Ulcers

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A peptic ulcer is an open sore or raw area in the inner lining of the stomach or duodenum (the first section of the small intestine).

Normally, the lining of the stomach is protected by a layer of mucus. But when this layer is disrupted, digestive enzymes and acids, which normally break down food, begin to digest the lining as well. The result is a painful ulcer.

Though ulcers generally aren't fatal, serious complications can arise. Some ulcer patients experience bleeding and vomiting. In some cases, the ulcer pierces a hole in the stomach. This is called a perforated ulcer and requires surgery.

Stomach ulcers increase the risk for stomach cancer.

People are at increased risk for developing a peptic ulcer if they're exposed to any factor that causes a disruption in the mucosal layer:

1. Helicobacter pylori (H. pylori) - This bacterium causes the vast majority of ulcers. While infection by this bacterium increases the risk of ulcers, not everyone who's infected develops an ulcer. People with a family history of ulcers may be genetically more susceptible to the effects of an H. pylori infection and therefore are at increased risk for ulcers. People who live in places without proper sanitation and sewage containment are at increased risk for becoming infected with H. pylori.

2. Non-steroidal anti-inflammatory drugs (NSAIDs) - These drugs block the body's ability to protect the stomach lining. People who take long-term, high dosages of these drugs, such as ibuprofen, are at increased risk for developing an ulcer. People over 60 are at higher risk for complications from NSAIDs.

3. Zollinger-Ellison Syndrome - People with this genetic condition are at increased risk because the body produces abnormally large amounts of stomach acid.

Dyspepsia, a burning and aching pain in the upper abdomen, is the most common symptom. The pain may be stabbing or feel like a heartburn. Food often improves symptoms, while hunger worsens them.

An ulcer can also be present without pain, but with a feeling of indigestion or nausea. Some patients experience a feeling of hunger one or two hours after meals.

More severe symptoms include abdominal pain, black or bloody stools and vomiting of blood or a substance that looks similar to coffee grounds. These symptoms could indicate a bleeding or perforated ulcer and require immediate medical attention.

Antibiotics are the treatment of choice for patients whose ulcer is caused by H. pylori. Most doctors prescribe a regimen of two antibiotics and an acid-reducing drug, which gives the ulcer an opportunity to heal.

Acid-reduction drugs are the principal therapy for ulcers not caused by H. pylori. These include ulcers caused by Zollinger-Ellison syndrome. Those caused by long-term and continuing use of NSAIDs are often treated with misoprostol, which is very effective at preventing ulcers from NSAID use.

Over-the-counter antacids are effective in relieving mild symptoms that occasionally flare up. Antacids should not be taken long-term.

For more serious cases, doctors may recommend surgical procedures to treat bleeding and perforated ulcers.

Ulcer patients who include more fiber in their diet by eating more fruits and vegetables experience faster healing.

• Speak to your doctor about taking NSAIDs for short periods rather than continuously.
• Speak to your doctor about NSAID alternatives.
• Take it easy on the coffee. It may increase your susceptibility to H. pylori.
• Cut down on carbonated beverages. They increase stomach acid amounts.
• Eat more fruits and vegetables. The fiber and nutrients decrease the risk of ulcer by 50 percent.
• Stop smoking. Smoking increases stomach acid and decreases the body’s ability to protect the stomach lining.