There are approximately 350,000 to 500,000 new cases of peptic ulcer disease each year with more than one million ulcer-related hospitalizations each year.  The direct costs to our health care system amount to more than $2 billion per year with indirect costs (lost time from work, lost productivity) estimated at more than $500 million.

What Are Ulcers?

Peptic ulcers are sores in the lining of your stomach or duodenum (the first part of your small intestine).  When found it the stomach, they are called gastric ulcers.  They are called duodenal ulcers if they’re found in the duodenum.  It is possible to have more than one ulcer.

What Causes Ulcers?

Ulcers have frequently been considered to be functions of acid in the stomach caused by stress or spicy foods.  While they (along with smoking) can aggravate ulcers, they do not cause ulcers to develop.  A specific strand of bacteria, called Helicobacter pylori, is believed to be the cause of most peptic ulcers (approximately two-thirds) as well as being associated with several common upper GI disorders.

H. pylori is almost always present with inflammation of the stomach and is found in the majority of ulcer patients and about half of individuals with heartburn.  It produces chronic infection in individuals and usually infects people during childhood.  While many people have this infection, not everyone will develop ulcers.

Ulcers can also be caused by nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen and other diseases, including cancer.

Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.

You are more likely to develop a peptic ulcer if you:

• have an H. pylori infection;
• frequently use NSAIDs;
• smoke cigarettes;
• drink alcohol;
• have relatives who have peptic ulcers;
• are 50 years old or older.

Symptoms of Peptic Ulcers

The most common symptom is a burning pain in the gut that feels like a dull ache and comes and goes for a few days or weeks.  It often starts 2 to 3 hours after a meal and will come in the middle of the night when your stomach is empty.  The pain typically goes away after you eat.  Additional symptoms include weight loss, lack of appetite, pain while eating, nausea and vomiting.

If they are not treated, peptic ulcers will get worse.  You should seek medical attention immediately if you have any of these symptoms:  a sudden sharp pain that doesn’t go away, vomit that is bloody or dark that resembles coffee grounds, or black or bloody stool.  These may be signs that the ulcer has broken a blood vessel, has prevented food from moving from the stomach into the duodenum, or has gone through or perforated the stomach or duodenal wall.

Treatment

The good news is that peptic ulcers are treatable and can be cured, but they take time to heal.  If your ulcer is caused by NSAIDs, the first step is to stop taking them.  If you smoke, you need to quit because smoking slows the healing of ulcers.  Taking antacids may help to stop the acids from working and reduce pain and can also help the ulcer heal.  However, they need to be taken several times per day.  If your ulcer is caused by bacteria, antacids won’t kill the bacteria; this means that even if the pain goes away, your ulcer could return.

If your ulcer is more serious, certain medications can help by preventing your stomach from making acids; typically they are taken for a few weeks and will stop the pain and help heal your stomach or duodenum.  If your ulcer is due to a H. pylori infection, antibiotics my be prescribed.  In the most severe cases, surgery may be required.  You and your physician should discuss the pros and cons of each treatment option to determine what is best for you.  

Prevention

Almost all ulcers can be treated successfully, usually without surgery. Many ulcers can be prevented.  First and foremost, stop using NSAIDs; talk with your physician about alternative pain relievers.  In addition, to lower your risk of getting peptic ulcers, don’t smoke and don’t drink alcohol.

Sources:  Foundation for Digestive Health and Nutrition, www.fdhn.org; Facts and Fallacies About Digestive Diseases, NDDIC; 8 Tips on Peptic Ulcer Disease, American College of Gastroenterology