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Stomach and Duodenal Ulcers (Peptic Ulcers)
What is a peptic ulcer?
A peptic ulcer is a sore on the lining of your stomach or the first part of your small intestine (duodenum). If the ulcer is in your stomach, it is called a gastric ulcer. If the ulcer is in your duodenum, it is called a duodenal ulcer.
Ulcers are fairly common.
What causes peptic ulcers?
In the past, experts thought lifestyle factors such as stress and diet caused ulcers. Today we know that stomach acids and other digestive juices help create ulcers. These fluids burn the linings of your organs.
Causes of peptic ulcers include:
- H. pylori bacteria (Helicobacter pylori). Most ulcers are caused by an infection from a bacteria or germ called H. pylori. This bacteria hurts the mucus that protects the lining of your stomach and the first part of your small intestine (the duodenum). Stomach acid then gets through to the lining.
- NSAIDs (nonsteroidal anti-inflammatory drugs). These are over-the-counter pain and fever medicines such as aspirin, ibuprofen, and naproxen. Over time they can damage the mucus that protects the lining of your stomach.
What are the symptoms of peptic ulcers?
Each person’s symptoms may vary. In some cases ulcers don’t cause any symptoms.
The most common ulcer symptom is a dull or burning pain in your belly between your breastbone and your belly button (navel). This pain often occurs around meal times and may wake you up at night. It can last from a few minutes to a few hours.
Less common ulcer symptoms may include:
- Feeling full after eating a small amount of food
- Not feeling hungry
- Losing weight without trying
- Bloody or black stool
- Vomiting blood
Peptic ulcer symptoms may look like other health problems. Always see your healthcare provider to be sure.
How are peptic ulcers diagnosed?
Your healthcare provider will look at your past health and give you a physical exam. You may also have some tests.
Imaging tests used to diagnose ulcers include:
- Upper GI (gastrointestinal) series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of the small intestine (the duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray.
- Upper endoscopy or EGD (esophagogastroduodenoscopy). This test looks at the lining of your esophagus, stomach, and duodenum. It uses a thin lighted tube called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your health care provider can see the inside of these organs. A small tissue sample (biopsy) can be taken. This can be checked for H. pylori.
You may also have the following lab tests to see if you have an H. pylori infection:
- Blood tests. These check for infection-fighting cells (antibodies) that mean you have H. pylori.
- Stool culture. A small sample of your stool is collected and sent to a lab. In 2 or 3 days, the test will show if you have H. pylori.
- Urea breath test. This checks to see how much carbon dioxide is in your breath when you exhale. You will swallow a urea pill that has carbon molecules. If you have H. pylori, the urea will break down and become carbon dioxide. You will have a sample taken of your breath by breathing into a bag. It will be sent to a lab. If your sample shows higher than normal amounts of carbon dioxide, you have H. pylori.
How are peptic ulcers treated?
Treatment will depend on the type of ulcer you have. Your healthcare provider will create a care plan for you based on what is causing your ulcer.
Treatment can include making lifestyle changes, taking medicines, or in some cases having surgery.
Lifestyle changes may include:
- Not eating certain foods. Avoid any foods that make your symptoms worse.
- Quitting smoking. Smoking can keep your ulcer from healing. It is also linked to ulcers coming back after treatment.
- Limiting alcohol and caffeine. They can make your symptoms worse.
- Not using NSAIDs (non-steroidal anti-inflammatory medicines). These include aspirin and ibuprofen.
Medicines to treat ulcers may include:
- Antibiotics. These bacteria-fighting medicines are used to kill the H. pylori bacteria. Often a mix of antibiotics and other medicines is used to cure the ulcer and get rid of the infection.
- h3-blockers (histamine receptor blockers). These reduce the amount of acid your stomach makes by blocking the hormone histamine. Histamine helps to make acid.
- Proton pump inhibitors or PPIs. These lower stomach acid levels and protect the lining of your stomach and duodenum.
- Mucosal protective agents. These medicines protect the stomach’s mucus lining from acid damage so that it can heal.
- Antacids. These quickly weaken or neutralize stomach acid to ease your symptoms.
In most cases, medicines can heal ulcers quickly. Once the H. pylori bacteria is removed, most ulcers do not come back.
In rare cases, surgery may be needed if medicines don’t help. You may also need surgery if your ulcer causes other medical problems.
What are the complications of peptic ulcers?
Ulcers can cause serious problems if you don’t get treatment.
The most common problems include:
- Bleeding. As an ulcer wears away the muscles of the stomach or duodenal wall, blood vessels may be hurt. This causes bleeding.
- Hole (perforation). Sometimes an ulcer makes a hole in the wall of your stomach or duodenum. When this happens, bacteria and partly digested food can get in. This causes infection and redness or swelling (inflammation).
- Narrowing and blockage (obstruction). Ulcers that are found where the duodenum joins the stomach can cause swelling and scarring. This can narrow or even block the opening to the duodenum. Food can’t leave your stomach and go into your small intestine. This causes vomiting. You can’t eat properly.
When should I call my healthcare provider?
See your healthcare provider right away if you have any of these symptoms:
- Vomiting blood or dark material that looks like coffee grounds
- Extreme weakness or dizziness
- Blood in your stools (your stools may look black or like tar)
- Nausea or vomiting that doesn’t get better, or gets worse
- A sudden, severe pain that may spread to your back
- Losing weight without even trying
Untreated peptic ulcers may cause other health problems. Sometimes they bleed. If they become too deep, they can break through your stomach.
Ulcers can also keep food from going through your stomach.
- These ulcers are sores on the lining of your stomach or the first part of your small intestine (the duodenum).
- Stomach acids and other digestive juices help to make ulcers by burning the linings of these organs.
- Most ulcers are caused by infection from a bacteria or germ called H. pylori (Helicobacter pylori) or from using pain killers called NSAIDs.
- The most common symptom is a dull or burning pain in the belly between the breastbone and the belly button.
- Ulcers can be treated with a mix of lifestyle changes and medicines. In rare cases, surgery is needed.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Duodenal Ulcer | Abdominal Pain
Duodenal ulcer causes inflammation and damage to the stomach lining that may result in a number of symptoms. The symptoms can vary in intensity among individuals.
Common symptoms of a duodenal ulcer
You may experience duodenal ulcer symptoms daily or just once in a while. At times any of these abdominal symptoms can be severe:
Serious symptoms that might indicate a life-threatening condition
In some cases, duodenal ulcers can be life threatening.
Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
The most common cause of duodenal ulcer is infection with
H pylori bacteria. Other causes of duodenal ulcer include agents that can cause inflammation of the stomach or duodenal lining, including alcohol, tobacco, or medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). Severe illness and radiation therapy have also been associated with duodenal ulcer.
What are the risk factors for a duodenal ulcer?
A number of factors increase the risk of developing duodenal ulcer. Not all people with risk factors will get duodenal ulcer. Risk factors for duodenal ulcer include:
H pylori infection
History of radiation therapy
Regularly taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin
Stress or severe illness
How is a duodenal ulcer treated?
Treatment for duodenal ulcer begins with seeking medical care from your health care provider. To determine if you have a duodenal ulcer, your health care provider may ask you to undergo diagnostic tests.
Antibiotic treatments for a duodenal ulcer
If your duodenal ulcer is caused by
H pylori infection, antibiotic therapy is the mainstay of treatment. It is important to follow your antibiotic regimen precisely to avoid re-infection or recurrence. Most commonly, two antibiotics are given for 14 days. Examples of antibiotic treatments include:
- Clarithromycin (Biaxin)
- Metronidazole (Flagyl)
Other medications to treat a duodenal ulcer
Medications such as proton pump inhibitors and histamine h3-receptor antagonists, which decrease the amount of acid in the stomach, can also be an effective treatment for duodenal ulcer.
Proton pump inhibitors that are effective in the treatment of duodenal ulcer include:
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Prilosec)
- Pantoprazole (Protonix)
- Rabeprazole (Aciphex)
Histamine h3-receptor antagonists that are effective in the treatment of duodenal ulcer include:
- Cimetidine (Tagamet)
- Famotidine (Pepcid)
- Nizatidine (Axid)
- Ranitidine (Zantac)
If you have diarrhea and vomiting, fluid and electrolyte replenishment is also a component of successful treatment.
What are the potential complications of a duodenal ulcer?
You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Possible complications of duodenal ulcer include:
- Internal hemorrhaging
- Perforated duodenal ulcer, which can lead to bleeding
- Severe discomfort or pain
- Spread of infection
Duodenal ulcer | healthdirect
Duodenal ulcers are a common cause of abdominal pain. Once treated, they usually get better in a matter of weeks.
What is a duodenal ulcer?
A duodenal ulcer is a sore that forms in the lining of the duodenum. Your duodenum is the first part of your small intestine, the part of your digestive system that food travels through straight after it leaves your stomach.
You can get an ulcer in your stomach as well as in your duodenum. Stomach ulcers and duodenal ulcers are both types of peptic ulcers. If you have either of these, you have what’s called ‘peptic ulcer disease’.
A duodenal ulcer is a sore that forms in the lining of the duodenum.
Causes of duodenal ulcers
Your stomach makes a strong acid that kills germs and helps you digest food. To protect themselves against this acid, cells of the stomach and duodenum make a barrier from mucus. If this barrier is damaged, an ulcer can form.
The main cause of this damage is infection with bacteria called Helicobacter pylori, or H. pylori. The bacteria can cause the lining of your duodenum to become inflamed and an ulcer can form.
Some medications can also cause a duodenal ulcer, particularly anti-inflammatory drugs such as ibuprofen and aspirin. Rarely, other medicines or medical conditions might cause an ulcer.
It’s possible that you are more likely to get a duodenal ulcer if you smoke, drink a lot of alcohol or you are stressed, but these things are less important than infection with H. pylori.
Symptoms of a duodenal ulcer
If you have a duodenal ulcer, you might:
- have pain in the stomach or abdomen (this might come and go and is relieved by eating or taking an antacid)
- have indigestion
- feel very full and bloated after eating
- feel like you might vomit (nauseous)
- lose weight
Very occasionally, an ulcer can cause serious complications. Go to the emergency department if:
- you have a sharp pain in your stomach that doesn’t go away
- your vomit or stools (poo) look bloody or a black colour
If you are concerned about symptoms, you can use healthdirect’s online Symptom Checker to get advice on the next appropriate healthcare steps and when to seek medical attention.
Diagnosis of a duodenal ulcer
To diagnose a duodenal ulcer, your doctor will talk to you and examine you. They will probably also run some tests, which could include:
- a gastroscopy (also called an endoscopy), where a specialist uses a thin, flexible tube with a camera on the end to look inside your stomach and duodenum
- a blood test, stool sample, or breath test to find out if you have a H. pylori in your system
If you have a gastroscopy, the surgeon might take a sample of tissue (a biopsy) to test for H. pylori.
Treatment for a duodenal ulcer
If your ulcer is caused by H pylori, the usual treatment is ‘triple therapy’. This involves taking 2 antibiotics to kill the bacteria, and a medicine to reduce the amount of acid made by your stomach.
If you don’t have an H. pylori infection, and you have been using anti-inflammatory drugs, you will need to stop taking them (if possible) and to start taking a drug to reduce acid production by your stomach.
Taking antacids, drinking less alcohol, and quitting smoking if you smoke may also help.
Stomach ulcer – NHS
Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach.
Ulcers can also occur in part of the intestine just beyond the stomach. These are known as duodenal ulcers.
Both stomach and duodenal ulcers are sometimes referred to as peptic ulcers. Here the term stomach ulcer will be used, although the information applies equally to duodenal ulcers.
Signs and symptoms
The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the tummy (abdomen).
But stomach ulcers aren’t always painful and some people may experience other symptoms, such as indigestion, heartburn and feeling sick.
Read more about the symptoms of a stomach ulcer and diagnosing a stomach ulcer.
When to seek medical advice
You should visit your GP if you think you may have a stomach ulcer.
Seek urgent medical advice if you experience any of the following symptoms:
- vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds
- passing dark, sticky, tar-like stools
- a sudden, sharp pain in your tummy that gets steadily worse
These could be a sign of a serious complication, such as internal bleeding.
What causes stomach ulcers?
Stomach ulcers occur when the layer that protects the stomach lining from stomach acid breaks down, which allows the stomach lining to become damaged.
This is usually a result of:
It used to be thought that stress or certain foods might cause stomach ulcers, but there’s little evidence to suggest this is the case.
Read more about the causes of stomach ulcers.
It’s not known how many people have stomach ulcers, although they’re thought to be quite common.
Stomach ulcers can affect people of any age, including children, but mostly occur in people aged 60 or over. Men are more commonly affected than women.
How stomach ulcers are treated
With treatment, most stomach ulcers will heal within a month or two. The treatment recommended for you will depend on what caused the ulcer.
Most people will be prescribed a medication called a proton pump inhibitor (PPI) to reduce the amount of acid their stomach produces and allow the ulcer to heal naturally.
If an H. pylori infection is responsible for the ulcers, antibiotics will also be used to kill the bacteria, which should prevent the ulcer coming back.
If the ulcers are caused by the use of NSAIDs, PPIs are usually prescribed and your doctor will discuss whether you should keep using NSAIDs.
Alternative medication to NSAIDs, such as paracetamol, may be recommended.
Stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed.
Read more about treating stomach ulcers.
Complications of stomach ulcers are relatively uncommon, but they can be very serious and potentially life threatening.
The main complications include:
- bleeding at the site of the ulcer
- the stomach lining at the site of the ulcer splitting open (perforation)
- the ulcer blocking the movement of food through the digestive system (gastric obstruction)
Read more about the complications of stomach ulcers.
Page last reviewed: 17 September 2018
Next review due: 17 September 2021
Stomach and Duodenal Ulcers | Boston Children’s Hospital
If your child has an ulcer, he has an open sore or lesion usually found on the skin or mucous membrane. An ulcer in the lining of the stomach or duodenum is referred to as a peptic ulcer.
- A peptic ulcer located in the stomach is known as a gastric ulcer.
- A peptic ulcer located in the duodenum is called a duodenal ulcer.
What causes gastric and duodenal ulcers?
In the past, lifestyle factors, such as stress and diet, were believed to cause ulcers. More recently, research has shown that stomach acids contribute to ulcers. Research also shows that ulcers can develop as a result of an infection caused by the bacterium Helicobacter pylori (H. pylori). While all of these factors play a role in why your child may have an ulcer, H. pylori is most likely to be the cause.
Are there other contributing factors?
- Emotional stress is no longer thought to be a cause of ulcers; people who have ulcers often report that emotional stress increases ulcer pain.
- Physical stress may increase the risk of developing ulcers.
- Aspirin, ibuprofen, and naproxen sodium — also known as non-steroidal anti-inflammatory drugs — make the stomach vulnerable to the harmful effects of the digestive fluids hydrochloric acid and pepsin.
What are some complications from ulcers?
Without proper treatment, children with ulcers may experience serious complications. The most common problems include:
- Bleeding: As the lining of the stomach or duodenal wall is eroded, blood vessels may also be damaged, causing bleeding.
- Perforation: Sometimes a hole has worn through the wall of the stomach or duodenum, and bacteria and partially digested food can spill through the opening into the sterile abdominal cavity (peritoneum).
- Narrowing and obstruction: Ulcers located at the end of the stomach (where the duodenum is attached) can cause swelling and scarring, which can narrow or close the intestinal opening.
What are the symptoms of gastric and duodenal ulcers?
Although ulcers don’t always cause symptoms, the most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in early in the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms include:
- poor appetite
- loss of weight
- feeling tired and weak
Duodenal ulcer | The London Clinic
A duodenal ulcer is an open sore that occurs when the protective mucus lining the wall of the intestine breaks down. Bacteria, stomach acid and digestive enzymes can then damage the wall itself.
Stomach and duodenal ulcers are commonly called peptic ulcers. They can cause quite alarming and distressing symptoms but treatment is relatively straightforward and the need for surgery is rare.
What causes a duodenal ulcer?
Traditionally, it was thought that duodenal ulcers were caused by a combination of stress, smoking, diet and alcohol. While these may all contribute, in the 1990s it was discovered that 95% of duodenal ulcers were caused by a bacterium called Helicobacter pylori, or simply H. pylori. This bacterium is picked up in childhood but only causes problems for most people when they are adults.
H. pylori used to be present in everybody’s stomach. With better hygiene, however, the majority of people in the UK no longer become infected with it, although it is still very common in southern Europe, Asia and Africa. Most people who have this bacterium in their gut have no symptoms, but in certain circumstances, the bugs can break through the protective mucus and cause an ulcer.
Another contributory factor can be the long-term use of common painkillers such as aspirin, ibuprofen and diclofenac. These drugs belong to a group of painkillers known as non-steroidal anti inflammatory drugs (NSAIDs), which can irritate the gut lining and increase the risk of duodenal ulcer in some people.
Symptoms of duodenal ulcers
A recent survey in Sweden showed that 4% of the general population have either a stomach ulcer or a duodenal ulcer but it is common to show no symptoms whatsoever. Some people have mild symptoms which come and go, so they are ignored, but a duodenal ulcer is unlikely to heal without treatment.
Milder symptoms of a duodenal ulcer include a feeling of being full very quickly, feeling sick, heartburn, a bitter taste in the mouth and, in the longer term, weight loss. Symptoms that are more difficult to cope with include:
- Pain in the abdomen/stomach region, typically just under the V of the ribcage, often described as a burning sensation. Pain may appear after eating, almost immediately with gastric ulcers and 2-3 hours later with duodenal ulcers, reflecting the time it takes for food to reach that part of the gut. Pain can sometimes occur as much as 5 hours later, which may result in disturbed sleep.
- Passing blood, which makes the stools turn black with a tar-like consistency.
- Vomiting blood, which can be bright red or take the appearance of small, dark granules (which are small blood clots).
Occasionally, the duodenal ulcer can extend right through the intestinal wall, and you develop a perforated ulcer. The gut contents can leak out through the hole, causing severe infection. A ruptured duodenal ulcer is a medical emergency and will require surgery.
Life after a duodenal ulcer
In the long-term, the vast majority of cases of duodenal ulcer are cured within 2 months with no long-term damage to the intestine wall except perhaps for slight scarring. This is unlikely to cause any symptoms.
Duodenal ulcers caused by H pylori rarely recur once the bacterial infection has been treated successfully. If your ulcer was due to NSAIDs, lifelong avoidance then becomes necessary to reduce your risk of developing another.
Peptic Ulcer Disease: Treatment, Symptoms, Causes, Prevention
What is peptic ulcer disease?
Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing stomach acid to damage the tissue.
Who is more likely to get ulcers?
One in 10 people develops an ulcer. Risk factors that make ulcers more likely include:
- Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain relievers that includes ibuprofen (Advil® or Motrin®).
- A family history of ulcers.
- Illness such as liver, kidney or lung disease.
- Regularly drinking alcohol.
Symptoms and Causes
What causes ulcers?
People used to think that stress or certain foods could cause ulcers. But researchers haven’t found any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:
H. pylori bacteria
H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms. Researchers believe people can transmit H. pylori from person to person, especially during childhood.
The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue.
However, for most people the presence of H. pylori doesn’t have a negative impact. Only 10% to 15% of people with H. pylori end up developing ulcers .
Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form:
- Aspirin (even those with a special coating).
- Naproxen (Aleve®, Anaprox®, Naprosyn® and others).
- Ibuprofen (Motrin®, Advil®, Midol® and others).
- Prescription NSAIDs (Celebrex®, Cambia® and others).
Acetaminophen (Tylenol®) is not an NSAID and won’t cause damage to your stomach. People who can’t take NSAIDs are often directed to take acetaminophen.
Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori infection is potentially the most dangerous. People who have H. pylori and who frequently use NSAIDs are more likely to have damage to the mucus layer, and their damage can be more severe. Developing an ulcer from NSAID use also increases if you:
- Take high doses of NSAIDs.
- Are 70 years or older.
- Are female.
- Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same time as taking NSAIDs.
- Use NSAIDS continuously for a long time.
- Have a history of ulcer disease.
Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:
- Being seriously ill from various infections or diseases.
- Having surgery.
- Taking other medications, such as steroids.
Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.
Can coffee and spicy foods cause ulcers?
It’s a common misconception that coffee and spicy foods can cause ulcers. In the past, you might have heard that people with ulcers should eat a bland diet. But now we know that if you have an ulcer, you can still enjoy whatever foods you choose as long as they don’t make your symptoms worse.
What are some ulcer symptoms?
Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:
- Gnawing or burning pain in your middle or upper stomach between meals or at night.
- Pain that temporarily disappears if you eat something or take an antacid.
- Nausea or vomiting.
In severe cases, symptoms can include:
- Dark or black stool (due to bleeding).
- Weight loss.
- Severe pain in your mid- to upper abdomen.
Diagnosis and Tests
How are ulcers diagnosed?
Your healthcare provider may be able to make the diagnosis just by talking with you about your symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori infection. To confirm the diagnosis, you’ll need one of these tests:
If you have severe symptoms, your provider may recommend an upper endoscopy to determine if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through your throat and into your stomach to look for abnormalities.
H. Pylori tests
Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your provider can also look for it with a blood or stool test, or by taking a sample during an upper endoscopy.
Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the imaging machines.
Management and Treatment
Will ulcers heal on their own?
Though ulcers can sometimes heal on their own, you shouldn’t ignore the warning signs. Without the right treatment, ulcers can lead to serious health problems, including:
- Perforation (a hole through the wall of the stomach).
- Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the stomach to the small intestine.
What ulcer treatments are available?
If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting medications into it. Your doctor could also use a clamp or cauterization (burning tissue) to seal it off and stop the bleeding.
For most people, doctors treat ulcers with medications, including:
- Proton pump inhibitors (PPI): These drugs reduce acid, which allows the ulcer to heal. PPIs include Prilosec®, Prevacid®, Aciphex®, Protonix® and Nexium®.
- Histamine receptor blockers (h3 blockers): These drugs also reduce acid production and include Tagamet®, Pepcid®, Zantac® and Axid®.
- Antibiotics: These medications kill bacteria. Doctors use them to treat H. pylori.
- Protective medications: Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. Doctors commonly recommend Carafate® or Pepto-Bismol®.
How can I prevent ulcers?
You may be able to prevent ulcers from forming if you:
- Talk to your doctor about alternatives to NSAID medications (like acetaminophen) to relieve pain.
- Discuss protective measures with your doctor, if you can’t stop taking an NSAID.
- Opt for the lowest effective dose of NSAID and take it with a meal.
- Quit smoking.
- Drink alcohol in moderation, if at all.
Outlook / Prognosis
Are ulcers curable?
For most people, treatment that targets the underlying cause (usually H. pylori bacterial infection or NSAID use) is effective at eliminating peptic ulcer disease. Ulcers can reoccur, though, especially if H. pylori isn’t fully cleared from your system or you continue to smoke or use NSAIDs.
How long does it take an ulcer to heal?
It generally takes several weeks of treatment for an ulcer to heal.
Will drinking milk help an ulcer?
No. Milk may temporarily soothe ulcer pain because it coats the stomach lining. But milk also causes your stomach to produce more acid and digestive juices, which can make ulcers worse.
Is it safe to take antacids?
Antacids temporarily relieve ulcer symptoms. However, they can interfere with the effectiveness of prescribed medications. Check with your doctor to find out if antacids are safe to take while undergoing treatment.
What should ulcer patients eat?
No foods have been proven to negatively or positively impact ulcers. However, eating a nutritious diet and getting enough exercise and sleep is good for your overall health.
What questions should I ask my doctor?
If you have stomach ulcers, you may want to ask your doctor:
- What pain reliever can I use instead of an NSAID?
- How will I know if the H. pylori infection is gone?
- How do we find out if the ulcer has healed?
- What can I do relieve symptoms at home during treatment?
A note from Cleveland Clinic
Contrary to commonly held beliefs, ulcers aren’t caused by stress or foods you eat. Most of time, bacteria causes them. Doctors can treat the bacteria with antibiotics and other medications.
If you’ve been popping a lot of antacids lately, you’re constantly snacking to get rid of a gnawing pain in your stomach or you have any other signs of an ulcer, the best thing you can do for your health is talk to your provider. Treatment can heal an ulcer in a matter of weeks.
90,000 Peptic ulcer and 12 duodenal ulcer
Peptic ulcer – a chronic recurrent disease, the main symptom of which is the formation of a defect (ulcer) in the wall of the stomach or duodenum. Duodenal ulcers are much more common than stomach ulcers. The most susceptible to peptic ulcer disease are people whose work is associated with neuropsychic stress, especially in combination with irregular nutrition (for example, the systematic use of spicy and rough food, hasty food and dry food, long breaks between meals).
Peptic ulcer and 12 duodenal ulcer
Long-term use of certain medications can provoke the development of the disease: acetylsalicylic acid, glucocorticoids, etc. exposure to hydrochloric acid of gastric juice.
The leading symptom of peptic ulcer disease is pain that occurs more often in the epigastric region, to the left of the midline (with ulcers of the stomach body) or to the right of it (with ulcers in the pylorus canal and duodenal bulb), often radiating to the left half of the chest, in the xiphoid process of the sternum, in the thoracic or lumbar spine.
Pain is usually clearly associated with food intake. So, with ulcers of the body of the stomach, they appear, as a rule, 30-60 minutes after eating (early pain), with ulcers of the pylorus canal and duodenal bulb – after 2-3 hours (late pain), as well as on an empty stomach (“hungry pain “). Night pains, which are observed more often when the ulcer is localized in the duodenum, are close in the mechanism of occurrence to “hungry” pains. Pain is usually relieved by antacids and antispasmodics, warmth, and late and “hungry” pains also stop after eating, especially milk.
A typical symptom of peptic ulcer disease is vomiting of acidic gastric contents, which occurs at the height of pain and brings relief, and therefore patients sometimes cause it artificially. Other dyspeptic disorders are often noted: heartburn, nausea, belching, constipation. But often there are asymptomatic forms of peptic ulcer disease: in such patients, the disease is discovered by chance, or its first clinical manifestations are complications, sometimes very formidable – for example, perforation of an ulcer or internal bleeding.
Peptic ulcer disease usually proceeds with alternation of exacerbations and remissions. Exacerbations are often seasonal in nature, occurring mainly in spring and autumn, remissions can last from several months to several years.
Endoscopic examination plays a leading role in the diagnosis of peptic ulcer and its complications. It allows you to confirm or reject the diagnosis, to accurately determine the localization, shape, depth and size of the ulcer, to assess the condition of the bottom and edges of the ulcer, to clarify the concomitant changes in the mucous membrane, as well as violations of the motor function of the stomach and duodenum, and provides the ability to control the dynamics of the process.Special techniques make it possible to detect Helicobacter pylori in the mucous membrane of the stomach and duodenum.
Patients with an uncomplicated course of peptic ulcer disease are treated with conservative therapy, which has excellent opportunities to eliminate the causes of the disease themselves, of course, subject to the patient’s scrupulous adherence to all doctor’s prescriptions, from the regimen and diet to the timeliness and completeness of medication to receive medical procedures. Otherwise, the development of the disease may lead to the need for surgical treatment, especially in cases where the patient does not follow the recommendations for anti-relapse therapy of peptic ulcer disease.
90,000 Peptic ulcer disease: familiar and so many-sided
Peptic ulcer is a chronic cyclically recurrent polietiologic disease, the main morphological substrate of which is an ulcer defect and / or a scar within the gastroduodenal zone, manifested mainly by abdominal pain syndrome and gastric dyspepsia syndrome.
Exacerbation of the disease: with the localization of ulcers in the cardiac and subcardial parts of the stomach – early pain, with ulcers of the antrum of the stomach, pyloric canal and duodenum – late pain, as well as “hungry” and “night”.Appetite usually does not decrease, and often even increases, especially with duodenal ulcer localization (“painful feeling of hunger”). The general condition of patients worsens, there is increased fatigue, weakness, sweating, disability, depression or, on the contrary, excitement is observed. Pain syndrome can be typical (pains are characterized by rhythm and frequency of occurrence, often appear at a strictly defined time for a given patient – a symptom of an alarm clock) and atypical.Pain in the epigastric region is the most characteristic clinical symptom of peptic ulcer disease. Early – pains that appear in the first 1 – 1.5 hours after eating. Late – pain that appears 2 – 5 hours after eating. Hungry – pains that, occurring a few hours after eating, quietly disappear or weaken after a new meal. Night – pains that occur at night and cause the patient to awaken. Early pain often suggests concomitant esophagitis. There is some peculiarity of the pain syndrome.Pain of a constant nature – interest of the pancreas. The paroxysmal nature of the pain is the interest of the gallbladder. Combination with symptoms of gastric dyspepsia (nausea, vomiting) – there is a noticeable violation of gastric evacuation of functional or organic origin.
The following types of pain syndrome in peptic ulcer disease can be distinguished:
Visceral – dull pain, pressing, aching, relieved by food intake, antacids, pronounced frequency, indefinite localization in the epigastrium, do not irradiate, symptoms of peritoneal irritation, local muscle tension on superficial palpation, tension of the anterior abdominal wall and skin hyperesthesia are absent, but present local soreness at the site of the affected organ with deep palpation, which does not coincide with the subjective localization of pain;
Visceral pain syndrome with irradiation – dull pain, diffuse, acute pain at altitude, can be stopped by eating, antacids, pronounced periodicity, irradiation is characteristic, Mendel’s symptom is positive, more often only when the ulcer is localized on the anterior wall, there is local muscle tension during superficial palpation , there is no tension in the anterior abdominal wall, skin hyperesthesia in the Zakharyin-Ged zones, local soreness at the site of the affected organ during deep palpation, which usually coincides with the subjective localization of pain;
Visceral-somatic pain syndrome – acute pains, cannot be stopped by eating, antacids, no periodicity, pronounced irradiation is characteristic, point pain in the area of the affected organ, Mendel’s symptom is positive, there is local muscle tension during superficial palpation, there is no tension in the anterior abdominal wall, cutaneous hyperesthesia at the site of ulcer localization and local soreness at the site of the affected organ with deep palpation, which coincides with the subjective localization of pain;
Somatic pain syndrome with perforation into the free abdominal cavity – pain is sharp, “dagger”, diffuse, no periodicity, irradiation, point pain in the area of the affected organ, symptoms of Mendel, Shchetkin-Blumberg are positive, diffuse soreness of the anterior abdominal wall, anterior abdominal wall tense, there is diffuse cutaneous hyperesthesia at the site of the ulcer and local soreness at the site of the affected organ with deep palpation, which coincides with the subjective localization of pain.
Atypical pain syndrome in peptic ulcer disease: cholecyst-like pain syndrome – right subcostal localization of pain, more often characteristic of women, with one or another interest in the gallbladder; retrosternal pain, as in angina pectoris, aggravated by physical exertion (with “high” ulcers and in the presence of perivisceritis with the formation of an adhesive process), however, unlike true angina pectoris, they are provoked or reduced after eating; pain in the region of the heart (when the ulcer is localized along the greater curvature of the stomach), appearing 30-40 minutes after eating and removed by eating, antacids, etc.e. Cramping pains, reminiscent of attacks of hepatic or renal colic, occurring acutely and periodically, regardless of food intake and its nature. Pain localized in the umbilical region and slightly below it, resembling the clinic of intestinal colic, appendicitis and other diseases of the abdominal organs, which are often the cause of diagnostic errors up to appendectomy. Ossalgic variant – irradiation of back pain (left or right scapula, interscapular space, thoracic spine).
Gastric dyspepsia syndrome: heartburn, belching (food, sour, air), changes in appetite (fear of eating with stomach ulcers due to provoking pain syndrome, frequent eating for duodenal ulcers to relieve pain), nausea and vomiting (hypertonicity n.vagus: hypersecretion, dysmotility and spasm of smooth muscles, including the pylorus), inflammatory edema of the mucous membrane or cicatricial deformity of the pylorus and duodenal bulb, nausea precedes vomiting, vomiting sour, brings relief, a feeling of heaviness, fullness in the epigastrium (equivalent pain syndrome, with motor-evacuation disorders).
Intestinal dyspepsia syndrome. Constipation (more typical for duodenal ulcers): vagotonia (peristalsis, sphincter tone), dietary restrictions (fiber), medication (aluminum, bismuth). Diarrhea (more typical for stomach ulcers): against the background of hypochlorhydria, impaired bile secretion, dysfunction of the pancreas, the effect of eradication therapy.
Astheno-vegetative syndrome: General weakness, increased fatigue, emotional lability.It is necessary to exclude complications: bleeding, anemia, electrolyte disturbances with frequent vomiting, malignancy.
Clinical variants of peptic ulcer
Subcardial ulcers: age – 40-60 years, mild and atypical pain syndrome, burning sensation, pressure under the xiphoid process, irradiation behind the sternum, in the region of the heart, early pain (including during meals), insufficiency of the cardiac pulp … Diagnostic difficulties, cardiac masks, left-sided pleurisy.High complication rate.
Ulcers of the body of the stomach: Average age, polymorphic clinical picture, moderate pain syndrome, early pain, to the left of the midline, nausea, belching, less often – heartburn, vomiting. Complications: bleeding 15%, often massive, perforation – 4%, malignancy – 8-10%, pay attention to ulcers along the greater curvature of the stomach!
Ulcers of the antrum: young and middle age, clinically similar to duodenal ulcers, late pain, heartburn, belching, vomiting, bleeding 10-15%.
Ulcers of the gatekeeper’s canal: Intense pain syndrome, late pain, paroxysmal, irradiation to the back, persistent nausea and vomiting, a feeling of fullness, fast saturation, difficulties in X-ray diagnostics, malignancy 3-8%.
Ulcers of the duodenal bulb: young and middle age, hereditary history, hypersecretion of HCl, pain syndrome, late and night pains, heartburn, vomiting of acidic contents, brings relief, cyclicity and seasonality of the course, interest of the pancreas when localized on the medial wall.
Postbulbar ulcers: persistent, prolonged course, frequent recurrence, prolonged exacerbations, often multiple, hypersecretion of HCl, persistent pain syndrome, late (after 3-4 hours) and night pains, do not stop immediately, localized in the navel, heartburn, frequent bleeding, lesions of the Vater papilla, it is necessary to exclude symptomatic ulcers, including gastrinoma. In adolescence: duodenal localization, onset with dyspeptic syndrome, vomiting, reflex nausea, weight loss, pallor of the skin, autonomic imbalance (red dermographism, sweating, hypotension, bradycardia, constipation, subfebrile condition), hypovitaminosis, more often in the form of “mono -pathology “, rare involvement of neighboring organs in the pathological process, more often according to the variant of functional changes, often – the beginning with complications. In old age: often – malosymptomatic and atypical course, against the background of concomitant pathology (vascular bed: HD, diabetes, ischemic heart disease, respiratory system – hypoxia), taking ulcerogenic medications, multiple organ lesions of the gastrointestinal tract, the role of a trophic factor, high localization, large size , long-term scarring, frequent complications.
Rare causes of peptic ulcer
adenocarcinoma, carcinoid, penetration of tumors of other organs, sarcoma, leiomyoma, foreign bodies, endocrine diseases, Crohn’s disease, syphilis, tuberculosis, HIV.
Duodenal ulcers: Zollinger-Ellison syndrome, chronic obstructive pulmonary disease, portal hypertension, Crohn’s disease, celiac disease, lymphoma, lesions, CNS trauma – Cushing’s ulcers, hypercalcemia, systemic mastoidosis, amyloidosis, polycythemia, HIV.
Purpose of peptic ulcer treatment: To accelerate the scarring of the ulcer, quickly stop the clinical manifestations of the disease (pain, dyspeptic syndromes, etc. )and prevention of complications and ulcer recurrence.
treatment and diagnosis of symptoms, causes in Moscow
Peptic ulcer of the stomach and duodenal ulcer is a chronic, seasonal recurrent disease of the stomach and duodenum, manifested by a defect in the mucous membrane (ulcers). These disorders occur against the background of destabilization of the nervous and humoral mechanisms in the human body, which regulate secretory-reparative processes in the stomach and duodenum.Peptic ulcer disease is characterized by periods of exacerbation (spring and autumn) and remission. The result of the healing of ulcers is the formation of a scar.
The prevalence of the disease in all countries is about 4-6% of the adult population. With a full-fledged medical screening of patients, this percentage increases to 20-25%.
The peak incidence occurs at the age of 30-45 years. Mainly in men aged 35-50 years, gastric ulcer and duodenal ulcer occurs 3-4 times more often.
Causes of peptic ulcer disease
- The presence of Helicobacter pylori in the stomach and duodenum, which is the main etiological factor in the occurrence of ulcers. Influence of other bacteria not proven
- Violation of the diet
- Alcohol and tobacco abuse
- Long-term use of drugs that affect the gastric mucosa, the main ones: NSAIDs and glucocorticosteroids (prednisolone)
- Emotional stress, stress
- Genetic predisposition
- Metabolic disorders
Symptoms of gastric ulcer and duodenal ulcer
- Aching or cramping pains, mild in the epigastric region, more often occur on an empty stomach or immediately after eating
- Constant heartburn, especially at night and morning hours, sour belching
- Belching of air, sour or bitter taste
- Severity in the epigastric region after eating, a feeling of rapid filling of the stomach
- Decreased appetite
- With bleeding from ulcers, vomiting of “coffee grounds”, dark stools (melena)
- With perforation of ulcers – severe, dagger pain in the epigastric region, nausea, vomiting, painful tension of the abdominal muscles
- General clinical analysis of blood, urine
- Analysis of feces for coprogram
- Analysis of feces for occult blood
- Biochemical blood test (liver function tests, cholesterol, alkaline phosphatase)
- X-ray of the chest organs in 2 projections and X-ray of the abdominal organs (to exclude perforation of ulcers)
- X-ray of the esophagus, stomach with barium mixture
- Ultrasound of the hepatobiliary system
- Daily monitoring of pH in the lower esophagus and stomach
- Non-invasive tests for the determination of Helicobacter pylori. (respiratory)
Treatment of gastric ulcer and duodenal ulcer
The main treatment for chronic gastritis consists of maintaining a healthy lifestyle and proper balanced nutrition.
Components of a healthy lifestyle and proper balanced nutrition:
- Refusal to consume alcoholic, strongly carbonated drinks
- Weight loss in obesity
- Quitting smoking
- Avoiding eating in large quantities and in late hours
If such non-drug treatments do not bring relief, medications are used.
It is recommended to start treatment already at the first signs of inflammation in the stomach.
The following preparations will be used:
- Prokenetics (help accelerate the movement of the food bolus from the esophagus into the stomach, then into the duodenum, increase the tone of the lower esophageal sphincter): domperidone (motilac, motilium), itopride (ganaton)
- Antisecretory drugs (help suppress the secretion of hydrochloric acid): proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, rabeprazole)
- Antacids (phospholugel, almagel, gaviscon)
In case of detected contamination of the gastric mucosa H. pylory, an antibacterial regimen is used.
The treatment regimen is selected individually in accordance with the patient’s condition and concomitant diseases.
There are several standard treatment regimens:
- Antibiotics (penicillin series: amoxicillin, macrolides – clarithromycin)
- Proton pump inhibitors (omeprazole, rabeprazole, esomeprazole, pantoprazole)
- Bismuth preparations (novobismol, de-nol)
Surgical treatment is carried out according to the indications: complications of gastric ulcer (bleeding, penetration, perforation), with frequent exacerbations, with gross deformities of the stomach and duodenum as a result of cicatricial changes with stenosis of the lumen.
90,000 treatment, operation, removal of stomach ulcers in St. Petersburg
This is a chronic disease, the morphological substrate of which is recurrent damage to the gastric wall or the wall of the duodenum, which occurs as a result of a violation of the mechanisms of regulation of gastric secretion.
What is gastric ulcer and 12 duodenal ulcer?
A set of substances that are peptic aggressors regularly enter the stomach cavity: hydrochloric acid, enzymes.Their action is aimed at breaking down food. In order for these substances not to damage the wall of the stomach or duodenum, a special protective factor is produced in the stomach, which consists of mucus and bicarbonates.
- The predominance of aggressive factors in combination with the depletion of the protective layer leads to damage to the stomach wall.
- Erosion appears, followed by an ulcer.
- The acidic contents of the stomach enter the duodenum.
- There is inflammation – duodenitis, erosion and ulcers can also develop in its mucous membrane.
- Particular importance in the development of the problem is attached to the microbe – Helicobacter pylori, which aggravates and provokes damage to the mucous membrane of both the stomach and duodenum.
The chronic nature of the pathology provides for the alternation of exacerbations and remissions. Exacerbations occur against the background of physical and mental overload, diet disorders, bad habits.Peptic ulcer disease often affects men. The working age of the main group of patients with gastric ulcer indicates the social and economic significance of the problem.
Causes of stomach ulcers
Distinguish between etiological factors of the disease and risk factors that increase the likelihood of ulcers. Among the causes of peptic ulcer disease, the following are distinguished:
- presence of Helicobacter pylori bacteria in the body,
- decrease in local immunity in the stomach,
- burdened heredity,
- imbalance between the protective factors of the gastric mucosa and its secretion,
- taking certain medications.
Among the drugs that destroy the gastric mucosa, non-steroidal anti-inflammatory drugs (NSAIDs) should be highlighted. Long-term treatment with their help, without proper protection of the mucous membrane, leads to the appearance of ulcers, bleeding from them.
Factors contributing to the appearance of ulcers:
- physical overvoltage,
- alcohol exposure,
- eating harmful products (spicy, smoked, fried),
- violation of the diet.
Symptoms that manifest a peptic ulcer in the presence of an ulcer
Symptoms of the disease usually appear quite brightly, which makes it possible to timely identify the disease and begin appropriate treatment. The main symptom is pain , depending on the nature of the pain, you can understand exactly where the ulcer is located. The timing of the onset of pain is also important. For peptic ulcer with localization of ulcers in the stomach, the so-called “hunger pains” are characteristic, which appear on an empty stomach, as well as a few hours after eating.
If the cardiac stomach is affected (it is adjacent to the esophagus), then pain occurs closer to the solar plexus 20 minutes after eating. It is not uncommon for the pain to spread to the chest in the region of the heart, which can be confusing and lead to misdiagnosis such as heart attack when trying to self-diagnose. Such localization of peptic ulcer disease is never accompanied by pain after exercise.
The defeat of the pyloric stomach ulcer (closer to the duodenum 12) causes prolonged acute pain, manifested in attacks. Sometimes the duration of one attack can be more than 40 minutes. The pain develops an hour after eating. May occur at night. Dyspeptic symptoms often occur: nausea, bloating, vomiting. Ulcer of this localization 5-10% becomes malignant. Also, there are frequent complications, penetration, perforation, bleeding, pyloric stenosis due to cicatricial deformity.
10-15% of ulcers are localized in the antrum, located between the pyloric and cardiac. Moreover, if the defective formation is in the lesser curvature of the stomach, the patient will feel severe pain in the left hypochondrium 1-1. 5 hours after eating. The stabilization of the state occurs after the contents of the stomach have been digested. Most of these patients experience pain in the evening.
The ulcer defect localized in the greater curvature of the stomach is characterized by a less pronounced clinic, occurs less often, more often in the elderly, and in 50% of cases has a malignant character, moreover, it is quite difficult to detect such an ulcer.
Incessant aching pain, experienced mainly in the evening and at night, may indicate the location of the defective formation in the antrum. In this case, the pain syndrome does not correlate with food intake.
The nature of pain in duodenal ulcer is characterized by the fact that it appears 1.5-2 hours after eating, often at night. This localization of the ulcer is more common in men under 40.The genetic factor is more significant for this category of patients. Dyspeptic disorders are less common than with localization in the stomach, but quite often patients are concerned about constipation.
Other signs of gastric ulcer
In addition to painful sensations of the presence of peptic ulcer disease, the following symptoms may also indicate:
- Nausea, sometimes accompanied by vomiting. This is due to a violation of gastric motility.In the presence of an ulcer, vomiting may begin 2 hours after eating.
- Heartburn . Most patients suffer from this symptom, which manifests itself as a burning sensation in the epigastric region. With heartburn, the acidic contents of the stomach are in the lumen of the esophagus, which is accompanied by a rather unpleasant sensation.
- Feeling of heaviness in the abdomen . It is observed after eating, and, regardless of the amount eaten.
- Poor appetite. The symptom is associated with a fear of heartburn and vomiting, which torment the patient after eating. This is a psychological factor that explains the deterioration in appetite by the patient’s desire to avoid unpleasant sensations.
- Belching with air can also be accompanied by the throwing of stomach contents into the oral cavity, after which an unpleasant sour or bitter taste remains in the mouth.
- Increased gassing .
Patients often complain of constipation caused by impaired bowel function.Among the atypical symptoms, one can distinguish a white coating on the tongue, sweating of the palms, pain when pressing on the abdomen. Sometimes the ulcer does not manifest itself with any symptoms, in which case it can be found in a rather neglected state.
Complications of ulcers
If left untreated, complications can develop. There are 5 conditions that threaten the patient if the ulcer is not treated:
- Ulcer perforation – perforation of the stomach wall through and through.
- Bleeding – if the integrity of the blood vessel in the walls or at the bottom of the ulcer is compromised.
- Stenosis of the pyloric stomach – narrowing of the exit site from the stomach, accumulation of food there.
- Ulcer penetration – perforation of an ulcer into an adjacent organ.
- Malignant ulcer – the growth of a malignant tumor.
Methods for the diagnosis of gastric ulcer
In order to make the final diagnosis, it is necessary to undergo esophagogastroduodenoscopy (FGDS) , the more common name is gastroscopy.
The endoscope is inserted through the mouth and esophagus into the stomach. The endoscope is a thin tube equipped with a special optical device. So, the doctor gets the opportunity to clearly see the inside of the gastrointestinal tract. Endoscopy allows you to assess the size of the ulcer, the number (with multiple process), localization, the presence of complications. During the study, samples of gastric juice, mucosal biopsy for morphological examination and the presence of Helicobacter pylori are taken.If the patient does not tolerate the procedure of such a study, then it is recommended to use medication sleep. To clarify the depth of the ulcer, gastrointestinal motility, some complications of peptic ulcer disease, such as stenosis, penetration, etc., fluoroscopy and radiography with a contrast agent are used. Diagnostic procedures may also include Helicobacter pylori tests, laboratory tests of urine, blood, and feces. Ultrasound does not allow a diagnosis of peptic ulcer disease.
Methods for the treatment of stomach ulcers
It is important for patients to adhere to the established daily regimen, avoid stressful situations, if possible, do not resort to smoking and drinking alcoholic beverages, at least for the duration of treatment, follow the diet prescribed by the doctor, adhere to the correct daily regimen.As usual, the duration of an active course of treatment is about two weeks, and then supportive therapy is needed with the obligatory observance of proper nutrition.
For each patient, an individual treatment is selected taking into account such significant factors as age, physical condition, the presence or absence of concomitant chronic diseases. A stomach ulcer is characterized as a rather serious, deadly disease, therefore, at the slightest suspicion, you should immediately undergo a diagnosis by visiting a specialist doctor.
Drug therapy consists of the following drugs:
- antibacterial drugs – the action is aimed at eliminating Helicobacter pylori from the body;
- antacids – drugs that reduce the secretion of gastric juice;
- proton pump inhibitors – their action affects the chemical composition of hydrochloric acid, disrupts its structure;
- H2 ‑ histamine blockers – reduce the aggression of gastric secretions;
- antispasmodics – symptomatic drugs that relieve pain.
Medicines must be taken strictly on the advice of a doctor. Each of the medicines is indicated only under certain circumstances of the disease. Medication must be taken within the prescribed period. If the patient feels relief, this does not mean that the drugs can be canceled on their own. The process of drug treatment is controlled by the attending physician; only he can make all changes to the reception.
Surgical treatment (surgery to remove stomach ulcers)
The need for surgical intervention may arise only with long-term non-healing ulcers, or with the appearance of complications.Such an operation can be planned or carried out urgently. Emergency surgery is indicated for perforation of an ulcer, bleeding that cannot be stopped with conservative measures. The ulcer is sutured, bleeding is stopped, the narrowing of the digestive tube expands. The previously used planned operations to remove a section of the stomach in order to reduce its secretion are currently practically not used, since a properly selected modern drug treatment, as a rule, leads to remission.
In case of malignancy (malignancy) of an ulcer, surgical treatment is necessary, the volume of which depends on how early the tumor is detected – whether it has time to germinate all layers of the stomach, or has only struck the mucous and submucous layers, has it managed to spread to nearby organs or lymph nodes, or has it already gave metastases to distant organs. The earlier the malignancy of the ulcer is detected, the less will be the volume of surgical intervention. In this case, the operation to remove the ulcer can be performed endoscopically or laparoscopically.Otherwise, extended intervention is performed in the traditional way.
Prevention and prognosis
As a prophylaxis for gastric ulcer, you should:
- devote at least 6 to 8 hours of sleep a day;
- to minimize the consumption of smoked, fatty and fried foods, such food irritates the mucous membrane;
- monitor the health of your teeth so that you can always chew food well;
- avoid frequent stressful situations, as they lead to nervous tension and cause pain in the stomach;
- do not drink alcoholic beverages or smoke;
- undergo the necessary examinations for pain in the stomach;
- Increase the number of meals to 6 per day.Food should be chopped, jelly, porridge, steamed meat, omelet, vegetables are shown.
Do not forget that a stomach ulcer affects the functioning of the whole organism, and therefore it is better to prevent this disease than to then adapt to it all your life, relieving the torment with medicines.
Seizures can be prevented by following a diet and proper diet, avoiding alcohol and cigarettes.You should visit a doctor at least once a year. For prophylactic purposes, patients are prescribed antiulcer drugs in courses, in spring and summer. It was at this time that the disease makes itself felt as the most striking manifestation of symptoms.
It is also necessary to remember patients suffering from peptic ulcer disease about the annual endoscopic control, which must be performed even in the absence of pain after the ulcer has healed.The need for such control is associated with a high probability of malignancy of gastric ulcers.
Duodenal ulcer – causes, symptoms and treatment – Medcompass
Duodenal ulcer is a pathological process that is characterized by systemic changes in the body in the presence of local manifestations in the form of an ulcer in the duodenal wall.
Symptoms of the disease
The clinical picture of duodenal ulcer is characterized by alternating periods of remission and periods of exacerbation. Each of these periods has a different severity of symptoms, which are most clearly defined in the exacerbation stage.
All clinical manifestations of duodenal ulcer should be basically divided into three main syndromes:
- Syndrome associated with changes in the level of gastric acidity
- Syndrome caused by damage to the lower parts of the gastrointestinal tract.
Pain syndrome in the presence of duodenal ulcer is characterized by the following symptoms:
- Pain occurs in the left hypogastric region
- Usually, in the absence of complications of peptic ulcer, pain irradiation is not typical
- The intensity of pain can be very different – from mild to mild to
- Pain can bother you constantly or periodically
- Pain can subside either immediately after eating, or after a certain time
- The nature of the pain is different – aching, dull, cutting, cramping, stabbing.
The concomitant level of gastric acidity determines the following clinical manifestations of duodenal ulcer:
- With increased acidity, heartburn and constipation appear
- With low acidity, there is a rotten belching, as well as a tendency to diarrhea.
Syndrome caused by damage to the lower gastrointestinal tract includes:
- Bloating (flatulence)
- Feeling of transfusion, etc.D.
Causes of the disease
The main reason for the development of duodenal ulcer is the ingestion of a microorganism such as Helicobacter into the gastrointestinal tract. This is usually possible through the following factors:
- Dirty hands
- Infected dishes
- Poorly processed and washed food.
Thus, the main mechanism of infection is fecal-oral.
Diagnosis of duodenal ulcer pursues the following tasks:
- Reveal the presence of an ulcer defect in the duodenal wall
- Detect Helicobacter pylori in the gastrointestinal tract
confirm the presence of peptic ulcer disease
To identify an ulcerative defect in the duodenal wall, such studies are carried out as:
- X-ray, in which they detect the leakage of a contrast agent outside the mucous membrane
- Fibrogastroduodenoscopy, which allows you to directly examine the ulcerative defect.
Helicobacter pylori can be detected in the gastrointestinal tract such tests as:
- Urease test, detects urea produced by Helicobacter in the exhaled air
- Serological reactions that determine the level of immunoglobulins of various classes in the blood
- during fibrogastroduodenoscopy
- Polymerase chain reaction, which is based on the determination of unique Helicobacter nucleic acid sequences.
To exclude or confirm various complications of duodenal ulcer, the following studies are shown:
- Ultrasound of the abdominal organs
In the absence of timely diagnosis and treatment of duodenal ulcer, certain complications may develop. These include:
- Gastrointestinal bleeding
- Malignancy, that is, malignant ulcers
- Penetration into nearby organs.
Treatment of the disease
Treatment of duodenal ulcer is based on the same principles as the treatment of gastric ulcer. They are as follows:
- Conducting conservative treatment in the absence of complications
- Carrying out surgical treatment when complications develop.
Naturally, the first place is given to pharmacological correction. To increase its effectiveness, physiotherapy treatment is carried out in parallel.Electrophoresis with drugs has proven itself especially well.
Conservative treatment has two main tasks:
- To cause the death of Helicobacter
- Reduce the acidity of gastric juice to a normal level.
The duration of one course of treatment is usually 14-21 days.
Peptic ulcer / Diseases / Clinic EXPERT
Peptic ulcer is a group of chronic diseases that manifest themselves by changing periods of exacerbation and remission.There is an inflammatory process and the formation of ulcerative defects in the mucous membrane of the stomach and / or duodenum (Duodenum). As a rule, peptic ulcer disease is seasonal in nature, the period of exacerbation of the disease is noted in the spring and autumn seasons.
Peptic ulcer disease is quite common in the modern world. In industrialized countries, there are 8-10% of the population who suffer from this ailment. In Russia, over the past 10 years, the incidence of peptic ulcer disease has increased by 38%.It is important to note that gastric ulcer is observed in the population over 40 years old, and duodenal ulcer is most often detected before the age of 40. As for gender, men are more likely to get sick than women. The ratio between women and men for stomach ulcers is 1: 2, and for duodenal ulcers 1: 4.
Causes of peptic ulcer disease
Causal factors causing the formation of ulcers are:
- infection Helicobacter pylori
- thermally, mechanically, chemically “rough food”, irregular, dry food
- taking ulcerogenic drugs
Peptic ulcer disease is based on the imbalance of protective and damaging factors in the stomach and duodenum.
- protective barrier from mucus
- adequate blood circulation
- regenerative capacity of stomach cells
- synthesis of substances that suppress and inhibit damaging factors
- infection of the mucous membrane Helicobacter pylori
- effects on the mucous membrane of the stomach and duodenum of bile, pancreatic juice
- tobacco smoking, alcohol
- some medications
9000 ulcers stomach – pain appears 1 / 2h-1h after eating, lasts 1-2 hours, and then subsides.Pain occurs in the epigastric (epigastric) region and on the left.
- With stomach ulcers: heartburn, sour belching, nausea, refusal to eat.
- For duodenal ulcers (duodenal ulcers): belching, heartburn, nausea, less often, sour vomiting.
- with stomach ulcers: a tendency to diarrhea
- with duodenal ulcers: a tendency to constipation
- Appears with any localization of irritation, decreased ulceration:
Peptic ulcer risk test
Take a few minutes to answer the questions below. Try to be honest. Answer the questions: “yes” or “no”.
- Do you and / or your relatives have any diseases of the gastrointestinal tract?
- Have any of your relatives been diagnosed with Helicobacter pylori?
- Do you smoke?
- Do you follow your diet?
- Are you worried about heartburn, sour belching, aversion to food?
- Have you recently noticed a decrease in body weight?
- Are you concerned about stomach discomfort or pain?
- Have you noticed that you wake up at night because your stomach hurts?
- Do you have blood group I?
- Do you often take painkillers?
- Do you often find yourself in stressful situations?
- Do you often visit common food places (fast food, canteen, cafe, restaurant)?
Test Results: If you answered “YES” to at least 2-3 questions, you are at risk of peptic ulcer disease.If you want to prevent the progression of the disease and reduce the risk of complications and disability, you should consult a gastroenterologist. Remember that peptic ulcer disease can be asymptomatic, both for you and your loved ones. Listen to your body, try to analyze your life, habits, nutrition, as well as the level of health in the family. A specialist of the EXPERT Clinic will be able to answer all your questions.
Diagnosis of peptic ulcer
At the first stage of diagnosis, the doctor collects complaints and a thorough objective examination.Then, taking into account all the risks of the disease, concomitant pathology, the doctor draws up an individual diagnosis plan, which includes laboratory and instrumental examination methods. Today, there are many biochemical indicators that help not only in the diagnosis of diseases of the gastrointestinal tract, but also in the timely identification of possible complications.
You can also start the examination with a basic screening for stomach diseases.
In case of timely diagnosis and adequate comprehensive treatment and the absence of complications, the prognosis is favorable.
Unfortunately, with an untimely appeal to an expert gastroenterologist, in some cases the condition progresses with the emergence of life-threatening complications leading to disability and sometimes death.
If peptic ulcer disease is not detected in time, the following serious complications may develop:
- Bleeding is a fairly common complication of peptic ulcer disease (10-15%). Duodenal ulcers bleed more often than gastric ulcers.Vivid symptoms of bleeding are manifested in the period of exacerbation of peptic ulcer disease and are very diverse. Typical signs: bloody vomiting, black – tarry stools, constant weakness, dizziness, decreased blood pressure, increased heart rate. It is necessary to urgently consult a doctor, as this condition harbors a person’s life.
- Perforation (perforation) of the ulcer occurs in 5-20% of cases. It occurs in men 10-20 times more often than in women. The patient feels a “dagger”, sharp pain in the stomach, takes a forced position (on the right side or back, knees are brought to the stomach).The state of health gradually worsens, pallor of the skin and mucous membranes appears, a decrease in the pulse rate (bradycardia). It is also important to note that in elderly patients, perforation can occur without visible symptoms and without severe pain.
- Penetration is a condition when an ulcer spreads beyond the boundaries of the stomach and duodenum. It is observed in 15% of cases. With this condition, pain in the stomach appears when eating. Also, the pain can be given to the back, to the right hypochondrium, it can be shingles in nature.The localization of pain is determined by the depth of damage and the organ that is involved in the process.
- Pyloric stenosis – in 6-15% of patients with peptic ulcer disease. The clinical picture depends on the severity of the narrowing of the pylorus. There is heaviness in the stomach after eating, vomiting, which brings relief, periodically there is sour belching. When the condition worsens, discomfort and a feeling of fullness in the stomach appear after eating a small amount of food, belching with a rotten egg. Only the correct antiulcer treatment can improve the condition.
- Malignancy – a stomach ulcer can transform into a malignant tumor. The frequency of malignancy ranges from 1 to 38%. In people over 60 years of age, the risk of peptic ulcer disease in stomach cancer is 1.4-2 times more often than in young people. Clinical manifestations range from latent (latent) course to vivid symptoms of the disease. That is why if you suspect that you have even minimal signs of stomach disease, consult an expert doctor in order to timely identify the risks of complications, improve the quality of life and avoid deaths.
Treatment of peptic ulcer disease should be comprehensive, taking into account the etiological factor of the disease. Depending on the area, the depth of the lesion and associated complications, conservative (drug) and surgical treatment are distinguished.
Drug treatment is selected individually, based on etiological factors and concomitant pathology. The doctor, starting the drug treatment of the patient, must also follow what drugs the patient uses in everyday life.Experts of the EXPERT Clinic always select an effective therapy, taking into account the individual sensitivity and characteristics of each patient, use drugs of a new level and generation.
Prevention and recommendations
It is necessary to exclude those factors that lead to the development of peptic ulcer and monitor the state of health in the presence of a hereditary predisposition, even if nothing bothers you.
Risk factors for the development of peptic ulcer:
- infection with Helicobacter pylori
- hereditary predisposition
- blood group I (0)
- bad habits (tobacco smoking, alcohol consumption and its surrogates)
- working conditions and stomach acidity
- rest, frequent stress
- taking ulcerogenic drugs (hormones, ibuprofen, nise, nurofen, diclofenac and others)
- non-compliance with food intake
- diseases of the gastrointestinal tract (cholecystitis, pancreatitis, gastritis, gastroduodenitis)
- obstructive Lungs, systemic diseases, chronic renal failure.
Frequently asked questions
Can peptic ulcer disease be inherited?
The ulcer itself cannot, but the risk factors for its development are certainly.
Is it possible to get a peptic ulcer?
In case of infection with Helicobacter, the risk of developing a peptic ulcer, mainly in the duodenum and antrum, is significantly higher.
Can an ulcer develop into cancer?
In the case of a long-term current inflammatory process, metaplasia may develop – a change in the typical structure of cells in the gastric mucosa and, less often, in the duodenum, which significantly increases the risk of malignancy.
Can an ulcer be cured?
An uncomplicated ulcer heals itself, and the disease “peptic ulcer” and the process of ulceration are cured when the cause (Helicobacter pylori, bile throwing, drug-induced effects, endocrine diseases, etc.) is identified and eliminated.
Can peptic ulcer disease be treated without antibiotics?
If the peptic ulcer is not caused by the HP bacterium – certainly, in the case of HP-associated disease – a course of antibiotic therapy is required.
Case history No. 1
When contacting the EXPERT Clinic, patient E., 32 years old, complained of aching, cutting pains in the epigastric region 1.5 hours after eating, often at night, on an empty stomach, heartburn, belching sour, constipation, weakness, fatigue.
Within 5 years, in the fall, noted the appearance of aching pains in the epigastrium, heartburn. Takes maalox on his own. 4 years ago, a 7-day eradication therapy was carried out using amoxicillin and clarithromycin.Post-treatment controls were not carried out. From the anamnesis of life: eats irregularly, work is associated with frequent business trips, smokes.
The patient was assigned an examination (blood test; ultrasound of the logans of the abdominal cavity, FGDS + HP-test, etc.) as a result of which the diagnosis was made: Peptic ulcer disease. Duodenal ulcer, exacerbation. HP (+). Cicatricial deformity of the duodenal bulb. Additionally, a C13-carbon breath test for HP was prescribed, which showed a high contamination of HP.A complex treatment was prescribed, aimed at eliminating the active factor – NR. During the control examination and examination, the patient did not show any complaints, and during the endoxopic examination, a significant positive dynamics was revealed. HP – not found. In the future, the patient undergoes a preventive examination once every 6 months. Over the past 2 years after the treatment, exacerbations were not observed.
Story # 2.
Patient S., 49 years old, turned to the EXPERT Clinic with complaints of aching pains in the epigastric region (more on the left), after 20 minutes.after eating, sour eructation, heartburn, ameliorated after taking Almagel. A year ago, there were similar complaints after errors in the diet, he took maalox, famotidine on his own.
Laboratory and instrumental examination revealed an ulcer of the body of the stomach. The patient was prescribed treatment, including dietary advice and drug therapy, aimed at protecting, restoring and reducing inflammation of the gastric mucosa. Complaints were stopped. The patient continues treatment and observation at the EXPERT Clinic.
Duodenal ulcer in children
Peptic ulcer – a chronic recurrent disease, accompanied by the formation of a peptic ulcer in the stomach and / or duodenum, caused by an imbalance between the factors of aggression and protection of the gastroduodenal zone.
In recent years, cases of peptic ulcer disease in children have become more frequent; currently, the disease is recorded with a frequency of 1 case per 600 children.Also noted is the “rejuvenation” of the disease, an increase in the proportion of pathology with a severe course and a decrease in the effectiveness of therapy. In this regard, gastric ulcer and duodenal ulcer in children is a serious problem in clinical medicine.
The disease develops as a result of exposure to the body of several adverse factors, including hereditary predisposition and emotional overload in combination with persistent alimentary inaccuracies (irregular eating, abuse of spicy foods, dry food, etc.).etc.). The main reasons are considered to be a disorder of the nervous and hormonal mechanisms of regulation of the activity of the stomach and duodenum, an imbalance between the factors of aggression (hydrochloric acid, pepsins, pancreatic enzymes, bile acids) and protective factors (mucus, bicarbonates, cell regeneration, prostaglandin synthesis). Ulceration is associated with prolonged hyperchlorhydria and peptic proteolysis, caused by vagotonia, hypergastrinemia and hyperplasia of the main glands of the stomach, as well as with gastroduodenal dysmotility and prolonged acidification of the anthrobulbar zone.
An important role in the development of peptic ulcer disease is played by Helicobacter pylori, found in 90-100% of patients in the mucous membrane of the antrum.
Peptic ulcer pathogenesis
Several mechanisms are distinguished that lead to an increase in the secretion of hydrochloric acid and pepsins, a decrease in the production of mucous substances and a violation of the motor regulation of the gastroduodenal zone. An important role in this process is played by the central nervous system, which has a double effect on the secretion and motility of the stomach and duodenum.
Pathological changes in the central and autonomic nervous system play an important role in the imbalance between protective and aggressive factors, contributing to the formation of an ulcer.
Classification of peptic ulcer disease in children
Localization of ulcer
Clinical phase and endoscopic stage
In the duodenum:
In the stomach and duodenum
The clinical picture depends on the localization of the process and the clinical and endoscopic stage of the disease.
Stage I (fresh ulcer)
The leading clinical symptom is pain in the epigastric region and to the right of the midline, closer to the navel. Pain occurs on an empty stomach or 2-3 hours after eating (late pain). Half of the children have night pains. A clear “Moynigam” rhythm of pains is revealed: hunger – pain – food intake – relief. Expressed dyspeptic syndrome: heartburn (the earliest and most common symptom), belching, nausea, constipation. Superficial palpation of the abdomen is painful, deep palpation is difficult due to the protective tension of the muscles of the anterior abdominal wall.
Endoscopic examination against the background of pronounced inflammatory changes in the mucous membrane of the gastroduodenal zone reveals a defect (defects) of a round or oval shape, surrounded by an inflammatory roller, with a bottom covered with fibrin overlays of gray-yellow or white.
In the stomach, ulcers are located mainly in the pyloroantral region (found more often in boys).
In the duodenum, ulcers are localized on the anterior wall of the bulb, as well as in the zone of the bulboduodenal junction.Motor-evacuation disorders include duodenogastric reflux and spastic bulb deformity.
Stage II (beginning of epithelialization of the ulcer)
Late epigastric pain persists in most children, but it occurs mainly during the day and is relieved after eating. The pains become more dull, aching. The abdomen is easily accessible by superficial palpation, but with deep palpation, muscle protection is preserved. Dyspeptic manifestations are less pronounced.
At endoscopic examination, the hyperemia of the mucous membrane is less pronounced, the edema around the ulcer defect is reduced, the inflammatory shaft disappears. The bottom of the defect begins to clear of fibrin, the folds converge to the ulcer, which reflects the healing process.
Stage III (ulcer healing)
Pain in this stage persists only on an empty stomach; at night their equivalent may be hunger. The abdomen becomes accessible to deep palpation, pain is preserved.Dyspeptic disorders are practically not expressed.
During endoscopy, at the site of the defect, traces of repair are determined in the form of red scars of various shapes – linear, circular, stellate. Possible deformation of the wall of the stomach or duodenum. Signs of an inflammatory process in the mucous membrane of the stomach and duodenum, as well as motor-evacuation disorders, persist.
Stage IV (remission)
General condition is satisfactory.No complaints. Palpation of the abdomen is painless. Endoscopically, the mucous membrane of the stomach and duodenum is not changed. However, in 70-80% of cases, a persistent increase in the acid-forming function of the stomach is revealed.
Complications of peptic ulcer disease are recorded in 8-9% of children. In boys, complications occur 2 times more often than in girls.
Bleeding dominates in the structure of complications, and with duodenal ulcers, they develop much more often than with stomach ulcers.
Ulcer perforation in children often occurs with stomach ulcers. This complication is accompanied by acute “dagger” pain in the epigastric region, often a state of shock develops. Characterized by the disappearance of hepatic dullness with abdominal percussion due to the flow of air into the abdominal cavity.
Penetration (penetration of an ulcer into neighboring organs) occurs rarely, against the background of a long difficult process and inadequate therapy. Clinically, penetration is characterized by sudden onset pain radiating to the back and repeated vomiting.The diagnosis is clarified using FEGDS.
The diagnosis of peptic ulcer disease, in addition to the above clinical and endoscopic justification, is confirmed by the following methods.