Erosion of the lining of the stomach causes a gastric ulcer (GU), while the erosion of the lining of the first portion of the small intestine (the duodenum) causes a duodenal ulcer (DU). Peptic ulcer disease (PUD) refers to either GU or DU.
Inflammation of the lining of the stomach and/or duodenum due to bacterial infection (H. pylori bacteria)
Medication use: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, naproxen
Less common causes:
Other drugs, e.g. steroids
Chronic kidney disease
Overproduction of stomach acid
Stomach pain (dull ache or burning pain) is the most common complaint. Occurs anywhere in the center of the abdomen. It may begin between meals or flare up at night, during sleep. The duration of the pain is variable. Pain may relieve with antacids or temporarily with the consumption of food.
Other symptoms of peptic ulcers may include
Vomiting (with blood in severe cases)
Blood in feces (or blackening of feces)
The following symptoms may indicate the need for prompt medical attention:
Sudden, sharp persistent abdominal pain
Black or bloody stools
Blood in vomit or if vomit that looks like coffee grounds
These symptoms might suggest:
Broken blood vessel due to ulcer, or
The ulcer has perforated (eroded through and through) the lining of the stomach
Stool antigen test (SAT): generally considered if the UBT is not available
The patient is given a mild sedative/anesthetic to help relaxation and induce sleep. A thin tube with a camera at the tip is inserted into the patient’s throat and passed down the esophagus into the stomach and duodenum. This allows doctors to observe and examine the lining of the alimentary canal and biopsy any suspicious appearing areas. The tissue sample taken during the biopsy can be sent to a laboratory to test for bacteria and cancer (if this is suspected).
Upper gastrointestinal (G.I.) examination:
The patient ingests a substance called barium which quotes the lining of the esophagus, stomach, and duodenum. Chest and abdominal x-rays can be used to identify the barium and observe for areas of erosion (ulcers).
PUD is treated according to its underlying cause:
Bacterial (H. pylori) associated ulcer
NSAIDs (e.g. aspirin) associated ulcers
Refractory (resistant to treatment) ulcers
Lifestyle (diet) modification
Diet modification: Patients are normally recommended to increase their liquid intake and reduce the consumption of spicy foods
Antibiotics may be administered to eliminate the H.pylori bacterial infection
Antacids and acid blockers are used to neutralize the effects of the acid that is naturally produced in the stomach, and hence reduce pain
A) H. pylori-associated ulcers:
Goal is to relieve gastrointestinal discomfort, promote healing, and cure the infection.
Medications to reduce stomach acid production Plus
Medications to coat and protect the lining of the stomach or duodenum
B) NSAIDs (e.g. aspirin, ibuprofen, naproxen) associated ulcers:
Discontinue offending medications
Use of medications to reduce stomach acid production
Consider additional investigations for other causes if symptoms persist
C) Refractory ulcers:
Patients with recurrent ulcers, who are H. pylori bacteria negative or have failed attempts to eradicate the bacteria, may require long term therapy with medications to reduce stomach acid.