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The Peptic Ulcer Disease symptoms, causes, and treatment.

A peptic ulcer is a defect of the lining of the stomach and duodenum. When ulcers appear, it is a condition known as peptic ulcer disease.

In the United States, around 4.6 million people are diagnosed with peptic ulcer disease. Of all these cases, H. pylori infection is accountable for around 70 to 90% of all peptic ulcers. The proportion of peptic ulcer cases increases with age. 

In the following article, you will learn everything about this common condition. A doctor will answer your frequently asked questions with simple words, so you make the most out of this reading. 

What is a peptic ulcer?

A peptic ulcer is an open sore in the stomach’s inner lining or duodenum (upper small intestine). It affects the mucosal layer, all the way through to almost affecting the muscular layer as well.

In normal conditions, your stomach cells will produce stomach acid. Its function is to digest or degrade the foods we eat. However, stomach acid can be dangerous, even for your own stomach. This is why we have other cells that produce a mucus barrier. This mucus barrier also contains bicarbonate, which acts as a buffer to the acid. It prevents the stomach acid from damaging the mucosa of the stomach.

File:Gastric Ulcer.png
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Sometimes, the latter balance between acid and buffer production is affected. This can be caused by increased acid secretion or impaired buffer or mucus production. If any of this happens, there will be consequences to your stomach. Your gastric mucosa can become inflamed and hurt. If this persists over time, you’ll end up with defects in your stomach lining. These defects are peptic ulcers. 

What causes peptic ulcers?

There are many identified causes of peptic ulcers. The main reason is the imbalance between acid production and the protective mucus barrier. This will cause that your stomach becomes injured as if it digests itself. Some many reasons and factors that can cause this imbalance and cause peptic ulcers. The most common are: 

  • Helicobacter pylori infection: It’s one of the main causes of peptic ulcer disease. In fact, around 60% of the stomach and duodenal ulcers are caused by H. pylori infection. Still, people with H. pylori don’t have a higher chance of developing complications of peptic ulcer disease.
  • Drugs: The use of non-steroidal anti-inflammatory drugs (NSAID) is the second leading cause of peptic ulcer disease. These drugs affect the mucus barrier, leaving the stomach and duodenal wall vulnerable to injury. Almost 30% of all the patients who take these drugs will develop an NSAID-induced ulcer. Also, these ulcers have a higher chance of developing complications. 
  • Habits: Lifestyle habits like smoking and drinking alcohol are also related to the development of peptic ulcers. Especially drinking has a damaging effect on the mucus barrier that protects your stomach from digestive juices. 
  • Stress: Stressful situations are closely related to stomach ulcers. This happens because there is an increase in acid production. People who suffer from chronic stress will have a chronic rise in acid production. This can also be seen in patients suffering from serious conditions like burns, central nervous system trauma, and severe medical illnesses. 
  • Genetics: Overall, around 20% of patients diagnosed with peptic ulcer disease, have a family history of this condition. 
  • Physiological factors: Around 1/3 of patients who suffer from peptic ulcer disease have increased acid production and faster gastric emptying. This results in the higher acidic load that gets to the first portion of the duodenum: The latter results in duodenal ulcers and chance in the duodenal tissue. 

How do H. pylori cause peptic ulcer and peptic ulcer disease?

Helicobacter pylori is a bacteria that can survive within the stomach and its acids. This bacterium creates an environment around it that ensures its survival in the stomach. Helicobacter pylori can neutralize the acids of the stomach to colonize the tissue later. After colonizing the stomach tissue, it weakens the protective mucous layer of the stomach and the duodenum. 

It creates an imbalance between the secretion of acids and the secretion of mucus. Therefore, after a higher secretion of acids and a lower mucus secretion, the acids damage the stomach tissue. Also, the bacterium irritates the lining or the layers of the stomach, causing the acid to damage the tissue. This will ultimately cause a sore or an ulcer in the stomach or the duodenum.

What are the symptoms of a peptic ulcer? 

At first, peptic ulcers may not cause any symptoms. However, it doesn’t take a long time for them to cause inconveniences to the patient. The most common peptic ulcer symptoms include: 

  • Stomach pain: Also known as epigastric pain. This is the most common symptom of this condition. A burning sensation after meals characterizes it. The appearance of the belly pain may be different for stomach and duodenal ulcers. In stomach ulcers, the pain usually starts shortly after meals. This pain is not relieved by food or antiacid medications. For duodenal ulcers, the pain starts around 2 to 3 hours after meals. Pain will typically follow a pattern for each patient. 
  • Nightly pain: More common in patients with duodenal ulcers. It can be so intense that it wakes up the patient during sleep. It can be present in patients with stomach ulcers too, but it’s not that common. 
  • Dyspepsia: This includes feelings of distension, belching, bloating, and intolerance to fatty foods. 
  • Heartburn or chest discomfort.
  • Signs of bleeding ulcer: Like melena (black poop resulting from digested blood) and hematemesis (vomits with blood)
  • Fatigue: That appears as a sign of anemia in the event of bleeding ulcers. 
File:Depiction of a patient suffering from peptic ulcers.png
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Are you at risk of complications related to a peptic ulcer? 

There are many risk factors associated with peptic ulcer disease. These factors on their own may not be the cause of ulcers, but they can make it worse. Also, they can increase your chance of developing any complications. The most common risk factors include: 

  • Sex: Men are usually more affected by peptic ulcers than women. 
  • Age: It varies for stomach and duodenal ulcers. In your 30-50s, you are more likely to develop stomach ulcers. Then, around your 60s, you are more likely to develop duodenal ulcers. The older the patient, the more difficult the treatment is. Older patients also have a higher chance of developing complications. 
  • Chronic use of NSAIDs: We already know this is a major cause of peptic ulcer disease. Still, it can also be a risk factor for developing complications. In fact, patients who take a combination of these medications have a higher chance of developing complications. 
  • Stomach irritants: Coffee, certain foods, and smoking can be irritants to the mucosa. This may not cause ulcers at first, but it can make ulcers difficult to treat. It may also be a risk factor for developing complications of peptic ulcer disease. 
  • Chronic stress: Untreated stress is also a major risk factor for developing complications. This happens because the acid production is increased, harming the lining of the stomach and duodenum. 

What are the complications of peptic ulcer disease?

Peptic ulcer disease can cause many complications if it remains untreated. Luckily, it is hard for any of them to cause death. Nevertheless, these complications require immediate medical assistance. The most common ulcer complications include: 

  • Bleeding ulcer: The damage of the mucosa can result in bleeding. Sometimes, the bleeding can occur in small and slow blood loss. In other cases, peptic ulcer bleeding can be abrupt and severe. It can result in hospitalization to stop the bleeding and receive blood transfusions. Severe bleeding can manifest with black stools, and bloody vomits.
  • Perforation: Sometimes, peptic ulcers can fully penetrate the stomach or small intestine wall. This is what doctors know as perforation. It is a dangerous complication because the content of the stomach can end up in your abdominal cavity. This results in a potentially deadly infection called peritonitis. 
  • Obstruction: Depending on the location of the ulcer, it can obstruct the passage of food. This happens due to swelling and scarring of the tissue where the ulcer is. Intestinal obstruction can cause symptoms like vomiting, unexplained weight loss, and being full easily when you eat.
  • Stomach cancer: Doctors have found a link between H. pylori infection and gastric cancer. People with H. pylori usually develop peptic ulcers, so that gastric cancer can be a complication of peptic ulcer disease. 

What is the prognosis for a person with peptic ulcer disease? 

When doctors treat the underlying cause of peptic ulcers, the prognosis is excellent. The key to an excellent prognosis is treating H. pylori infection, stopping NSAID use, and preventing acid hypersecretion. Only by eradicating H. pylori infection, the ulcer recurrence rate drops from 80% to 15%. 

On the other side, the chance of NSAID-induced ulcers perforation is only 0.3% a year. In the case of obstructions, the chance is around 0.1%. Even if we put together the rate of any complications in both stomach and duodenal ulcers, it remains below 2% 

In terms of mortality, peptic ulcers are accountable for one death out of every 100,000 cases a year.

What procedures and tests diagnose peptic ulcers? 

First, you need to get a doctor’s appointment if you suspect you have peptic ulcers. The doctor will ask about the symptoms you’ve been having. They can also ask about Your family history and lifestyle habits.

By doing the latter, doctors can calculate your chance of having this condition. Then, they will perform a physical examination. This examination can be focused on the abdomen by palpating to see if there’s any pain. Also, they can indicate which studies you need to get done to confirm the diagnosis.

Since H. pylori is a major cause of peptic ulcers, you’ll need to get tested for this bacterium. Testing for H. pylori may include:

  • Measuring antibodies in the blood.
  • Looking for antigens of H. pylori in stools.
  • Other invasive methods.

Doctors can also detect H. pylori with breath tests. These include a biopsy of the gastric tissue to determine the presence of H. pylori in the tissue. They do this by measuring the amount of urea in your breath since H. pylori produce ureases. 

The definite diagnosis of peptic ulcers is made with endoscopy. This is an invasive procedure that inserts a tube and a camera down your mouth into your stomach. This way, doctors can observe the lesions and take samples of tissue and brush cells. This study lets doctors differentiate between benign ulcers and malign lesions. Endoscopies are also useful to determine bleeding or a perforating ulcer.

When should I see a doctor if I think I have a peptic ulcer?

You should always see a doctor if you think you have peptic ulcers. However, if you are not having any complications at the time, you’ll probably get outpatient treatment. You need to get emergency medical attention if you experience any of the following symptoms:

  • Sharp, persistent, or sudden stomach pain.
  • Black or very dark stools containing blood: This results from the blood from the stomach being digested through the intestine.
  • Vomits containing blood or look like ground coffee is a clear sign of a bleeding ulcer.
  • Nausea and vomiting; can be a sign of obstruction caused by ulcers. 
  • Unexplained weight loss
  • Fatigue or feeling like you’re going to faint.
  • Appetite changes, like suddenly feeling full when you eat. 

All of these ulcers symptoms can be a sign of complications like bleeding, perforation, and obstruction. 

What kind of doctors treat peptic ulcers?

For uncomplicated ulcers, any doctor can treat them. You can go with your family doctor or primary care physician for control and treatment. Still, since the only way to diagnose an ulcer is an endoscopy, you’ll have to see a Gastroenterologist. These are the doctors who specialize in diseases of the digestive tract. They are also the ones trained to perform an endoscopy. Also, they will treat you in the event of an emergency related to peptic ulcer disease. Sometimes, you may also need an endoscopy done to treat the complications of the ulcers.

What is the treatment for peptic ulcers?

The treatment of peptic ulcers will depend on what’s causing the ulcer. There are mostly three keys to treating peptic ulcers:

  • Eradicating H. pylori
  • Stopping NSAID use as much as possible
  • Treating already present ulcers with medications

Medical treatment for peptic ulcers include: 

  • Antibiotics to kill the H. pylori bacteria. Usually, the treatment for this infection includes a combination of antibiotics. Doctors mostly prescribe Amoxicillin, Metronidazole, Tetracycline, and levofloxacin. The antibiotic treatment usually lasts for two weeks.
  • Medications to block acid production: Mostly proton pump inhibitors. They decrease acid production by blocking the part of the cells that produce acid. This includes medications like omeprazole and pantoprazole. 
  • Medications to reduce acid releasing: Acid blockers or histamine blockers reduce the amount of acid released to your digestive tract.
  • Antacids: These don’t work as a treatment, but they can help ease the symptoms.
  • Medications that protect the lining of the stomach like sucralfate. They help regenerate the mucus layer that protects the stomach lining.

How long does it take for a peptic ulcer to heal?

It depends on the type of ulcer you have. For uncomplicated ulcers, the healing time is around two to three months. Stomach ulcers are the ones that take the longest to heal. This is because they are the ones more exposed to digestive acid.

On the other side, duodenal ulcers can heal faster within six weeks. Both stomach and duodenal ulcers can heal without antibiotic treatment. However, ulcer healing can be interrupted or lost if the bacteria are not fully eradicated. This results in the recurrence of the ulcer or the appearance of new ulcers nearby. 

How do you find out if the ulcer has healed? 

The only way to know for sure if your ulcer has healed is by repeating the endoscopy. It’s the only way to find lesions and to observe their progression. Yet, your symptoms can also be a sign of improvement. When your ulcer is getting better, your symptoms will get better too.

Can coffee and spicy foods cause ulcers? 

Doctors used to think coffee and spicy foods can cause ulcers. But now, we already know this is not the case. It is actually pretty rare for foods on their own to cause ulcers. Still, these foods can interfere with the healing of the ulcer. They can also worsen your symptoms after you consume them.

Can peptic ulcers be prevented? 

Yes, there are certain measures you can take to prevent peptic ulcers. The most effective ways to prevent this are:

  • Limit your alcohol intake
  • Limit the use of pain relievers like ibuprofen and naproxen: Or substitute with other forms of pain medications. Also, don’t mix or combine many medications. 
  • Avoid irritating foods like coffee, citrus, and spicy foods: They don’t cause ulcers, but they can worsen symptoms and interfere with ulcer healing. 
  • Avoid unhealthy habits like smoking.
  • Adopt a healthy diet with food and vegetables for your overall gastric health. 

Do you have symptoms of a peptic ulcer?

This tool is a Peptic Ulcer Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it that their symptoms are likely because of peptic ulcer disease.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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