Peptic ulcer

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Overview

Peptic ulcers are holes in the lining of the stomach and duodenum (upper part of the small intestine), usually caused by a bacterial infection with Helicobacter pylori (H. pylori). The stomach produces hydrochloric acid and enzymes, including pepsin, that break down and digest food. A mucus layer coats the stomach and protects it from the acid. Prostaglandins also aid in protecting the lining.

When these defences are not performing their job properly, acid and pepsin eat away at the lining, forming an open sore called an ulcer. H. pylori decrease the stomach’s ability to produce mucus, making it more likely that acid will cause peptic ulcers. Although H. pylori infection is found in many people, it does not cause ulcers in all of them. Long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), such as aspirin, naproxen and ibuprofen can also cause peptic ulcers.

Symptoms

The most common symptom is abdominal pain that is dull, comes and goes over a period of time, may occur a few hours after eating or during the night, and is relieved by food and/or antacids. Weight loss, bloating and nausea are lesser indicators. Symptoms that require immediate medical attention include sharp, sudden, persistent stomach pain, bloody or black stools, or bloody vomit or vomit that looks like coffee grounds.

Tests

  • The most common laboratory test for diagnosing peptic ulcers is a blood test for the presence of antibodies to H. pylori.
  • A stool sample may be collected to look for the H. pylori antigen. A breath test also is available.
  • Some invasive procedures may be used to diagnose an ulcer. These include x-rays of the upper GI tract and endoscopy, in which a tiny camera on the end of a thin tube is fed through the mouth, down the oesophagus to the duodenum.
  • If tissue is removed during the endoscopy (a biopsy), it may be examined in the laboratory for the presence of H. pylori.

Treatment

Peptic ulcers are rarely fatal, but they can be very serious if they go through the stomach or duodenal wall (perforation), break a blood vessel (haemorrhage), or block food leaving the stomach (obstruction). Treatment usually involves antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced.

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