Peptic ulcer disease refers to the development of painful sores within the lining of the stomach or the beginning portion of the small intestine (duodenum). They occur as the result of acid erosion into the lining of the digestive tract.
At times, patients with peptic ulcers have no symptoms at all. Those who have symptoms may feel any of the following:
• Abdominal pain, typically in the upper abdomen
• Early fullness with eating
• Vomiting, at times with blood in the vomit
• Black tar-like stools
The two major causes of peptic ulcers are the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and an infection with Helicobacter pylori (H. pylori) bacteria.
NSAIDs include any medications that contain aspirin, ibuprofen, naproxen, meloxicam, ketorolac, diclofenac and celecoxib, among others. They are frequently used as over the counter pain relievers. The use of these medications can lead to ulcers by damaging the protective mucus layer of the gastrointestinal tract. Without this mucus layer intact, the gastrointestinal lining is more susceptible to damage from acid.
H. pylori is a very common bacterial infection of the gastrointestinal tract. It is found in roughly 50% of the world’s population. However, most people with this infection do not develop stomach or duodenal ulcers. When diagnosed, it is always treated given it can lead to chronic inflammation of the stomach that is a risk factor for stomach cancer. Testing for H. pylori is essential in the work up of peptic ulcer disease. Testing can be performed through non-invasive methods such as breath testing and stool analysis.
Other risk factors for peptic ulcer disease include cigarette smoking, family history, alcohol use, lifestyle factors, other medications and severe physiologic stress (i.e. burns, surgery, severe medical illness).
Your healthcare provider will review your history and perform a physical examination to see if your symptoms are consistent with peptic ulcer disease. H. pylori testing is generally performed, and if positive, treatment is prescribed. An upper endoscopy is typically required to confirm the presence of peptic ulcers. An endoscopy is a procedure in which a thin, long camera is inserted through the mouth and into the digestive tract which allows the doctor to visualize, biopsy and potentially treat peptic ulcers, if needed. Another way to diagnose peptic ulcers is with a specialized contrast X-ray looking at the upper digestive tract. These are not routinely performed but may be beneficial in some patients.
Identifying the cause of the peptic ulcer is the first step in management. If H. pylori infection is diagnosed, a treatment regimen consisting of antibiotics and acid suppressing medications will be prescribed. If NSAIDs are determined to be the cause, further use of these medications should be avoided. For non-H. pylori related ulcers, treatment includes the use of medications that suppress stomach acid secretion, thereby allowing the ulcers the opportunity to heal. Treatment commonly includes medications such as proton pump inhibitors (Nexium®, Prilosec®, Prevacid®, Protonix®, Dexilant®, Zegerid®) and H2-receptor antagonists (Pepcid ®, Axid ®, Tagamet ®).
The information provided above is meant to be used as an informative guide for patients. For precise and individualized recommendations, please consult with one of our board certified gastroenterologists to discuss your symptoms.
For additional information or to book an appointment at the Gastroenterology Center of New York, please feel free to reach out to our dedicated team by calling us at 718-210-2960. You can also schedule online or reach out to us via the Contact Us form.