Dr. M.J. Bazos, MD. Patient Handout

About Your Diagnosis
Peptic ulcers are erosions in the lining of the esophagus, stomach, or duodenum. Ulcers in the stomach are called gastric ulcers, and duodenal ulcers if in the duodenum. The cause of peptic ulcer disease (PUD) is not fully known. It is clear that Helicobacter pylori (H. pylori) does play a role in PUD. Helicobacter pylori is a bacteria found in the stomach and duodenum. Drugs such as aspirin and nonsteroidal anti-inflammatory drugs play a role in
some cases of PUD, particularly with gastric ulcers. Peptic ulcer disease is common; there is a 10% lifetime prevalence in men and 5% in women. Duodenal ulcers are four times more common than gastric ulcers. Peptic ulcer disease is detected by an upper gastrointestinal (GI) x-ray or endoscopy (a flexible lighted tube used to view the stomach and duodenum). Occasionally biopsy specimens are obtained during the endoscopy to make sure a more serious disease is not present. Testing is available to determine whether H. pylori is present in the stomach and duodenum. With treatment, ulcers do heal within a few weeks. However ulcers do reoccur. Before treatments for H. pylori, reoccurrence was common. Many individuals required long-term maintenance treatment. Since the development of effective treatments for H. pylori, the reoccurrence rate is less than 10% in the first year.

Living With Your Diagnosis
The symptoms of a peptic ulcer do not vary depending on location. The most common symptom is pain, occurring in the epigastric (upper abdominal) area. It is described as a burning, gnawing, or boring pain. It generally occurs 1–3 hours after meals. It may awaken one from sleep. The pain is relieved by food or antacids. The pain appears in clusters. It may be present for a few weeks, then resolve for weeks to months only to return. Other symptoms of PUD include abdominal bloating, heartburn, nausea, and vomiting. Up to 25% of individuals with PUD will initially be seen with a complication of the disease. Internal bleeding is a common complication. Some individuals with PUD will have black, tarry stools indicating a bleeding ulcer. Others will have vomiting with blood or “coffee ground” material in it. The bleeding may be severe enough to cause shock. Others will initially be seen with a perforation. A perforation is a hole in the stomach or duodenum. The pain of a perforation happens suddenly and is severe. The pain starts in the epigastric area and moves to the right shoulder.

The goal of treatment is to heal the ulcer, help the symptoms, stop relapses, and avoid complications. There are two treatment options: medication and surgery. Medications are used to decrease the acid production in the stomach and treat the H. pylori (when present). Antacids have been available for many years to treat ulcers. However, they can be inconvenient because of the frequency in which they have to be taken. To decrease acid production, a histamine-2 (H2) blocker is frequently given. Another drug, sucralfate, coats the ulcer and protects the lining of the stomach from the acid. Proton pump inhibitors such as omeprazole can be used to suppress the acid secretion. Multiple drug combinations are used to treat the H. pylori infection. Antibiotics, proton pump inhibitors, and bismuth are used in various combinations. After the treatment is completed, many individuals are started on a lower dose of the medicine to prevent reoccurrence. Surgery is an option when medications fail or there are serious complications. There are different options that the surgeon may choose depending on the type of ulcer and the complications that may be present. Because medications have improved in recent years, the frequency of surgery has declined.
The DOs
• Maintain proper eating habits.
• Take medications as prescribed.
• Antacids may help relieve the symptoms.
• Try to reduce the stress in your life. It can play a role in ulcer formation.
The DON’Ts
• Avoid smoking.
• Avoid excess alcohol consumption.
• Avoid aspirin and nonsteroidal anti-inflammatory drugs.
• Avoid caffeine and any food that makes the symptoms worse.
When to Call Your Doctor
• If you have symptoms of an ulcer.
• If you vomit blood or “coffee ground” material.
• If there is blood in the stool or stools are dark and tarry.
• If pain does not improve with treatment
Websites: www.niddk.nih.gov