A peptic ulcer is an open sore in the lining of the stomach or duodenum (first part of the small intestine). Although less common, it can occur in the lower esophagus (in the event of acid reflux) or even extend as far as the jejunum or ileum of the small intestine (in cases of a Meckel diverticulum). Duodenal ulcers are more common than stomach ulcers and in most cases there is a solitary (single) ulcer.
A peptic ulcer appears as a round to oval punched-out sore in the lining. The bases of the ulcer is smooth and underlying tissue or even blood vessels may be visible upon an upper GI endoscopy. Most peptic ulcers are small shallow ulcers measuring less than 3mm (millimeters) in diameter. Deeper ulcers tend to be large, often over 6mm in diameter.
Signs and Symptoms of a Peptic Ulcer
Peptic ulcers may go by unnoticed for a short period of time as a minority of cases remain asymptomatic.
- Stomach ache or abdominal pain often described as a gnawing or burning pain in the epigastrium. The pain tends to aggravate at night and eases with food and antacids. However, ulcer pain due to duodenal ulcers may aggravate shortly after eating as the gastric acid secretion and activity of pyloric pump increases. The pain may refer to the back or chest and is often mistaken for cardiac chest pain.
- Dyspepsia (indigestion) which is a combination of symptoms like belching, abdominal bloating and nausea.
- Vomiting is rarely seen but may occur, especially if there is gastric outlet obstruction (projectile vomiting), or severe nausea. Vomiting up blood (hematemesis) may be seen with bleeding ulcers and dark blood in the stool (melena) may also be present in these cases.
- Appetite changes – loss of appetite or increased appetite. The ulcer pain is often mistaken for hunger pangs. These appetite changes can lead to weight loss or weight gain.
Treatment of a Peptic Ulcer
While antacids are commonly used and provide significant relief for ulcer pain, it is not an effective measure for treating peptic ulcers, unless it is used in conjunction with other medication. Most cases of peptic ulcer disease appears to be a consequence on H.pylori infection or NSAIDs, while other aspects like cigarette smoking and alcohol excess may be contributing factors.
In the case of H.pylori infection, eradication by the use of triple therapy, as described under H.pylori Gastritis Treatment, is necessary. This involves the use of :
- Antibiotics to destroy the bacteria,
- Proton pump inhibitor or H2-blocker to reduce gastric acid secretion,
- Sucralfate, misoprostol or bismuth subsalicylate to protect the ulcer from the stomach acid thereby allowing it to heal. These types of medication are discussed further under Stomach Acid Medication.
Discontinuing NSAIDs may be necessary but if it not an option then the concomitant use of a certain medication like a proton pump inhibitor may be advisable. Switching to a different type of NSAID may also have to be considered but this should only be done under the supervision of a medical doctor and pharmacist.
In cases of non-healing peptic ulcers, usually stomach ulcers, the affected portion of the stomach may need to be removed. This partial removal is known as a gastrectomy and is only considered in chronic cases where the risk of complications from peptic ulcer disease are high and could be potentially life-threatening.