What is it?
A generalized irritation of the stomach is called gastritis; a localized injury that is irritated and inflamed is an ulcer. An ulcer contains dead or damaged tissue. The irritation can be due to infection or to chemical agents. Peptic ulcers include gastric ulcers in your stomach and duodenal ulcers in the first part of your small intestine immediately below the stomach. You may find that they return year after year, sometimes in the same place and in the same season.
How bad is it?
Peptic gastritis and ulcers can cause you a lot of distress, mostly pain after eating and in the middle of the night. Beyond that, they can cause life-threatening complications such as bleeding, perforation (an abnormal opening) with spreading infection throughout your abdomen and obstruction so that food cannot pass through.
What causes it?
It was believed until recently that these ulcers were due entirely to stomach acid and other digestive juices that had penetrated your stomach's defenses. Certainly these chemicals have a lot to do with causing ulcers. But not long ago, a physician discovered a bacterium called Helicobacter pylori infecting these ulcers. After the initial skepticism wore off that any germ could actually live in this highly acidic environment (hydrochloric acid), a revolution in treatment occurred that is still evolving. Now, in addition to controlling acid, you may be given antibiotics to eliminate this infection.
Another major cause of peptic ulcers is pain medicines, specifically NSAIDs -- non-steroidal anti-inflammatory drugs -- such as ibuprofen and naproxen. These medicines promote ulcers in several ways. If you have any tendency toward peptic disease, you should avoid them.
How do I know I have it?
See your doctor if you have any of these symptoms:
- Burning or gnawing pain between the bottom of the breastbone and the navel that gets better after you eat but returns a few hours later or while you are sleeping
- A change in appetite with weight gain or weight loss
- Nausea or vomiting
- Frequent burping or bloating
What can I do about it?
Mild symptoms that readily ease with antacids may require only a change of diet. Alcohol, tobacco and caffeine are likely to worsen the disease. Very effective medicines are now available without a prescription. Drugs like Tagamet® (cimetidine), Pepcid® (famotidine) and Zantac® (ranitidine) decrease acid production significantly. Prilosec OTC® (omeprazole), a powerful acid suppressor, has recently become available without a prescription. Your physician can prescribe even more effective medicines if these don't work. In addition, physicians are now being encouraged to detect and treat every ulcer patient for Helicobacter pylori so that your ulcer will be less likely to return. You should also consult your physician if symptoms persist, because an ulcer may be cancerous. You may be advised to have X-rays or a gastroscopy.
Ulcer surgery is an effective last resort. (Medical treatment has improved so much that it is harder and harder to find a surgeon with much ulcer experience.) With the advent of proton pump inhibitors (PPI) like omeprazole and Prevacid® (lansoprazole), the medical treatment of peptic acid ulcer disease has become so effective that ulcer surgery is rarely required for control.
Points to remember
- Ulcers are a common cause of indigestion and abdominal pain.
- They can lead to severe complications if not treated.
- Many forms of treatment are effective.
- For people with ulcers associated with H.pylori, it is essential to eradicate this infection to prevent recurrence of the disease.
- Eradication of the H.pylori requires a 10- to 14-day course of a combination of oral antibiotics and a PPI.
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External Sources
 | American College of Gastroenterology
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| National Institute of Diabetes, Digestive, and Kidney Diseases
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This article was reviewed and updated June 2007.
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