Ulcers, also called peptic ulcers, are sores that form in the lining of the upper part of the small intestines (duodenal ulcers) and stomach (gastric ulcers), the areas in the digestive tract that are exposed to stomach acid and enzymes, and in the esophagus (although esophageal ulcers are less common). The most common symptom of ulcers is a burning abdominal pain that is felt anywhere between the naval and the chest. Although many causal factors are associated with ulcers, the most common factors include excessive use of NSAIDs and H. pylori infection. With proper treatment, most ulcers heal, but if timely treatment is not sought or other complications arise, ulcers can develop into more serious conditions that cause internal bleeding and even stomach cancer.
SYMPTOMS
Symptoms associated with ulcers include:
- Nausea
- Bloating
- Burning upper abdominal pain that worsens at night and when the stomach is empty
- Gastrointestinal bleeding
- Weight loss
- Vomiting (sometimes with the presence of blood)
- Changes in appetite
- Black stools or dark blood in the stool
Conditions associated with ulcers are:
- Anemia
- Stomach cancer
- Gastrointestinal bleeding
- Infection
- Scar tissue buildup
CAUSES
Ulcers occur when stomach acid eats away at the protective lining of the digestive tract, creating an open sore. Usually, the digestive tract’s mucosal lining protects the digestive organs from stomach acid, but if acid is abnormally increased or the protective lining damaged, or both, ulcers can develop. Common factors that may cause peptic ulcers are:
- Alcohol abuse
- Crohn’s disease
- Excessive intake of fatty foods
- Excessive stomach acid secretion (which can be genetically determined and is indicative of Zollinger-Ellison syndrome due to overproduction of stomach acid)
- H. pylori infection
- NSAIDs
- Smoking
- Stomach cancer
- Stress
Lifestyle choices such as poor diet and excessive alcohol consumption, smoking, and NSAIDs increase intestinal permeability of the gut lining, which allows bacteria to translocate through and damage the mucosa. Older populations are more at risk for developing ulcers. This may be due to the prevalent use of NSAID’s in arthritic elderly individuals or the fact that the valve between the stomach and the duodenum relaxes with age, allowing bile to leak into the stomach and damage the lining. Studies show that in the majority of individuals suffering from ulcers, the bacteria H. pylori is detected. Because of these studies, H. pylori infection is thought to be one of the most common causes of ulcers, along with NSAIDs.
DIAGNOSIS
Tests that are commonly administered to diagnose an ulcer are:
- Upper endoscopy: a small tube with a camera on its end, called an endoscope, is inserted through the mouth, and is used to look at the esophagus, stomach, and small intestine to detect ulcers
- X-ray of the upper digestive tract: x-ray images of the esophagus, stomach, and small intestine are taken to look for ulcers
Because a large percentage of people suffering from ulcers have H. pylori in their gut, being tested for H. pylori may be helpful in diagnosing your ulcer. The following tests are used to diagnose H. pylori:
- Biopsies taken during upper endoscopy: a small tube with a camera on its end, called an endoscope, is inserted through the mouth, and used to look at the upper gastrointestinal system (esophagus, stomach, and the first section of the small intestine); biopsies are taken to assess H. pylori infection
- Blood test: blood is tested for H. pylori antibodies (the immune system’s response to the infection)
- Breath test: a baseline exhalation of air into a bag and an exhalation of air after drinking a lemon-flavored solution (containing urea, which H. pylori bacteria convert into carbon dioxide) are taken and carbon dioxide levels measured; an increase in carbon dioxide is a positive test for H. pylori
- Stool test: a stool sample is taken and tested for traces of H. pylori
TREATMENT
Lifestyle Modifications
With proper treatment, most ulcers heal without complication. Adopting healthy lifestyle that include stress reduction, eating a healthful, vegetable and fiber rich diet, and avoiding alcohol, smoking, and NSAIDs, will help you heal your ulcer while avoiding toxic medications that may lead to short term fixes with long-term consequences.
Medications
The following medications are often prescribed for ulcers:
- Antibiotics that kill H. pylori
- Proton pump inhibitors to block acid production
- H2 blockers to reduce acid production
- Antacids to neutralize acid in the stomach
- Cytoprotective agents to line your digestive tract and protect tissue from damage
Although these medications may offer short-term relief, they can put you at risk for developing additional ulcers in the future. Antibiotics and acid blocking medications throw off the bacterial balance that protects the intestinal lining from damage by pathogenic bacteria. Because of these detrimental effects, lifestyle modifications should always be the first line of defense in treating an ulcer.
