Peptic Ulcers

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Medical Author:

Michael W Stratemeier, MD

Coauthor:

Lisa Vignogna, MD

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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• Peptic Ulcers Overview
• Peptic Ulcers Causes
• Peptic Ulcers Symptoms
• When to Seek Medical Care
• Peptic Ulcer Diagnosis
• Peptic Ulcer Treatment
• Peptic Ulcers Self-Care at Home
• Peptic Ulcers Medical Treatment
• Peptic Ulcer Medications
• Peptic Ulcers Surgery
• Peptic Ulcer Follow-up
• Peptic Ulcer Prevention
• Peptic Ulcer Prognosis
• Synonyms and Keywords
• Authors and Editors
• Read more on Peptic Ulcers from Healthwise
• Viewer Comments: Peptic Ulcers - Symptoms At Onset Of Disease

Peptic Ulcers Overview

In the digestive system, an ulcer is an area where tissue has been destroyed by gastric juices and stomach acid. Peptic ulcer disease is a general term for ulcers that occur in the stomach or duodenum (upper part of the small intestine).

• A peptic ulcer is an erosion or sore in the wall of the gastrointestinal tract.
• The mucous membrane lining the digestive tract erodes and causes a gradual breakdown of tissue.
• This breakdown causes a gnawing or burning pain in the upper middle part of the belly (abdomen).
• Although most peptic ulcers are small, they can cause a considerable amount of discomfort.

Peptic ulcers are a very common condition in the United States and throughout the world.

• In the United States, about 10% of the population will develop a duodenal ulcer at some point in their lives.
• Peptic ulcer disease affects about 4.6 million people annually.
• The occurrence of peptic ulcer disease is similar in men and women. Approximately 11%-14% of men and 8%-11% of women will develop peptic ulcer disease in their lifetime.
• The mortality rate for peptic ulcer disease is approximately one death per 10,000 cases. The mortality rate due to ulcer hemorrhage is approximately 5%.

Ulcers can occur at any age, although they are rare in children and teenagers.

The good news is that we have learned a lot about ulcers in the past 20 years and effective therapies are now available.

Peptic Ulcers Causes

When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.

• The food is partially digested in the stomach and then moves on to the duodenum to continue the process.
• Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall.

In the past it was throught that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.

• Now it is understood that people with ulcers had an imbalance between acid and pepsin coupled with the digestive tract's inability to protect itself from these harsh substances.
• Research done in the 1980s showed that ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori.
• Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.

Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slows healing of existing ulcers.

• Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex])
• Alcohol
• Stress: physical (severe injuries or burns, major surgery) or emotional
• Caffeine
• Cigarette smoking
• Radiation therapy:-used for diseases such as cancer

People who take aspirin or other anti-inflammatory medication are at increased risk even if they do not have H pylori infection.

• Elderly people with conditions such as arthritis are especially vulnerable.
• People who have had prior ulcers or intestinal bleeding are at higher-than-normal risk.
• If a person takes these medications regularly, alternatives should be discussed with a health care professional. This is especially true if the affected individual has an upset stomach or heartburn after taking these medications.

H pylori bacteria spread through the stools (feces) of an infected person.

• The stool contaminates food or water (usually through poor personal hygiene).
• The bacteria in the stool make their way into the digestive tracts of people who consume this food or water.
• This is called fecal-oral transmission and is a common way for infections to spread.

The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum.

• Many people who are exposed to the bacteria never develop ulcers.
• People who are newly infected usually develop symptoms within a few weeks.
• Researchers are trying to discover what is different about the people who develop ulcers.

Infection with H pylori occurs in all ages, races, and socioeconomic classes.

• It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
• It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
• African Americans and Hispanic Americans are more likely to have the bacteria than whites and Asian Americans.

It is important to distinguish between ulcers caused by H pylori and those caused by medications only, because the treatment is completely different.

Ulcers can be linked with other medical conditions.

• People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers.
• A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.