What Leads to Stomach Ulcers?

Peptic ulcers occur when the lining of the stomach or the duodenum, the first few inches of the small intestine, are eroded by acid. They were once considered a scourge of the industrialized world. Treatments frequently failed, recurrences were common and surgery to excise the affected parts of the stomach and small intestine was necessary to prevent complications and death. Research has improved both the diagnosis and treatment of peptic ulcers.

Causes

• While an effective type of painkiller, NSAIDs are a major cause of ulcers.

  Up to 70 percent of diagnosed peptic ulcers are caused by H. pylori infections. The presence of the bacteria causes a chronic inflammation that allows stomach acid to erode the lining of the stomach as well as the duodenum, causing the ulcer.

  The remainder of ulcers appear to be caused by use of non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen. NSAIDs are acidic, and in combination with stomach acid, can overwhelm the lining of the stomach. They also interfere with the production of a hormone that limits stomach acid formation, causing greater amounts of stomach acid to be released.

Risks

• Smoking increases the risk of developing an ulcer.

  Cigarette smoking contributes to the risk of developing a peptic ulcer. The more cigarettes a person smokes on a daily basis, the greater her chance of developing an ulcer. Heavy drinking also increases the risk. Moderate drinking, however, does not appear to influence the development of a peptic ulcer.

Symptoms

• If you have frequent heartburn, you may have an ulcer.

  In many patients, the symptoms of a stomach ulcer go unnoticed until complications have developed. For those who experience symptoms of an ulcer without complications, the symptoms are usually limited to halitosis (bad breath), pain after eating if the ulcer is in the stomach, pain on an empty stomach if the ulcer is in the duodenum, and frequent heartburn.

Diagnosis

• Diagnosis is made by blood test confirming the presence of antibodies to H. pylori and a urea breath test where the patient is given a capsule to swallow. If the bacteria is present in the stomach, it will metabolize the contents of the capsule and liberate a type of carbon dioxide that is then exhaled. If neither of these tests confirms an H. pylori infection, then an endoscopic examination may be done to confirm the presence of ulcers.

Complications

• A peptic ulcer by itself is painful and unwelcome. If left untreated, it can progress to debilitating and even deadly symptoms. The eroded tissue can bleed copiously, causing vomiting of fresh blood from the stomach or partially digested "coffee ground" blood from the duodenum. If the blood travels through the entire gastrointestinal tract, it will be seen in bowel movements as a sticky, tar-like stool. If enough blood is lost, the patient become anemic, pale, exhausted and weak.

  If the ulcer erodes the tissue until it penetrates the stomach, the ulcer is considered perforated. Stomach acid can leak into the abdominal cavity, causing excruciating pain. The acid can damage organs such as the pancreas, spleen and liver, and the patient can die in short order.

  Even if the ulcer does not progress to such dangerous extent, if there is an H. pylori infection present, the patient has a three to six times greater chance of developing stomach cancer. Because stomach cancer rarely presents noticeable symptoms until it has metastasized, it has a very high death rate.

Treatment

• Thankfully, research done over the last 30 years has allowed doctors to successfully treat the vast majority of peptic ulcers. If the cause is diagnosed as an H. pylori infection, the treatment is a 14-day regimen of two antibiotics, such as clarithromycin and amoxicillan, and a drug to reduce acid production in the stomach, such as omeprazole, known as Prilosec. Once the regimen is completed, the ulcer may take several extra weeks to heal, but recurrence is rare.

  If the ulcer is due to use of NSAIDS, the patient is advised to use a different medication that will not irritate the lining of the stomach, and, if necessary, the doctor will prescribe omeprazole or another medication to limit the production of stomach acid.