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Peptic Ulcers: Gastric and Duodenal Ulcers

Gastric or stomach ulcers and duodenal ulcers both fall into the general category of peptic ulcers.

Peptic Ulcers and the H. pylori Bacterium

Peptic ulcers are sores or breaks in the lining of the gastrointestinal tract, primarily in the stomach or duodenum. Ulcers can vary in size, with the average ulcer between a quarter and half an inch in diameter.

The most common cause of peptic ulcer is the bacterium H. pylori (Helicobacter pylori).

What is Pepsin?

Pepsin is a digestive enzyme produced by the gastric glands, which, along with hydrochloric acid, plays an important role in the breakdown of proteins, fats and starch. If the stomach or duodenal lining is irritated by medications or byH. pylori, pepsin and hydrochloric acid may erode the lining of the stomach and duodenum—the first part of the small intestine into which food passes after leaving the stomach.

What is H. pylori?

Helicobacter pylori is a bacterium often found on the lining of the gastrointestinal tract. H. pylori is known to irritate the lining of the stomach and duodenum causing a number of gastrointestinal diseases, including peptic ulcers. Inflammation of the stomach lining is called "gastritis."

Researchers continue to gain a better understanding of the mechanisms of H. pylori and its role in gastrointestinal disorders, such as peptic ulcer.

Risks and Causes: Peptic Ulcers

Peptic ulcers may be triggered by one or a combination of the following:

H. pylori: Helicobacter pylori infections are caused by physical contact with persons infected with H. pylori.
heredity: A family history of peptic ulcers is a contributor.
smoking: Smoking is an irritant that increases the amount of acid produced in the stomach.
alcohol: A known irritant of the stomach lining, alcohol also increases the production of stomach acid.
over-the-counter medication: Long-term use of aspirin or NSAIDs such as ibuprofen can damage the stomach lining.
prescription drugs: Anti-inflammatory drugs such as those used for arthritis can damage the digestive tract.

Symptoms of Peptic Ulcers

Symptoms of peptic ulcers include:

localized sharp pain or a "burning" sensation between the breastbone and the navel, often occurring at nighttime, but subsiding after a meal
sudden stomach pain
recurrent nausea and/or vomiting
bloating and feeling full
belching
appetite changes
weight fluctuations—sudden weight gain or loss.

Bleeding ulcers may indicate a more serious condition.

Treatment for Peptic Ulcers

Antibiotics to eliminate H. pylori is the most common treatment for peptic ulcer. Other standard treatments involve medications to reduce the levels of acid produced by the stomach and to protect the lining of the gastrointestinal tract. Histamine 2 receptor blockers (H2-blockers) and proton pump inhibitors (PPIs) may also be used to manage the symptoms of peptic ulcer.

Surgery is rarely required, except in the case of severely bleeding ulcers and is usually a last resort when peptic ulcers have failed to respond to standard medication.

How to Prevent Peptic Ulcer Flare-ups

Lifestyle and dietary adjustments are strongly recommended to minimize recurrence of peptic ulcer disease.

Quit smoking.
Moderate alcohol and caffeine consumption.
Avoid taking aspirin, ibuprofen (Motrin®), naproxen (Aleve®), ketoprofen (Actron®, Orudis® KT); instead limit over-the-counter medication to the occasional use of acetaminophen (Tylenol®).
Consult a dietician; change to a diet that limits foods and beverages known to trigger gastrointestinal inflammation and increase production of stomach acid; eat frequent small meals.
Reduce stress, which may aggravate an existing peptic ulcer.

Diagnosis of Peptic Ulcers

The initial diagnosis of a peptic ulcer is symptom-based. Most doctors prescribe appropriate medication to treat the symptoms before carrying out tests for peptic ulcer.

If the condition persists, further exploration may be necessary, including blood and breath tests to establish the presence of H. pylori and an endoscopy to take a closer look at the stomach lining.

Bleeding Ulcer Treatments

Endoscopy is routinely used to treat bleeding ulcers. The initial treatment includes stemming the blood flow from the ulcer. Patients taking non-steroidal anti-inflammatory drugs are taken off the drugs. Epinephrine may also be used for treating patients with bleeding ulcers.

Approximately ten to twenty percent of patients presenting with bleeding ulcers require abdominal surgery.

Zollinger-Ellison (ZES) Syndrome

Zollinger-Ellison syndrome is a rare gastrointestinal disorder that causes multiple small tumors called gastrinomas to develop in the pancreas and the duodenum.

Gastrinomas produce abnormally high levels of the hormone gastrin, which, in turn, triggers excess production of stomach acid. Chronic high levels of stomach acid may lead to duodenal and stomach ulcers.

Over fifty percent of individual gastrinomas are malignant and often metastasize to the lymph nodes and other adjacent organs such as the liver.

Symptoms of Zollinger-Ellison syndrome include:

abdominal pain or discomfort
diarrhea
stomach or duodenal ulcers
gastrointestinal bleeding
nausea
fatigue
weight loss.

Resources

Adam Healthcare Center. (2005). Pepticulcers.

American Academy of Family Physicians. (2000). Ulcers: What you can do to heal your ulcer.

Beers, M.H. & Berkow, R. (ed). Peptic ulcer disease.The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

Diet Site. (2004). Diet for peptic ulcer disease.

Home Health UK. (nd). Heliobacter pylori and ulcers.

National Library of Medicine. (2004, May 3). Zollinger-Ellison syndrome. MedlinePlus Medical Encyclopedia.

Stevens, L.M. (2001, October 24). JAMA Patient Page: Peptic ulcers. Journal of the American Medical Association 286(16), 2052.

Yale Medical Group. (2004). Digestive disorders.