A peptic ulcer, sometimes called a stomach ulcer, is a sore that forms in the lining of the stomach or of the duodenum, which is the first part of the small intestine. Peptic ulcers are often the result of infection by Helicobacter pylori bacteria.
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Helicobacter pylori (H. pylori)
Early in the twentieth century, peptic ulcers were thought to be caused by emotional stress and spicy foods. As a result, people were treated with bed rest and a bland diet, but they often failed to get better. Later in the century, the disease was blamed on excess stomach acid. People were treated with medicines that counteract acid or block its production, which made them feel better for a little while. The ulcers and the pain they caused, however, often came back.
Then in 1982, Australian doctors Robin Warren and Barry Marshall first discovered a link between ulcers and a bacterium known as Helicobacter pylori (hel-i-ko-BAK-ter pi-LOR-ee). Today, doctors know that nine out often ulcers are caused primarily by H. pylori, but the public has been slow to accept this idea. In fact, a 1995 study by the American Digestive Health Foundation (ADHF) found that nearly 90 percent of Americans with ulcers still blamed their problem on stress or worry. An equally large percentage were totally unaware of H. pylori. But as the ADHF points out, ulcers are not caused by a boss, unless that boss is a bacterium.
- Over 1 million Americans are hospitalized each year because of peptic ulcers.
- The cost of health care for Americans with peptic ulcers is more than $2 billion a year.
- Recent studies have found a link between long-term infection with H. pylori and stomach cancer.
A peptic ulcer, sometimes called a stomach ulcer, is a sore that forms in the lining of the stomach or of the duodenum (doo-o-DEE-num), which is the first part of the small intestine. This common disease can happen to people of any age and both sexes. Almost 25 million people in the United States currently have peptic ulcers, and there are about 500,000 to 850,000 new cases of the disease diagnosed each year.
Doctors now know that most peptic ulcers are caused primarily by infection with H. pylori, a type of bacteria that lives on the lining of the stomach. In the United States, about 20 percent of people under age 40 and half of people over age 60 are infected with H. pylori. Most never go on to develop ulcers, however. Doctors still do not know why one person gets ulcers and another does not. They also are not sure how people catch H. pylori, although it may be through water or food. The bacteria also might be spread by close contact, such as kissing.
Normally, the stomach makes acid as part of the digestive process. The sensitive lining of the stomach and duodenum is protected from this acid by a mucous coating. H. pylori bacteria cause ulcers by weakening this mucous coating, which lets acid get through and eat holes in the lining beneath.
About 10 percent of ulcers are caused by something other than H. pylori. Many result from long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are pain relievers such as aspirin and ibuprofen. NSAIDs interfere with the stomach’s ability to protect itself against acid. A few ulcers are caused by cancer of the stomach or pancreas (a gland near the stomach).
The most common symptom of a peptic ulcer is a gnawing or burning pain in the stomach. This pain comes and goes over a period of days or weeks. It may occur two to three hours after a meal. It also may occur in the middle of the night, when the stomach is empty. Eating helps relieve the pain. Other possible symptoms include weight loss, poor appetite, bloating, burping, nausea, and vomiting.
If left untreated, ulcers can lead to serious problems. In some cases, the ulcer makes a hole all the way through the stomach or duodenum wall. In other cases, the ulcer or acid breaks a blood vessel and causes internal bleeding. In still other cases, the ulcer blocks the path of food trying to leave the stomach. It is important to get medical help right away for the following symptoms, which may signal a peptic ulcer or other serious problem:
- sharp, sudden, or long-lasting stomach pain
- bloody or black stools (bowel movements)
- bloody vomit or vomit that looks like coffee grounds.
To see if a person has an ulcer, the doctor may do a barium x-ray or endoscopy. In a barium x-ray, the person drinks a chalky liquid that makes the stomach, duodenum, and any ulcers show up clearly on an x-ray image. In endoscopy, the person is given medicine to relax. Then a thin, lighted tube is passed through the person’s mouth and down the throat to the stomach and duodenum. This tube has a tiny camera on the end that lets the doctor view the inside of these organs.
To find out if an ulcer is caused by H. pylori, the doctor can check a sample of the person’s blood for signs of infection. As a second option, the doctor can do a breath test, in which the person drinks a harmless solution that contains a special carbon atom. If H. pylori is present, it releases the carbon. The person’s breath then can be tested to see if it contains the carbon. As a third option, the doctor can take a small tissue sample while doing an endoscopy. The tissue is removed through the thin viewing tube. It then can be checked for signs of infection.
People with ulcers caused by H. pylori are treated with antibiotics (bacteria-fighting drugs). The most common treatment involves taking antibiotics for one or two weeks along with a medicine to reduce the amount of acid in the stomach. To be sure that all the H. pylori bacteria have been killed, the doctor may do another endoscopy or breath test 6 to 12 months later to check for any remaining bacteria. When antibiotics kill all the bacteria, the odds are excellent that the ulcer will completely heal.
No one knows for sure how H. pylori bacteria spread, so ulcers are difficult to prevent. As a general precaution, however, people always should wash their hands thoroughly after going to the bathroom and before eating. They should eat food that has been properly cooked and drink water from a clean, safe source.
American Digestive Health Foundation, 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814-3015. This organization of professional societies has an Ulcer Education program that posts information about peptic ulcers at its website. Telephone 800-NO-ULCER http://www.gastro.org/adhf/ulcers.html
U.S. National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD 20892-3570. This service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) publishes brochures and posts fact sheets about H. pylori, peptic ulcers, and NSAIDs at its website. http://www.niddk.nih.gov/health/digest/pubs/hpylori/hpylori.htm
U.S. Centers for Disease Control and Prevention (CDC), H. pylori Education Campaign, 1600 Clifton Road, N.E., M.S. C09, Atlanta, GA 30333. CDC posts English and Spanish fact sheets about H. pylori and peptic ulcers at its website. Telephone 888-MY-ULCER http://www.cdc.gov/ncidod/dbmd/hpylori.htm
1. relating to pepsin.
2. relating to digestion. p. ulcer a breach in the lining (mucosa) of the digestive tract produced by digestion of the mucosa by pepsin and acid. This may occur when pepsin and acid are present in abnormally high concentrations. See duodenal ulcer, gastric (ulcer), oesophageal ulcer.
pep·tic ul·cer • n. a lesion in the lining (mucosa) of the digestive tract, typically in the stomach or duodenum, caused by the digestive action of pepsin and stomach acid.
pep·tic / ˈpeptik/ • adj. of or relating to digestion, esp. that in which pepsin is concerned.