A peptic ulcer is an erosion in the mucosal lining (equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 70-90% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach.
The lifetime risk for developing a peptic ulcer is approximately 10%. A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer.
Contrary to general belief, more peptic ulcers occur in the first part of the small intestine, just after the stomach (the duodenum) rather than in the stomach itself. About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.
If you have a peptic ulcer, you may only experience very mild symptoms or none at all. However, abdominal discomfort is the most common symptom associated with ulcers. Other symptoms include:
Ulcers commonly produce burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty.
Sometimes the pain may flare at night and it can be relieved temporarily by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for every sufferer. Ulcers can be caused or worsened by drugs such as aspirin and other NSAIDs.
An esophagogastroduodenoscopy (EGD) is carried out on patients with a suspected peptic ulcer. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken.
Patients who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue in order to help prevent peptic ulcers.
When H. pylori infection is present, the most effective treatments are combinations of antibiotics and proton pump inhibitors (PPI). In the absence of H. pylori, long-term higher dose PPIs are often used. Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics.
Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.