Peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. This area of the small intestine is called the duodenum. Peptic ulcers may be named by their location:
Upsets in the balance of stomach acid and digestive juices can lead to an ulcer. This can be caused by:
Rare causes include:
Risk factors for ulcer from H pylori infection include:
Risk factors for ulcer from anti-inflammatory drugs include:
Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food may increase gastric ulcer pain. Food will often relieve duodenal ulcer pain.
Symptoms include:
Ulcers can cause serious problems and severe abdominal pain. Problems include:
The doctor will ask about your symptoms and medical history. A physical exam will be done. Tell your doctor about all medication you are taking.
Tests may include:
The goal is to remove the source of the problem and heal the ulcer. Gastric ulcers may take longer to heal.
Treatments include:
Some medications block or reduce acid production. Some coat the ulcer to protect it. If H pylori caused the ulcer, you will need to take a combination of drugs to kill the bacteria. This usually consists of antibiotics and a proton-pump inhibitor. It is very important to take these drugs as directed. The doctor may order tests 6-12 months after treatment. This is done to check that the bacteria are gone.
Medications may include:
You may need surgery if you have bleeding, a perforation, or an obstruction. Surgical options include:
This may be done to stop bleeding. A thin, lighted tube is inserted down the throat into the stomach or intestine. Then, heat, electricity, epinephrine, or a substance called “fibrin glue” can be applied to the area. This should stop the blood flow.
Vagotomy is the cutting of parts of the vagus nerve. This procedure can greatly reduce acid production. Cutting the entire nerve can also create problems with stomach. In this case, drainage must be created. Drainage may be done with one of the following:
Two other forms of vagotomy include:
To decrease the risk of ulcer from H pylori infection:
To decrease the risk of ulcer from NSAIDs:
RESOURCES:
The American College of Gastroenterology
http://www.acg.gi.org/
American Gastroenterological Association
http://www.gastro.org/
References:
Conn HF, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Dambro MR, Griffith HW, Griffith JA. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Fauci AS ed. Harrison's Principles of Internal Medicine . 15th ed. Columbus, OH: McGraw Hill; 2001.
H pylori and peptic ulcer. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/ . Published October 2004. Accessed June 13, 2008.
Ulcers. The American College of Gastroenterology website. Available at: http://www.acg.gi.org/patients/patientinfo/ulcers.asp . Accessed June 13, 2008.
Ulcers. American Gastroenterological Association website. Available at: http://www.gastro.org . Accessed June 13, 2008.
Ulcers and H pylori infection. America Academy of Family Physicians website. Available at: http://familydoctor.org/online/famdocen/home/common/digestive/disorders/271.html . Published May 1999. Updated December 2006. Accessed June 13, 2008.
Last reviewed February 2009 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.