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Peptic ulcer

Definition

A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine.

Alternative Names

Ulcer - peptic; Ulcer - duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:

Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency.

The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following factors raise your risk for peptic ulcers:

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers.

Many people believe that stress causes ulcers. It is not clear if this is true for normal stress.

Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain is a common symptom. The pain can differ from person to person, and some people have no pain.

Other symptoms include:

Other possible symptoms include:

Exams and Tests

To diagnose an ulcer, your doctor may perform a test called an upper endoscopy (EGD).

Upper endoscopy is done on most people when peptic ulcers are suspected or when you:

Tests for H. pylori is also needed.

Your doctor may also order these tests:

Sometimes, you may need a test called an upper GI. A series of x-rays are taken after you drink a thick substance called barium.

Treatment

In order for your ulcer to heal and to reduce the chance it will come back, you will be given medicines to:

Take all of your medicines as your doctor recommends. Other changes in your lifestyle can also help.

If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 7- 14 days:

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.

You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

Other medicines used for ulcers are:

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include:

Surgery may be needed if:

Outlook (Prognosis)

Peptic ulcers tend to come back if untreated. There is a good chance that the H. pylori infection will be cured if you take your medicines and follow your doctor’s treatment advice. You will be much less likely to get another ulcer.

Possible Complications

When to Contact a Medical Professional

Get medical help right away if you:

Call your doctor if:

Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:

The following lifestyle changes may help prevent peptic ulcers:

References

Kuipers EJ, Blaser MJ. Acid peptic disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 141.

Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 53.

Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-1825.

Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738.

McColl KEL. Helicobacter pylori infection. NEJM. 2010;362:1597-1604.



Review Date: 7/18/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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