What are Peptic Ulcers?

An ulcer is a general medical term that refers to a damage of the surface of an organ or tissue, produce by sloughing of inflamed tissue.  The most common type of ulcer, and the one that most lay people are aware of, are peptic ulcers of the stomach or duodenum (first portion of the small intestine).   Peptic ulcers represent an area of inflammation that bores down into the intestinal lining and may present with symptoms or may be completely asymptomatic.

Causes of Peptic Ulcers

Most peptic ulcers are caused by either infection with the bacteria H. pylori or by the use of NSAIDs (see below).  Ulcers can rarely be caused by cancer, Crohn’s disease, infiltrative diseases such as sarcoidosis, and other infections such as tuberculosis.  In 20-40% of cases, no cause for the ulcer is apparent.  Contrary to popular belief, there is no compelling evidence that ulcers are caused by psychological stress or dietary factors.  Anxiety likely exacerbates the symptoms associated with ulcers through its affect on gastrointestinal motility (i.e. causes spasm).

Symptoms of Peptic Ulcers?

When symptoms occur, they may include a burning upper abdominal pain often relieved by food or antacids; food-provoked indigestion; or heartburn.  Eighty-percent (80%) of patients with ulcers diagnosed at endoscopy have upper abdominal pain, often in the midline.  Stomach acid is felt to play a role in the symptoms felt by patients and neutralizing or decreasing acid production is the mainstay of symptom relief and ulcer treatment. Peptic ulcers are a common cause of upper GI bleeding.

Frequently, peptic ulcers are asymptomatic.  Between 43 and 87 percent of patients with bleeding peptic ulcers present are without heralding symptoms.  This “silent” presentation may be more frequent in elderly patients and in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs).   Since NSAIDs are pain-relief medications, this comes as no surprise.  Examples of NSAIDs include naproxen, ibuprofen, and aspirin.

Peptic Ulcer Diagnosis & Treatment

Currently, ulcers are diagnosed almost exclusively by endoscopy.  Treatment of ulcers involves searching for the underlying cause.  Acid-suppression typically helps with symptom relief and healing of ulcers regardless of cause.  If H. pylori is present, treatment with antibiotics is indicated.  If a patient is taking an NSAID, this medication should be discontinued.  In a study from 1984, 57% of ulcers healed spontaneously by 6 weeks, although ulcer recurrence was common.  This study predates the discovery of H. pylori playing a role in ulcer formation and it is likely that the recurrences were due to infection with H. pylori. A follow up endoscopy may be recommended by your doctor to confirm healing of the peptic ulcer.

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The board-certified physicians at San Francisco Gastroenterology are specialists in the diagnosis and treatment of disorders affecting the digestive tract, including peptic ulcers. Our doctors serve patients from Marin County, Oakland, Berkeley, Palo Alto and the entire San Francisco Bay Area. Our goal is simply to provide the highest quality medical care and patient service possible.

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