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Ulcers

Aria Health Center for Gynecology & Women's Health

Ulcers are sore-like inflammations or irritations that have a created partial hole or break on the lining (mucous membrane) of the stomach or sometimes other areas of the GI tract, such as the esophagus or small intestine near the stomach. Typically, these are caused by Helicobacter pylori (or H. pylori), a spiral-shaped bacterium found in the stomach, which (along with acid secretion) can damage stomach and duodenal tissue in some circumstances, causing inflammation and peptic ulcers. Peptic ulcers - collectively referring to stomach (gastric) and duodenal ulcers - are so common that tens of millions of Americans suffer from them.

The relationship of H. pylori to the health and function of the stomach is a complex one that is not fully understood. But, the bacteria, which are found in the vast majority of patients with ulcers (as well as many without them), can sometimes penetrate the stomach's protective mucous lining. This makes the stomach cells more susceptible to the damaging effects of acid and pepsin (digestive juices in the stomach). The bacteria can also attach to stomach cells, further weakening the stomach's defensive mechanisms and producing local inflammation. H. pylori have a complicated role in sometimes stimulating the stomach to release more acid but also producing substances that neutralize the acid.


Causes/risk factors

Stress and diet are traditionally associated with this common condition; however, the precise connection of these two factors to ulcer disease remains in debate. It is established that too much acid can damage the lining of the stomach or duodenum and cause an ulcer. Thus, stress and diet may be more properly considered to aggravate symptoms of ulcers, or perhaps dispose someone to ulcers, as opposed to causing them directly.

Why certain people develop H. pylori-related symptoms or ulcers, and others do not, remains largely unknown. H. pylori can survive in the stomach and be passed from one person to another, usually by oral-to-oral contact.

It is known, however, that individuals who regularly use nosteroidal anti-inflammatory drugs (NSAIDS) such as aspirin, and those who smoke cigarettes, are at greater risk of the peptic ulcers. Smoking also slows the healing process of existing ulcers and increases the likelihood that ulcers will recur.


Signs & symptoms

Some people who have ulcers experience little or no symptoms from them. For others, who are symptomatic the discomfort can range from a dull, gnawing discomfort to a sharp, burning pain in the upper abdomen (between the stomach and the center of the rib cage) or mid-abdomen. This pain may:

  • occur two to three hours after a meal;
  • come and go for several days or weeks;
  • occur in the middle of the night or early hours of the morning when the stomach is empty, sometimes waking the individual as a result of the pain;
  • be relieved by eating or by taking antacids.

Other effects of peptic ulcers include:

  • weight loss;
  • loss of appetite;
  • bloating;
  • burping;
  • nausea;
  • indigestion;
  • vomiting (sometimes with the presence of blood).

Complications from ulcers can include:

  • bleeding from the ulcer itself, sometimes resulting in regurgitated blood;
  • perforation of obstruction, when the ulcer eats through the wall of the digestive tract;
  • and narrowing or obstruction of the GI tract.


Diagnosis

In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose ulcers:

  • barium, upper-GI x-ray;
  • upper endoscopy;
  • blood tests to identify antibodies that indicate the presence of the bacteria;
  • a stool culture to reveal the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems;
  • or blood, breath or stomach-tissue tests to detect the bacteria.

Treatment

Understanding of peptic ulcers has improved significantly in recent years. Antibiotics have proven effective in killing the H. pylori bacteria.

In addition, physicians can prescribe any of a number of drugs available for suppressing acid production that are safe for long-term use. These include H2-blockers (to reduce the amount of acid in the stomach by blocking histamine, a powerful stimulant of acid secretion) and proton-pump inhibitors (to more completely block stomach acid by stopping secretion by the stomach's acid pump, the final step of acid production).

Changes in lifestyle habits can also help in addressing peptic ulcers. Patients should stop smoking; should be aware that caffeine seems to stimulate acid secretion in the stomach; may want to moderate alcohol consumption; should avoid NSAIDs; and may want to seek was of reducing stress.

For cases that have resisted all noninvasive treatment, surgery is sometimes the best option. In a vagotomy, the surgeon cuts part of the vagus nerve to reduce messages to the stomach to secrete acid. In a antrectomy, the surgeon removes part of the stomach related to secretion of digestive juices.

Patients with complications of ulcers may need surgical or other urgent care.  In addition to repairing the ulcerated portion of the stomach, operations may also address inflammation of the abdominal cavity (peritonitis) due to leakage of bacteria and partially digested food from ulcerative perforations or may address swelling and scarring that prevents food from moving into the small intestine.  Surgeons in Aria's Division of General Surgery are experts in providing surgery for the stomach, surgery for the small intestine, and surgery for the peritoneum, as treatment for complications of ulcers and for other conditions.