An Educational Resource For Heartburn And Acid Reflux

What are the symptoms of peptic ulcer disease?
Peptic ulcer disease may cause any or all of the following problems: Gnawing or burning sensation below the breastbone in the soft part of the abdomen. The symptoms may be improved or exacerbated by meals and may last minutes to hours. Antacids often improve the discomfort.

What causes an ulcer?
If you answered "stress" or "poor diet," you are wrong. Don't worry. You are in good company. In a 1995 survey, 90% of those questioned answered "stress," and 60% answered "poor diet." Actually, we now believe that stress and diet have little to do with ulcer formation. They may exacerbate existing ulcer disease but do not actually cause ulcers to form. In fact, ulcers are more often related to a bacterial infection, use of certain medications, social habits (alcohol and tobacco), than to stress.

The real culprit, in more than 90% of cases, is a bacteria called Helicobacter pylori. This bacteria can inhabit the lining of the stomach and set the stage for ulcer formation in some people. Although the mode of transmission is not clear, the bacteria is thought to be ingested in food, and it is extremely common, particularly in lower socio-economic communities. About 20% of Americans under the age of 40, and about 50% of people over 60 have H. pylori in their stomachs.

Given the prevalence of the bacteria in our population, it is clear that only a small percentage of people with H. pylori ever develop problems from it. In fact, there is now a growing concern that we may be over-treating people with antibiotics for this organism and creating more resistant strains of bacteria, including H. pylori. Some scientists even speculate that in certain cases, H. pylori eradication may actually cause a paradoxical increase in reflux disease (GERD), possibly due to an increase of gastric acid following H. pylori treatment. Thus, the presence of the organism alone may not be enough to warrant treatment unless an ulcer or severe stomach inflammation is suspected.

What are some other causes of ulcers?
The second major cause of ulcers includes a class of drugs known as NSAIDs (non steroidal anti-inflammatory drugs), which include aspirin, Motrin, Advil, and Aleve. NSAIDs cause an irritation of the stomach lining if taken over a prolonged period of time. In older patients where NSAID use is common, these drugs can cause painless ulcers and serious gastrointestinal bleeding. A new class of anti-inflammatory medications known as COX-2 inhibitors (Celebrex, Vioxx) does not seem to pose the same risk of gastrointestinal bleeding, but is not risk-free.

Alcohol and tobacco use may also contribute to ulcer formation and inhibit ulcer healing.

How is an ulcer diagnosed?
There are three ways H. pylori can be diagnosed. A blood test can be performed to see if there are antibodies against H. pylori indicating exposure to the bacteria. A breath test works by measuring labeled carbon dioxide in the breath suggesting an H. pylori infection. Endoscopy, a procedure that allows a physician to visualize the lining of the stomach, may be required. A sample of cells can be obtained from the stomach lining and examined under a microscope.

What are the main complications of peptic ulcer disease?
One ulcer complication is bleeding from an ulcer of the stomach or duodenum. A warning sign is jet-black, tarry bowel movement, which indicates blood in the stool. Many patients do not initially recognize black, tar-like stool as bleeding since red blood may be absent.

A deep ulcer may also cause the leakage of gastrointestinal contents into the abdominal cavity. The result is severe pain due to a condition known as peritonitis and often requires surgical intervention.

An ulcer at the pylorus, the small opening between the stomach and the first part of the intestine, can cause a blockage between the stomach and small intestine and result in poor stomach emptying. Since the stomach cannot empty, the stomach fills completely, distends, and nausea and vomiting occur.

What is the treatment for peptic ulcers?
For those people with H. pylori infection, a combination of antibiotics, acid inhibitors and stomach protectants are recommended. Smoking and alcohol use should be avoided to offer the ulcer a chance to heal. If aspirin or other NSAIDS are used, these medications should be stopped if possible.

The good news is: most ulcers can be healed with medications alone. Surgery is only required if an ulcer fails to heal or is complicated by uncontrolled bleeding, perforation, or obstruction.

Conclusion
We have come a long way in understanding and treating peptic ulcer disease. Once thought of as a chronic disease of stress and diet, it is now known to be caused by H. pylori infection, NSAIDs, alcohol and/or tobacco. With the appropriate medical evaluation and intervention, peptic ulcer disease is now a condition that we can treat and cure.