Peptic Ulcer. Anatomy The stomach is a hollow organ. It is located in the upper abdomen, under the ribs.

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1 Peptic Ulcer Introduction A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. Peptic ulcers may also develop in the esophagus. Nearly 1 in 10 people will develop an ulcer at some time. Peptic ulcers are very common throughout the world. If left untreated, peptic ulcers can cause serious health problems. This reference summary will help you better understand peptic ulcers, including what causes a peptic ulcer and what you can do to treat a peptic ulcer. Peptic Ulcers Anatomy The stomach is a hollow organ. It is located in the upper abdomen, under the ribs. After swallowing, food goes through a long tube, called the esophagus, to the stomach. In the stomach, acids start breaking down the food. This process is known as digestion. Muscles in the stomach push the liquid into the small intestine. The wall of the stomach is made up of many different layers of tissue. Small Intestines Esophagus Stomach 1

2 Peptic Ulcers A peptic ulcer is a sore in the lining of your stomach or duodenum. Peptic ulcers often cause a dull or burning pain in your stomach. If left untreated, peptic ulcers can cause other, more serious health problems. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the duodenum is called a duodenal ulcer. Peptic ulcers also may develop just above your stomach in the esophagus. However, this is rare. Many people have peptic ulcers. You can have both gastric and duodenal ulcers at the same time. People may have more than one ulcer during their lifetime. Luckily, peptic ulcers can be treated successfully. Seeing your healthcare provider is the first step. Symptoms A dull or burning pain in your stomach is the most common symptom of a peptic ulcer. You may feel pain from a peptic ulcer anywhere between your belly button and breastbone. The pain often: Starts between meals or during the night Briefly stops if you eat or take antacids Lasts for minutes to hours Comes and goes for several days or weeks Other symptoms of peptic ulcers may include: Weight loss Poor appetite Bloating Burping Vomiting Feeling sick to your stomach Even if your symptoms are mild, you may have a peptic ulcer. You should see your healthcare provider to talk about your symptoms. Peptic ulcers can get worse without treatment. 2

3 The symptoms of a peptic ulcer can be very similar to the symptoms of a heart attack. Symptoms should be taken very seriously because they could be a sign of a heart attack in progress Call your healthcare provider right away if you have any of the following, more serious symptoms: Sudden sharp stomach pain that does not go away Black or bloody stools Bloody vomit or vomit that looks like coffee grounds Serious symptoms could be signs that an ulcer has opened up a blood vessel or gone through your stomach or duodenal wall. It is also possible that food has stopped moving from your stomach into the duodenum. You may need surgery to correct these problems. Causes Most peptic ulcers are caused by bacteria that cause infection, known as Helicobacter pylori or H. pylori. Nonsteroidal antiinflammatory drugs, or NSAIDs, such as aspirin and ibuprofen are also a common cause of peptic ulcers. Examples of NSAID medications that you can buy without prescriptions in the US are: Aspirin such as Bayer Ibuprofen such as Advil and Motrin Naproxen such as Aleve Examples of NSAID brand medications that require a prescription in the US are: Anaprox Celebrex Clinoril Feldene H. pylori is the most common cause of peptic ulcers. H. Pylori may be spread through unclean food or water, or by mouth-to-mouth contact such as kissing. However, many people who have an H. pylori infection never develop an ulcer. 3

4 Frequent use of NSAIDs is the second most common cause of peptic ulcers. Ulcers caused by NSAIDs are usually found in people who: Are age 60 or older Are female Have taken NSAIDs for a long time Have had an ulcer before Other causes of peptic ulcers are rare. One rare cause is Zollinger-Ellison syndrome, a disease that causes the body to produce too much stomach acid. This harms the lining of the stomach or duodenum. Stress or spicy food does not cause peptic ulcers, but they can make ulcer symptoms worse. Diagnosis Tell your healthcare provider about your symptoms and which medicines you take. Be sure to mention those you get without a prescription, such as Bayer, Motrin, Advil, or Aleve. These medicines are all popular, over-the-counter NSAIDs. To see if you have an H. pylori infection, your healthcare provider will test your blood, breath, or stool. Your healthcare provider may also want to look inside your stomach and duodenum by doing an endoscopy or an upper gastrointestinal series, which is a type of x-ray. Both procedures are painless. For an endoscopy, you will be given medicine to relax you. Then the healthcare provider will pass an endoscope through your mouth to your stomach and duodenum. Your healthcare provider also may take a small piece of tissue to look at through a microscope. This process is called a biopsy. An endoscope is a thin, lighted tube with a tiny camera that can be inserted into the body to give a view of its internal parts. For an upper GI series, you will drink a type of liquid called barium. The barium will make your stomach and duodenum show up clearly on the x-rays. 4

5 Treatment If you have a peptic ulcer, it can be treated and even cured. Depending on what caused your ulcer, your healthcare provider may prescribe a number of different medicines. If an H. pylori infection caused your peptic ulcer, your healthcare provider may prescribe antibiotics. Antibiotics are medicines used to treat bacterial infections. If an NSAID caused your peptic ulcer, your healthcare provider may tell you to: Stop taking the NSAID Reduce how much of the NSAID you take Take additional medicine to reduce stomach acid Switch to another medicine that won t cause ulcers Some of the medicines your healthcare provider may prescribe are used to reduce stomach acid and protect the lining of your stomach and duodenum. These medicines will stop the pain and help heal the ulcers. Pepto Bismol is an example of this kind of medicine. In many cases, medicines heal ulcers. If an H. pylori infection caused your ulcer, you must finish all antibiotics and take any other medicines your healthcare provider prescribes. The infection and ulcer will only heal if you take all medicines as prescribed. Tell your healthcare provider if the medicines make you feel sick or dizzy or cause diarrhea or headaches. Your healthcare provider can change your medicines. Rarely, surgery is needed to help ulcers heal. You may need surgery if your ulcers: Do not heal Keep coming back Bleed Break through the stomach or duodenal wall Block food from moving out of the stomach 5

6 Surgery can remove the ulcers and reduce the amount of acid in your stomach. If you smoke, you should quit. You should also avoid alcohol. Smoking and drinking alcohol slows the healing of ulcers and can make them worse. Peptic ulcers can come back if you smoke or take NSAIDs. If you need to take an NSAID, your healthcare provider may switch you to a different medicine or add medicines to help prevent ulcers. Preventing Peptic Ulcers To help prevent ulcers caused by H. Pylori you need to prevent the likelihood of becoming infected with germs. You should: Wash your hands with soap and water after using the bathroom and before eating Eat food that has been washed well and cooked properly Drink water from a clean, safe source To help prevent ulcers caused by NSAIDs: Stop using NSAIDs, if possible Take NSAIDs with a meal, if you still need NSAIDs Use a lower dose of NSAIDs Ask your healthcare provider about medicines to protect your stomach and duodenum while taking NSAIDs Summary A peptic ulcer is a sore in the lining of the stomach, duodenum, or esophagus. Helicobacter pylori (H. pylori), a germ, is the most common cause of peptic ulcers. Use of nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, is the second most common cause of peptic ulcers. Neither stress nor spicy food causes peptic ulcers. But similar to smoking or drinking alcohol, they can make ulcer symptoms worse. 6

7 If H. pylori caused the ulcers, antibiotics are taken to kill the germ. If NSAIDs caused the ulcers, a healthcare provider will decide the best treatment. People may have more than one ulcer during their lifetime. Luckily, peptic ulcers can be treated successfully. Seeing your healthcare provider is the first step. 7