Gastric Ulcers & Duodenal Ulcers: Upper Digestive Tract Disorders
Peptic ulcers are deep, nonhealing defects or sores in the lining of the stomach and duodenum. When they occur in the stomach, they're called gastric ulcers. Ulcers in the duodenum are duodenal ulcers. Duodenal ulcers tend to affect young people, especially males. Gastric ulcers are more common with age, because older people are more likely to be infected with H. pylori or to use NSAIDs.
Both gastric and duodenal ulcers tend to recur after they've been treated.
Causes of peptic ulcer disease
Peptic ulcers occur when the lining of the stomach or duodenum becomes damaged, usually by acid. Between 70 and 80% of gastric ulcers and nearly all duodenal ulcers result from H. pylori gastritis.
NSAIDs and the osteoporosis drug alendronate (Fosamax) also can damage the lining of the stomach, increasing the risk of gastric ulcers. Smoking increases the risk of slow-healing duodenal ulcers.
Symptoms of peptic ulcer disease
The symptoms of a peptic ulcer depend on whether the ulcer is in your stomach or duodenum. A gastric ulcer results in pain in the upper abdomen 15 to 30 minutes after eating. Because of the pain, you may be afraid to eat and you may lose weight. With a gastric ulcer, pain rarely occurs at night or when you are fasting.
A duodenal ulcer, on the other hand, results in pain in the upper abdomen two to three hours after meals, when the stomach is empty. The pain can awaken you at night and is relieved by eating.
If not treated, peptic ulcers can lead to complications such as bleeding, perforation, or penetration. Bleeding occurs when the ulcer causes a blood vessel to rupture in the lining of the stomach or duodenum. Perforation results when an ulcer erodes through the wall of the stomach or duodenum and into the abdominal cavity, leading to infection and inflammation of the abdominal cavity (peritonitis). Penetration happens when an ulcer erodes through the wall of the stomach or duodenum and into adjacent organs, such as the liver, pancreas, or colon (large intestine).
Less often, an ulcer can deform the stomach or duodenum and block the passage of food through the gastric outlet or duodenum, resulting in nausea and vomiting that do not improve with treatment.
Diagnosis of peptic ulcer disease
Peptic ulcers can be diagnosed using an upper endoscopy or an upper GI series. During endoscopy, a peptic ulcer appears as a round or elongated defect in the lining of the stomach or duodenum. On an upper GI series, barium accumulates inside the ulcer or shows changes in the normal appearance of the folds of the lining (such as convergence of the folds toward the ulcer).
Treatment of peptic ulcer disease
Peptic ulcers can be healed temporarily by suppressing gastric acid production, usually by taking H2-blockers and proton pump inhibitors. Ulcers often return once these drugs are stopped.
The more common way to treat ulcers is to eradicate H. pylori from the stomach. Once the infection is treated, gastric secretion returns to normal and peptic ulcers are usually cured. The treatment regimen to eradicate H. pylori includes antibiotics and acid-reducing medications.
Usually doctors first prescribe triple therapy, which consists of a proton pump inhibitor and two antibiotics. This approach cures ulcers more than 90% of the time. If triple therapy does not produce a cure, a second triple therapy containing different drugs may be tried.
Another option is quadruple therapy: bismuth subsalicylate (Pepto-Bismol and other brands), two antibiotics, and a proton pump inhibitor or H2-blocker. If the H. pylori infection is not eradicated, the likelihood is high that peptic ulcers will recur.
Continued use of NSAIDs or cigarette smoking lowers the chances that gastric ulcers will heal.
Bleeding ulcers are commonly treated with endoscopic therapy that stops the bleeding, followed by medication. Ulcers were once commonly treated with surgery: either partial gastrectomy or vagotomy.
Partial gastrectomy involves removing the acid-producing portion of the stomach; vagotomy involves cutting the vagal nerve to decrease acid production. Now that ulcers can be effectively treated with medication, surgery is rarely needed. Surgery is still used, however, for people with ulcer complications—for example, to stop bleeding, close perforations, or open up the gastric outlet if an ulcer is blocking it. But these days, ulcers rarely progress to this stage.