A peptic ulcer is a craterlike sore in the stomach or duodenal lining. It’s called a gastric ulcer when it occurs in the stomach, and a duodenal ulcer when it occurs in the first 12 inches of the small intestine. Symptoms of the two are similar.(Peptic refers to pepsin, an enzyme in the area of the digestive system where ulcers develop.)
Duodenal ulcers are about three times more common than gastric ulcers and are most likely to affect men. Gastric ulcers are more common in people between the ages of 60 and 70, perhaps because of heavy use of aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) for managing pain, especially from arthritis.
Up to 10 percent of Americans will have an ulcer at some point in their lives. Although most ulcers occur in people over 30, children may get them as well.
Even after pain has subsided and an ulcer has healed, it’s common for it to recur. Fortunately, the high rate of ulcer recurrence has been significantly reduced since the introduction of short-term drug regimens that combat the bacterial organism involved in causing most ulcers.
Symptoms of Ulcers
- Pain is the distinguishing stomach ulcer characteristic. In most instances there is a burning or gnawing feeling in the upper abdomen, sometimes below the breastbone, which may resemble heartburn. The pain is usually mild to moderate in severity and can last from 30 minutes to several hours.
- Often the pain occurs between meals and may be relieved by eating or by taking antacids, though in some people with gastric ulcer, eating food aggravates the pain. The pain may also awaken you at night or early in the morning. It may come and go for no apparent reason; many people experience multiple-week cycles of pain and freedom from pain.
- Less common symptoms include nausea, vomiting, and loss of appetite and weight.
- 10 to 20 percent of people with ulcers have no symptoms.
What Causes Ulcers?
Many factors contribute to ulcers. For years a stressful lifestyle and a high-fat or spicy diet were blamed for ulcers. Then in 1982 two Australian researchers discovered that a bacterium called Helicobacter pylori (H. pylori) was present in more than 90 percent of duodenal ulcers and more than 73 percent of gastric ulcers. Scientists theorize that the H. pylori organism weakens the stomach’s protective mucous membrane, so that even small amounts of stomach acid can cause new ulcers or delay the healing of existing ones.
Experts are cautious about saying that the bacteria cause ulcers. Other factors, such as heredity and smoking, seem to be involved, and not everybody who is infected with H. pylori develops ulcers. Also, some people get ulcers apparently without being infected—as, for example, those who take large doses of NSAIDs over long periods.
It’s not known how the bacterial infection spreads, but researchers think it’s transmitted orally. Young children and adolescents, when they carry the bacteria, may be more infectious than adults. According to researchers, it’s unlikely that one adult can transmit the bacteria to another. But infected children may transmit it to adults and other children.
Once an ulcer develops, several secondary factors may aggravate it. People who often take large doses of NSAIDs are at risk for ulcers, because these drugs may damage the stomach lining, and then digestive acid makes the lesion worse and interferes with healing.
Cigarette smoking is another factor that promotes ulcers, though it’s not clear how. Smoking definitely slows an ulcer’s healing. Food has also been blamedcoffee, tea, cola beverages, and spicy foods, as well as alcohol. But no food has ever been shown to promote ulcers.
Emotional stress, chronic anxiety, and even an “ulcer-prone personality” have all been blamed, too. But calm, happy people as well as tense unhappy ones get ulcers. There is no “ulcer personality.”
What If You Do Nothing?
Ulcers are not contagious, nor do they cause cancer, but they are usually painful. Rarely are ulcers life-threatening, but ulcers that go untreated can sometimes progress and lead to serious complications such as bleeding. In severe cases an ulcer eats a hole in the wall of the stomach or duodenum, and bacteria can spill through this perforation into the abdominal cavity, or peritoneum. This causes peritonitis, an inflammation of the abdominal cavity and wall that usually requires surgery.
Therefore, you should always see a doctor if you suspect you have an ulcer.
Home Remedies for Ulcers
Ulcer symptoms should be evaluated by a doctor. Prescription medications are the most effective form of treatment.
The following measures can help you avoid ulcers, or at least reduce the risk of them.
- Be careful with NSAIDs. If you must take aspirin, ibuprofen, or other NSAIDs regularly, take the smallest possible dose and always take it with food. If you are prone to ulcers and you must take NSAIDs, your doctor may recommend you take your NSAID with one of several medications that may help prevent the recurrence of NSAID-induced ulcers. Or you may be advised to try one of the newer NSAIDs called COX-2 inhibitors, which carry a lower risk of NSAID-related stomach problems.
- Eat sensibly. A diet rich in fiber is recommended because it is thought to reduce the risk of developing a duodenal ulcer by enhancing the development of mucin, which protects the intestinal lining.
- Quit smoking, if you smoke. The nicotine in cigarettes may prevent the pancreas from secreting enzymes that protect the intestinal lining. Smoking also slows the healing of existing ulcers and is a cause of ulcer recurrence.
- Be careful of what you eat. Though no food is known to cause ulcers, it won’t hurt to avoid foods that seem to give you indigestion or cause pain. Spicy foods as well as those that have a high fat content are common problems.
- Limit milk consumption. Its antacid effects work only briefly, and once the effects wear off, it actually stimulates acid secretion.
- Drink in moderation. If you drink alcohol, drink moderately and never on an empty stomach. Although alcohol consumption and ulcers are not directly linked, ulcers are common in people who have cirrhosis of the liver, an ailment that is associated with excessive alcohol consumption.
- Reduce stress in your life. Stress has not been proven to be a cause of ulcers, but it can irritate existing ones.
- Wash hands thoroughly after using the bathroom and before eating. This will prevent the H. pylori bacteria from spreading.
- Exercise regularly.
Beyond Home Remedies: When To Call Your Doctor
Call your doctor if you develop symptoms of a peptic ulcer.
Contact your physician or a hospital immediately if you vomit blood, if you feel faint or cold, or if you do faint; these are signs of potentially serious blood loss. Also contact your physician if your stools are black, tarry, or bloody, which are signs of internal bleeding.
Call for advice if you develop ulcer symptoms combined with back pain; the ulcer may have perforated into your pancreas. Also contact your physician if you’ve been diagnosed with an ulcer and now have a pallid complexion and begin to feel fatigued; these are signs of anemia.
What Your Doctor Will Do
A careful history will be taken and other medical conditions will be eliminated as primary causes of your problem. Diagnosing and treating an ulcer can be complex, and your doctor may refer you to a gastrointestinal specialist. The definitive method of determining that someone has an ulcer, and that the cause is H. pylori, is to perform an endoscopy, which involves inserting a tube-like instrument down the throat into the stomach and duodenum. This allows the doctor to view tissue and also biopsy samples to test for the presence of H. pylori and/or other problems. A barium swallow, visible on an x-ray, is a less precise but noninvasive tool that can detect an ulcer.
Since both tests are expensive, an otherwise healthy person who has an initial bout of pain suggesting an ulcer may first be treated with medication to see if symptoms resolve. If symptoms persist, worsen, or recur, then further evaluation is in order. In addition to endoscopy and barium x-ray, there are less expensive noninvasive tests, including a blood test and an in-office breath test, that can be used in initially detecting H. pylori and to monitor the effects of treatment.
For most cases of peptic ulcer, drug therapy will be recommended. If H. pylori. is present, your doctor may prescribe a course of antibiotics, usually in combination with acid-suppressing heartburn medications. Treatment with antibiotics greatly reduces the chance of an ulcer recurring. (Never take antibiotics just because you have gastric symptoms, however, unless you’re sure you have an ulcer.)
Consult your doctor before using any heartburn medication on your own to treat ulcer symptoms. Some of these medications—which include H2-blockers such as Pepcid, Tagamet, and Zantac—are available in over-the-counter formulations, but the OTC versions are only half the strength of the prescription drugs and may be ineffective for ulcers.
Antacids may also help, but they can interfere with the actions of other drugs if both types are taken in close succession—another reason to see your doctor before taking medication. Antacids and H2-blockers can also help heal ulcers in which H. pylori isn’t a factor, such as NSAID-induced ulcers.
If you have a severe ulcer that is bleeding or if treatment with medication is unsuccessful, surgery may be recommended.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media