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Peptic Ulcer Disease

Disease Summary:

A peptic ulcer is a sore in the lining of the stomach or duodenum, which is the first part of the small intestine.  These are referred to as gastric ulcers or duodenal ulcers depending upon their location.  Some individuals with peptic ulcer disease may have no symptoms, while others will have upper abdominal pain that may be made better or worse with food.  Other symptoms include nausea, vomiting, and bleeding.  Bleeding is potentially the most severe problem.  It can be gradual and go unnoticed or it can be life-threatening.  Severe bleeding could result in one's bowel movement being black and tarry, maroon, or dark red.  If there is vomiting, the vomit may look like coffee grounds or contain red blood.  If this occurs one should seek immediate medical attention.


The two most important causes of ulcers are infection with Helicobacter pylori and taking NSAID medications (ibuprofen, naproxen, aspirin), and aspirin-containing products (Alka-Seltzer, BC Powder, and Excedrin).  Helicobacter pylori is a bacterium that lives in the stomach lining of those individuals infected.  Often this infection causes no symptoms, but in some individuals the infection can lead to inflammation in the stomach lining and an ulcer develops.  The infection is usually acquired in childhood and can be transmitted through food, water, and close human contact.  Those with Helicobacter pylori infection may be more likely to develop gastric cancer and a certain type of lymphoma effecting the lining of the stomach.  NSAIDs cause ulcers by interfering with the stomach and the duodenum's ability to protect itself from stomach acid.  Those individuals who require chronic NSAID use should discuss with their doctors medication which can prevent or significantly reduce the risk of an NSAID ulcer.  Acetaminophen (Tylenol) is not an NSAID and does not cause ulcers.  Peptic ulcer disease is not caused by stress or spicy foods.  Alcohol and smoking increase one's risk of developing ulcers.


Upper endoscopy, esophagogastroduodenoscopy (EGD), is the most accurate test to diagnose ulcers.  This is when a flexible lighted camera is inserted into the mouth to look at the lining of the stomach and duodenum.  This is usually done with sedation.  Ulcers can be photographed, biopsied, and bleeding can be treated during the procedure.  Acid reducing medication, usually proton pump inhibitors (PPIs) are used to treat ulcers.  These include omeprazole, lansoprazole, esomeprazole, and pantoprazole.  If NSAIDs have been taken, they should be stopped.  If the Helicobacter pylori infection is present, proton pump inhibitor medication along with two antibiotics and possibly bismuth will be prescribed for 10 to 14 days.  It is very important to take all of the medication.  Proton pump inhibitor medications require a meal to activate them and therefore one should eat within 30 minutes to an hour after taking proton pump inhibitor medication.  It is important to document that the Helicobacter pylori infection is gone.  A stool sample, breath test, or endoscopy must be performed to document resolution of the infection.  Depending upon the location and size of the ulcer, your physician may want to perform another endoscopy to confirm healing of the ulcer and eradication of the bacteria.

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