 10% of Canadians will experience ulcers at some point.
What causes ulcers?
Most ulcers result from infection with bacteria called Helicobacter pylori (H. pylori). Contrary to old beliefs, neither eating spicy food nor living a stressful life cause ulcers. H. pylori bacteria weaken the protective mucous coating of the esophagus, stomach, or duodenum, which then allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
At this time, it is unclear how these bacteria spread from person to person. It is also unknown why only a small percentage of people infected with H. pylori develop peptic ulcers. Just because you have H. pylori does not mean you will get an ulcer, although most people with ulcers have an H. pylori infection.
Another cause of ulcers is the regular use of pain medications called non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin and ibuprofen. Frequent or long-time use of NSAIDs, especially among older people, can increase the risk of developing an ulcer.
What are the symptoms of ulcers?
The most common symptom of an ulcer is a burning pain in the upper abdomen, somewhere between the breastbone and the navel. The pain often occurs between meals and sometimes awakens people from sleep. The pain may last anywhere from a few minutes to several hours. Food or antacids may help relieve the discomfort.
Less common symptoms of an ulcer include nausea, vomiting, and lack of appetite or weight loss.
What are the complications of ulcers?
There are three main complications of peptic ulcers: bleeding, perforation, and obstruction.
Bleeding: Bleeding may be the first and only symptom of an ulcer. Bleeding ulcers can cause vomiting of acidified blood that looks like ‘old coffee grounds’, or bowel movements can become tarry black or even bloody. When an ulcer bleeds and continues to bleed without treatment, a person may become anemic and weak.
Perforation: When ulcers are untreated, gastric juices can literally eat a hole in (perforate) the stomach lining, requiring surgery.
Obstruction: Chronic inflammation from an ulcer can cause swelling and scarring. Over time, this scarring may close (obstruct) the outlet of the stomach, preventing the passage of food and causing vomiting and weight loss. Surgery is required to repair obstructions.
It is important to contact a doctor immediately if your symptoms worsen.
How are ulcers diagnosed?
The most common tests used to check for the presence of an ulcer are:
Upper GI series: X-rays are taken after the patient swallows a special liquid to coat the esophagus, stomach, and upper part of the small intestine.
Upper GI endoscopy: After patient sedation, a long flexible tube with a tiny video camera on the end (endoscope) is passed through the mouth and down the esophagus to the stomach so the doctor can visually examine for the presence of inflammation or ulcers. If necessary, a biopsy (removing a small sample of tissue) is taken for further testing.
Tests for Helicobacter pylori
There are several tests available to detect H. pylori infection. These include a simple breath test, checking the blood for antibodies to the bacteria, or examination of biopsies from the stomach.
How are ulcers treated?
Doctors often recommend lifestyle and dietary changes for people with ulcers, in addition to medications, until complete ulcer healing. Patients should avoid certain food and beverages such as chocolate, coffee, alcohol, fatty foods, peppermint, citrus fruits and juices, tomato products, pepper, mustard, and vinegar. Eating smaller meals that are more frequent may also control symptoms better. Stopping smoking is important, as smoking inhibits ulcer healing. You should also not take NSAIDs, like aspirin or ibuprofen.
Treatment: Medications
The cause of your ulcer will determine the type of medical treatment that your doctor recommends. If NSAID use has caused your ulcer, then your doctor may discontinue prescribing NSAID medication, may suggest a different pain medication, or may add another medication to protect your stomach and duodenum, such as a proton pump inhibitor (PPI) that blocks stomach acid.
If H. pylori infection is the cause of your ulcer, then your doctor will prescribe a treatment plan to kill the infection and reduce the acid in your stomach. Usually, this is in the form of a combination of one or more antibiotics (to kill the bacteria) plus a PPI. It is important to follow the treatment plan exactly as your doctor prescribes. This treatment can permanently cure 80% to 90% of peptic ulcers.
Some of the common antibiotic medications prescribed for treatment of ulcers caused by H. pylori include amoxicillin, clarithromycin, tetracycline, and metronidazole. It is important to take antibiotic prescriptions until they are complete. This helps prevent the growth of more resistant bacteria (superbugs) that may make it more difficult to treat other infections later.
There are two classes of medication that suppress acid secretion: histamine H2-receptor antagonists (H2-RAs) and proton pump inhibitors (PPIs).
H2-RAs work by blocking the effect of histamine, which stimulates certain cells in the stomach to produce acid. These are cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®). H2-RAs are all available as prescription medications and some are available in a lower dose, 'over-the-counter' without a doctor's prescription. H2-RAs are generally very safe.
PPIs are a newer class of medication. They work by blocking an enzyme necessary for acid secretion. The first PPI introduced into Canada was omeprazole (Losec®), followed by lansoprazole (Prevacid®), pantoprazole (Pantoloc®), and more recently by esomeprazole (Nexium®), and rabeprazole (Pariet®). PPIs are available only with a prescription from your doctor. PPIs have emerged as the most effective therapy for relieving symptoms and improving quality of life, as well as healing and preventing ulcer damage. PPIs are generally very safe.
It is important to take all of your medication, exactly as your doctor prescribes it, even if you begin to feel better part way through treatment. This will help to ensure that you remain ulcer-free.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
