By Melissa Chen, MD, Staff Writer, myOptumHealth
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What is a peptic ulcer?
A peptic ulcer is an open sore on the inside lining of the stomach or the duodenum. The duodenum is the start of the small intestine. A peptic ulcer in the stomach is called a gastric ulcer, and one that occurs in the duodenum is a duodenal ulcer. You can have both gastric and duodenal ulcers at the same time.
The main cause of peptic ulcers is Helicobacter pylori (H. pylori) bacteria. H. pylori infection is common, although most people don't have any symptoms or develop ulcers. H. pylori live in the stomach of infected people and may disrupt the protective mucous layer of the stomach and duodenum. This disruption allows stomach acid to damage the lining underneath, causing an ulcer. H. pylori infection has been linked to the development of stomach cancer. But most people who have H. pylori infection never get stomach cancer.
Another common cause of peptic ulcers is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These pain medications include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve).
What are the symptoms?
The most common symptom of a peptic ulcer is a dull or burning pain felt anywhere between the breastbone and navel. This pain may be worse when your stomach is empty, usually between meals or at night. The pain can last a few minutes to several hours and may be briefly relieved by eating food or taking antacids. Other possible symptoms include weight loss, poor appetite, nausea and vomiting.
A peptic ulcer can be life-threatening if it bleeds or perforates.
Call 9-1-1 if you have:
- Dizziness or feel like passing out
- Bloody vomit or vomit that looks like "coffee grounds"
- Bloody or black, tarry stools
Also seek emergency medical help if you have either:
- Sudden, sharp or severe abdominal pain
- A rigid, hard abdomen that is tender to the touch
How are peptic ulcers diagnosed?
If you have been having signs of an ulcer, your doctor will decide how to proceed. This will depend on your personal risk factors or "alarm" symptoms: These alarm symptoms include:
- Gastrointestinal bleeding
- Unexplained weight loss
- Frequent vomiting
- Difficulty or painful swallowing
- Family or personal history of cancer of the stomach or esophagus
- Anemia
- Feeling full after eating just a small amount
If you are under the age of 55 without any of the above risk factors, your doctor may order one of three tests to determine if have H. pylori infection:
- Blood test. A blood sample is taken and tested for H. pylori antibodies.
- Breath test. You drink a "labeled" liquid and after a few minutes, blow into a bag. If you are infected with H. pylori, your exhaled breath will contain "labeled" carbon dioxide.
- Stool test. Your stool is tested for H. pylori antigens.
The breath test and stool test may be more accurate in detecting H. pylori than the blood test.
Treatment for H. pylori infection is antibiotics and an antacid medication called a proton pump inhibitor. At least four weeks after treatment, your doctor may retest using either the breath test or stool test to make sure the infection is cured.
- The risk of stomach cancer rises with age. If you have had an ulcer, are 55 years or older or are younger than 55 years old with "alarm" features, your doctor may advise one of two tests. They are an upper gastrointestinal (GI) series or an upper GI endoscopy.
What is an upper GI series?
In this test, you will drink a thick, chalky liquid (barium) that coats the inside lining of the upper GI tract (esophagus, stomach and duodenum). The barium makes the lining show up more clearly on x-rays. A series of x-rays are taken as the barium moves through the upper GI tract.
What is an upper GI endoscopy?
This procedure is also called esophagogastroduodenoscopy (EGD). The doctor uses a small, lighted endoscope to see inside your upper GI tract.
What are the pros and cons of each procedure?
Based on current evidence, there appear to be some benefits and risks when comparing upper GI series to endoscopy. But talk with your doctor about which procedure is right for you.
Upper GI series
Pros:
- Test is noninvasive.
- Sedation is not needed.
Cons:
- May not detect some ulcers or abnormal growths.
- Complications may include mild constipation, allergic reaction to barium and, rarely, blocking of the intestines.
Upper GI endoscopy
Pros:
- More accurate in diagnosing ulcers and abnormal growths.
- Allows the doctor to see directly inside the upper GI tract.
- Ability to take biopsies of ulcers and remove abnormal growths.
- Biopsies can be tested for H. pylori infection and checked for precancerous changes.
- Ability to treat bleeding ulcers.
Cons:
- Procedure is invasive.
- Sedation is needed.
- Driving is not allowed for 12 to 24 hours after the procedure.
- Complications may include abnormal reaction to sedatives, bleeding from biopsy and accidental puncture of the upper GI tract.
Your doctor may advise repeat endoscopy if:
- Your gastric ulcer looks abnormal even though the biopsy from the first endoscopy is normal
- You continue to have symptoms after treatment for H. pylori infection
- Your ulcer re-bleeds after the first endoscopy treatment
What is important to me?
- Your willingness to undergo an invasive procedure. If you are not willing to undergo endoscopy, an upper GI series may be an option.
- Weigh the risks of endoscopy against the risks of upper GI series with your doctor.
