What Are Peptic Ulcers? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A peptic ulcer is a type of sore that develops on the inner lining of your stomach or duodenum, the upper part of the small intestine just beyond the stomach. In some cases, a peptic ulcer may develop just above your stomach, in your esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Anyone can develop a peptic ulcer, and the most common symptom is abdominal pain, according to the Mayo Clinic. Peptic ulcers may be caused by a bacterial infection, certain drugs, or rare tumors. They are not caused by stress or spicy foods.

Types of Peptic Ulcers

The most common kinds of peptic ulcers are named based on the location where they occur. These include:

Gastric Ulcers A common type of ulcer, these occur on the inside of the stomach.

Duodenal Ulcers These are located in the upper part of the small intestine, called the duodenum.

Esophageal Ulcers These occur inside the esophagus, the tube that carries food from your throat to your stomach.

You can have more than one type of peptic ulcer at the same time.

Signs and Symptoms of Peptic Ulcers

Many people with peptic ulcers don’t have any signs or symptoms. If they do, however, upper abdominal pain is the most common one.

The abdominal pain can occur anywhere from your navel up to your breastbone, and it may follow any of these patterns:

• Feels worse when your stomach is empty
• Feels better temporarily when you eat or take an antacid
• Gets worse at night
• Comes and goes for days or weeks

Less commonly, a severe or complicated peptic ulcer may cause the following symptoms:

• Nausea or vomiting
• Vomiting red or dark blood
• Bloody, black, or tar-like stools
• Unexplained weight loss
• Changes in your appetite
• Difficulty breathing
• Feeling faint or weak

Causes and Risk Factors of Peptic Ulcers

For a long time, it was thought that spicy foods or stress caused peptic ulcers — but doctors now know that isn’t the case. Those two factors can, however, make peptic ulcer symptoms worse, the Mayo Clinic notes.

In fact, the most common causes of ulcers are:

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, Advil or Motrin (ibuprofen), and Aleve (naproxen), which can damage the inner lining of your digestive tract
• Helicobacter pylori, a type of bacteria that can infect your stomach

Certain factors may put you at greater risk of developing a peptic ulcer, including:

• Taking high doses of NSAIDs
• Taking NSAIDs regularly over a long period of time
• Taking both NSAIDs and corticosteroids, medications that may be prescribed to treat asthma, arthritis, or lupus
• Being female
• Being 70 or older
• Smoking
• Drinking alcohol
• Having a history of peptic ulcers

In very rare cases, peptic ulcers may be caused by a condition called Zollinger-Ellison syndrome (also known as gastrinoma). It occurs when a tumor of acid-producing cells forms in the digestive tract, producing an excessive amount of acid that damages nearby tissue. Other rare causes of peptic ulcers may include serious illness, surgery, or medications other than NSAIDs, according to the Cleveland Clinic.

Treatment and Medication Options for Peptic Ulcers

Your course of treatment will be based on the cause of your peptic ulcer. Treatment typically involves taking acid-suppressing medications to kill H. pylori bacteria, if present, and to promote healing, as well as stopping any medications that are causing your peptic ulcer. You may also experience symptom relief from certain lifestyle measures.

Medication Options

If your peptic ulcer is found to be caused by an H. pylori infection, your doctor will prescribe antibiotics to kill the bacteria in your digestive tract.

Over-the-counter antacids like Mylanta, Maalox, or Tums can help you feel better, but they will not heal ulcers. If left untreated, complications from ulcers can occur.

Proton pump inhibitors (PPIs) are drugs that block acid production and promote healing of peptic ulcers.

PPI drugs include:

• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec, Zegerid)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)

Acid blockers, also called h3 blockers, reduce acid production and heal ulcers. These include:

• Cimetidine (Tagamet)
• Famotidine (Pepcid)
• Nizatidine (Axid)
• Ranitidine (Zantac)

Another option that your doctor may prescribe is a cytoprotective agent — a drug that protects the lining of your stomach and small intestine, which can help relieve symptoms of an ulcer.

Alternative and Complementary Therapies

Certain lifestyle changes may help you recover from a peptic ulcer:

• Watch your diet. If you know that there are specific foods that make your ulcer feel worse, avoid them until your treatment is over. For many people, those include alcohol, caffeine, fatty foods, spicy foods, and chocolate.
• Stop smoking. Ulcers take longer to heal, and medications for ulcer treatment may be less effective, if you are a smoker. Scientists don’t know exactly why smoking has those effects.
• Use pain medications with caution. Pain relievers known as NSAIDs, which include aspirin, ibuprofen, and naproxen, can slow ulcer healing even if they didn’t cause your peptic ulcer. Acetaminophen (Tylenol) does not cause ulcers, so it may be a good substitute. Be sure to talk to your doctor before taking any of these medications; they may continue putting you on a PPI drug to prevent ulcer recurrences.

Prevention of Peptic Ulcers

Limiting your use of NSAIDs may help prevent peptic ulcers. Taking an alternative pain reliever, such as acetaminophen, may help you avoid NSAIDs. If you need to take an NSAID, opt for the lowest effective dose and take it with a meal.

Peptic ulcers caused by an infection with H. pylori are not usually preventable.

Limiting alcohol and avoiding smoking may also help prevent peptic ulcers.

Complications of Peptic Ulcers

Left untreated, peptic ulcers can result in severe complications and potential medical emergencies:

• Internal Bleeding Ulcers can cause bleeding that occurs quickly or slowly over time. Gradual bleeding can lead to anemia (inadequate red blood cells), while sudden bleeding often requires immediate hospitalization, potentially including a blood transfusion.
• Perforation (Hole) in the Stomach Wall If an ulcer eats through your stomach wall completely, you’ll be at risk of an infection in your abdominal cavity (peritonitis), which may be life-threatening.
• Obstruction Swelling or scarring related to your ulcer can block the passage of food through your digestive tract. If that happens, you may feel full quickly or vomit when you eat, and you may lose weight, according to the Mayo Clinic.

Symptoms of a severe or complicated peptic ulcer may include:

• Blood (black or red) in your stool
• Blood in your vomit, or vomit that looks like coffee grounds
• Increasing pain
• Weakness
• Mental confusion
• Severe abdominal distension (outward swelling)

If you think you or someone you know is having an ulcer emergency, seek immediate medical attention.

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Gastroparesis | Boston Children’s Hospital

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Gastroparesis is a condition in which the stomach muscles do not work properly. As a result, food empties from the stomach very slowly, or not at all. Children with this disorder may feel full all the time, be very nauseous, have pain, or vomit undigested food left in the stomach. There isn’t yet a cure for gastroparesis. In some cases, it gets better after a few months to years, and in others it may be a lifelong condition. But with proper management and diet, specialists can help you and your child control the symptoms.

What are the symptoms of gastroparesis?

The most common symptom of gastroparesis is vomiting. Children with this condition often get sick late in the day after a meal and commonly vomit foods eaten several hours earlier. Other symptoms may include:

• upper abdominal discomfort or pain
• feeling full after small amounts of food
• nausea
• bloating

What causes gastroparesis?

Experts don’t yet know exactly what causes gastroparesis. In many cases, it starts after an infection. Other risk factors include:

• surgery, particularly fundoplication, a procedure that controls reflux in patients with gastroesophageal reflux disease (GERD)
• medications, such as anticholinergics and certain chemotherapy drugs
• congenital defects that affect the stomach or abdomen, such as gastroschisis, which cause a baby’s intestines to stick out of the body
• other underlying conditions, including diabetes, hypothyroidism, neurologic disorders, or metabolic disorders such as Riley Day syndrome

How we care for gastroparesis

If we suspect that your child has gastroparesis, we will recommend motility testing to evaluate and diagnose the condition. Boston Children’s Hospital is known worldwide for our advanced gastrointestinal motility testing services. In fact, many of our motility doctors are pioneers in the development of the newest, noninvasive tests. Once your child has been diagnosed, the team of experienced clinicians in Boston Children’s Motility and Functional Gastrointestinal Disorders Center will work with you and your child to develop a personalized treatment plan that draws from the latest therapies and research available.

Gastroparesis | Diagnosis & Treatments

How is gastroparesis diagnosed?

If your doctor suspects your child may have gastroparesis, they may order one or more of the following tests.

Gastric emptying scintigraphy

This nuclear medicine test uses an external scanner that tracks radioactive materials (eaten by your child in food) as they move through the digestive system. A four-hour emptying test has become the gold standard for diagnosis and is available at Boston Children’s Hospital. Experts are developing even newer tests for the evaluation of gastric emptying.

Antroduodenal manometry

An antroduodenal manometry test places a small, flexible tube (catheter) through the nose into your child’s stomach and small intestine to measure pressure. If your child has a gastrostomy (feeding tube), your physician may insert the catheter through that instead.

Wireless motility capsules

Your child swallows a capsule containing a tiny device that measures pH, temperature, and pressure levels as it travels through the digestive system. The capsule transmits real-time data to a monitor worn by the patient.

How is gastroparesis treated?

The first step in treating children with gastroparesis is to address any underlying conditions and stop any medications that may contribute to the problem. Other treatment options may include:

• Special diet: Your child’s physician and dietician will develop a customized diet plan involving smaller portions and easily digestible foods. You will learn how to choose the best foods, plan meal times, and balance eating with exercise.
• Medications to control nausea: Drugs called antiemetics may decrease nausea and vomiting.
• Medications to improve stomach emptying: Prokinetic drugs may improve stomach function in some children. Some medications like cisparide, domperidone, or botulinum toxin injection to the pylorus are only available through specialized programs like those at Boston Children’s Hospital. These medications should be prescribed and managed by physicians with pediatric motility expertise.
• Pain control: We provide a multidisciplinary team to control pain and improve quality of life.
• Gastric electrical stimulation: This treatment involves surgically implanting a neurostimulator in your child’s stomach. The device delivers mild electrical pulses to the stomach muscle to control nausea and vomiting.
• Surgical jejunostomy: In some children, gastroparesis is so severe that they cannot keep down any food or liquids. In these cases, a surgeon may need to place a jejunostomy (feeding tube) directly into your child’s intestines so they get proper nutrition.

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Gastric distension, unsuccessful urge to vomit, gastric volvulus

Gastric volvulus: what is it?

Acute disease, characteristic mainly for dogs of large and giant breeds, accompanied by a rapid (within several hours) increase in the volume of the abdomen and progressive deterioration of the dog’s condition until death.

What does gastric volvulus look like?

Deterioration occurs against the background of external well-being, more often in heavily fed dogs after an active walk. The animal begins to behave restlessly, groans, cannot find a place for itself. You can observe salivation, unsuccessful attempts to vomit, a significant increase in the volume of the abdomen, shortness of breath, when tapping on the abdominal wall in the region of the last rib on the left, a tympanic sound (as if a drum is hit) is heard.

In the later stages (already after 1-2 hours!) the symptoms of respiratory distress increase, tachycardia (rapid heartbeat) occurs, weakness first of the hind legs, then of the front legs, the temperature usually decreases, the mucous membranes are pale.

Who gets gastric volvulus?

Most common in large and giant breed dogs weighing over 25 kg, but can occur in any breed. Frequency of occurrence (in descending order):

• East European Shepherd
• German Shepherd
• mastiff
• Central Asian Shepherd Dog
• doberman
• Giant Schnauzer
• Dogue de Bordeaux
• black terrier
• bullmastiff
• Labrador etc.

Why is this happening?

Many factors lead to the onset of the disease:

• constitution: dogs with a deep chest are most susceptible to gastric volvulus;
• feeding and maintenance: abundant feeding once a day with voluminous (cereals and vegetables) and poor-quality feeds, greed when eating food, swallowing air during meals, active walks after a hearty meal;
• physiological causes. Violation of gastric motility as a result of chronic stretching of its walls with voluminous feed, diseases of the stomach (chronic gastritis, neoplasm of the wall). Chronic diseases of the liver and bile ducts, diseases of the pancreas, helminthiases can also predispose to the disease;
• anatomical causes. The dog’s stomach has few attachment points in the abdominal cavity and is highly movable. The main points of attachment of the stomach are the final section of the esophagus (cardia area) and the initial section of the duodenum (pyloric part), which ensure the relative immobility of the stomach, as well as a number of ligaments and the lesser omentum.

Why does the dog feel unwell?

The main thing in the development of the disease is a sharp expansion of the stomach, the accumulation of gases in it (the result of fermentation of feed) with simultaneous spasm of the gastric sphincters (cardiac and pyloric), which leads to a violation of innervation and blood supply to the stomach wall.

In the second stage, the gas-filled stomach rotates around its own axis (actual torsion). Simultaneously with the stomach, the spleen and the gastro-splenic ligament rotate around the esophagus, which leads to occlusion of blood vessels and impaired blood circulation throughout the body.

As a result of stagnation of blood in the spleen, insufficiency of respiratory volume (excessive pressure of the expanded stomach on the diaphragm), toxic products accumulate in the body, the functioning of the nervous system and all organs is disrupted. Malnutrition of the heart muscle leads to death.

What to do?

If you have a large dog older than 4 years old, and he SUDDENLY feels unwell, he has the signs of ill health described above, then you should URGENTLY contact the nearest specialized (presence of a surgical department) clinic and insist on an IMMEDIATE appointment with a doctor.

REMEMBER: if help is not provided to your pet within 4-6 hours from the appearance of the first signs of the disease, he will definitely die.

Maybe we don’t have a bloat after all?

There is such a possibility. Sometimes (more often in young dogs) there is an expansion of the stomach without torsion.
This disease also requires medical attention, but is not so dramatic. In this case, the doctor will empty your dog’s stomach with a tube, rinse it thoroughly and inject anti-fermentation drugs (activated charcoal, lignin, enterosgel or other). In addition, you will be advised to change your diet and exercise, if necessary (relapse), undergo a routine examination and, possibly, treatment of the digestive system based on the results of the diagnosis.

Still a twist!!!

Diagnosis of gastric volvulus is made by a doctor based on the results of anamnesis (history of the development of the disease), clinical examination (palpation-palpation, auscultation-listening – of the abdominal and chest organs, percussion-tapping), and, if necessary, special instrumental methods (X-ray and Ultrasound of the stomach and spleen, gastric probing). When a dog is diagnosed with gastric torsion, an emergency operation is required to return the stomach to its normal position, free it from food masses and gases by probing and washing or by gastrotomy (surgical opening of the stomach cavity) and subsequent gastropexy (suturing in the lateral abdominal wall) to prevent re-displacement stomach. During the operation, the doctor (anaesthesiologist) continuously monitors heart rates, supplies oxygen and injects various solutions to maintain blood pressure and correct disorders that have occurred in the body.

What will happen to us?

Gastric volvulus is a common pathology. According to some sources, patients with this diagnosis make up 0.4% of all surgical patients. Despite the good reputation among practitioners, the frequency of complications and death in the postoperative period reaches 25%, in 30% of patients who successfully underwent surgery, a relapse is possible (in the absence of gastropexy).

If timely assistance is not provided, the mortality rate of dogs with gastric torsion is 100%. However, those who are lucky with attentive hosts, and the operation went without complications, please the hosts with their company, warmth and cute tricks for a long time.

Why children have stomach pains

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Abdominal pain in a child: causes.

If the baby complains of abdominal pain, pay attention to its frequency or frequency. Perhaps these are isolated cases and they are associated with overeating or rejection of any product. But, if discomfort and pain occur frequently, then this is a reason to see a doctor.

Why a child has a stomach ache can only be determined by a specialist.

The reasons may be the following:

• Food poisoning . This is a common cause of poor health, which is accompanied by other symptoms – nausea, fever, dizziness and general weakness. If the baby is lethargic, complains of feeling unwell, feels sick, then go to the hospital, as this is a rather dangerous disease that leads to unpleasant consequences. In case of poisoning, intoxication of the body occurs, and diarrhea and vomiting quickly dehydrate it, which requires emergency treatment and hospitalization.
• Constipation . The appearance of problems with the stool provokes malnutrition, overeating and a sedentary lifestyle. The abundance of flour and rich products, sweets and chocolate adversely affects not only weight, but also digestion. As a result, stool retention occurs, and if gases are still accumulated in the intestines, then the pain can be very strong. In order for such problems to occur as rarely as possible, it is necessary to give the child more fruits, normalize the drinking regime and ensure physical activity.
• Dysbacteriosis . Complete digestion of food and protection of the body are impossible without the participation of microbes living in the intestines. Dysbacteriosis is a condition in which the composition of microorganisms that inhabit the intestines changes (beneficial bacteria become smaller, and harmful ones, respectively, more), which leads to disruption of the gastrointestinal tract. When the immune system weakens and malnutrition occurs, these bacteria begin to actively conduct their vital activity. The state of the intestinal microflora is also affected by the use of antibiotics. To normalize the microflora and populate it with beneficial bacteria, experts prescribe drugs with lactobacilli and a diet.
• Intestinal infections . The inflammatory process occurs due to the penetration of viruses and bacteria that cause diseases, such as dysentery. In addition to abdominal pain, nausea, vomiting, high fever appear. If these symptoms occur, you should immediately consult a doctor.
• Intestinal obstruction is a syndrome characterized by a partial or complete disruption of the movement of contents along the digestive tract and is caused by a mechanical obstruction or impaired intestinal motility. This disease is divided into mechanical and dynamic. With mechanical obstruction, the cause is a blockage of the intestinal lumen due to some kind of obstacle, and a dynamic one is caused, for example, by injuries, and as a result, intestinal motility and its muscle tone are weakened. In addition to pain, vomiting, diarrhea, sometimes with blood, strong gas formation appear. In this case, you must immediately contact a medical institution.
• Viral and bacterial infections . Pain sensations appear due to the fact that bacteria and viruses get not only to the respiratory tract, but also to the stomach. The sensations are not strong and disappear after recovery.
• Worm infestations . The presence of worms is evidenced by symptoms such as: poor appetite, pale skin, flatulence and abdominal pain. In this case, you need to consult a doctor, pass the necessary tests and undergo a course of treatment.
• Appendicitis . Pain in appendicitis is not always localized in the right side. This is due to the fact that the appendix in different people can be displaced to the right or left side. Therefore, the stomach can prick or pull on the right, in the middle or below. Associated symptoms are fever, nausea and vomiting.
• Overeating . The stomach and intestines cannot cope with such an amount of food, it bursts the walls, which causes discomfort. Watch the baby’s diet, try not to feed him fatty and heavy foods, do not force him to eat everything from the plate. If such a condition occurs regularly, it can cause problems with the intestines and form a certain line of eating behavior, in which in the future there will be problems with weight and all related diseases. When overeating, abdominal pain occurs very often, so carefully monitor how the baby eats.
• Stress. Due to experiences and negative emotions, pain in the stomach occurs not only in a child, but also in adults. This is a physiological reaction of the body. Therefore, due to stress, such feelings can occur quite often, especially if the baby is emotional, just went to school, or there were some shocks in the family.

These are the most common causes of discomfort, but not all. Therefore, if a child has a severe stomach ache, it is better to immediately consult a doctor. He will conduct an examination, prescribe tests and suggest appropriate therapy.

The child has a stomach ache: what to do and how to help

Any parent, seeing how his child suffers, how it hurts, will do everything possible to help him.

But he cannot be given most of the drugs – either contraindications or age restrictions.

When a child has a stomach ache, not all parents know what to do. The course of action depends on the age of the baby. And parents should analyze and understand the possible causes of pain.

Remember what he ate today, ask when the pain started, and then. This will help both you and the doctor if you call him.

If you realize that your child is likely to overeat, or the discomfort is caused by gas and constipation, then you can help him in the following ways.

Increased intestinal peristalsis and massage

In cases of gas formation, overeating and constipation massage will help. You need to put the child on his back and stroke his stomach clockwise with his palm. If the baby is chest, then you can help him get rid of gases with the help of gymnastics.

Lay the baby on his back and, holding his legs, lift them up and press them to your chest. Do this exercise for about 10-15 minutes, and excess gases will release the baby’s intestines, and therefore the pain will pass.

Quick help: “Neobutin”

A new drug “Neobutin” has been launched into production, which, despite its novelty, has already proven itself positively.

It is sold without a prescription, so it is available to everyone and in any pharmacy.

The drug has the following advantages:

1. High speed of action.
2. After taking Neobutin, the pain disappears after 20 minutes.
3. The drug acts on the cause of the pain, so it eliminates it for a long time.
4. Normalizes gastrointestinal motility.
5. Approved for use by children from 3 years of age.

Seek medical attention if you suspect you have appendicitis or other serious gastrointestinal problems.

Child Abdominal Pain Prevention

These tips will not prevent appendicitis, intestinal infections, or other serious illnesses, but will help prevent overeating, bloating, and other ailments caused by poor diet and lifestyle.

Physical activity. The key to good digestion. Encourage your child to exercise. Make it a tradition to exercise and outdoor games in the fresh air. Such games strengthen the abdominal muscles, improve blood circulation and speed up metabolism. As a result, digestion improves and there are no problems with it.

Power mode. Five or six meals a day will prevent overeating. Since very often a hungry child eats much more than he can. And with this mode, he will eat every 3-4 hours, which will not allow a great feeling of hunger to develop.