What anyone who has one will say is that it usually starts with burning pain, which can last for hours in some cases, and causes misery in the afflicted.
The condition is common. U.S. News & World Report claims 500,000 new peptic ulcer cases occur each year, affecting about 5 million people at any specific point, with about 25 million people expected to have an ulcer condition at some point in their lifetime. Most are 25 to 64 years old, with the direct and indirect costs of treating the condition estimated at $10 billion collectively per year.
The good news is that there are fewer incidences of ulcers; the primary bacterial cause has decreased, thanks to effective over-the-counter medications.
Causes of Ulcers
There is no specific reason people get ulcers. Some say stress and spicy food cause them, and while those factors can aggravate the condition, they are not the cause.
An ulcer develops because of an infection with Helicobacter pylori (H. pylori), bacteria that causes an imbalance in the digestive fluids in the stomach and the duodenum, the first part of the small intestine. The acids that normally digest food instead turn on the walls of the stomach, the esophagus or in the duodenum itself. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen also can damage the stomach.
Ulcer sufferers know there is something seriously wrong. The burning pain typically starts during the night, interrupting sleep, or between meals. It can last for hours and will disappear for days or weeks, only to return. The miserable condition can sap strength and cause the sufferer to lose sleep, creating another set of conditions that can cause lost productivity, inattention, inability to concentrate, and mistakes or accidents.
Most people will ignore initial symptoms, blaming the problem on something they ate or other conditions. But while ulcer sufferers can treat the condition with antacids and milk, more serious intervention is needed, typically with antibiotics and, in some cases, surgery if the ulcer does not heal.
THREE TYPES
There are three types of peptic ulcers:
1) Gastric ulcers – These are found on the inside of the stomach.
2) Esophageal ulcers – These occur in the tube that carries food from the throat to the stomach.
3) Duodenal ulcers – These sores occur in the upper portion of the small intestine.
All ulcers' main symptom is a burning pain caused by the ulcer and stomach acid touching it and aggravating it. Think of pouring acid on a skin wound, and you’ll have an approximation of what’s going on. The pain generated can be felt even when the stomach is empty, can radiate from the navel to the breastbone, sometimes acts up at night and may calm down for a period before returning. Severe ulcers may cause sufferers to vomit red or black blood, pass dark, black or tarry stools, experience extreme nausea, have a change in appetite, and experience unexplained weight loss.
Five Things to Know about Ulcers
Here are five things that those who suspect they have an ulcer should know about the condition.
1) No one knows how the bacteria that causes ulcers is acquired. H. pylori bacteria live in the mucous layer that covers the tissue lining the stomach and small intestines. Normally, it causes no issues, but whatever sets it off inflames the lining of the stomach, esophagus or duodenum, causing an ulcer. Some speculate that close person-to-person contact like kissing may cause its transmission, while others believe it is spread by food or water.
2) Pain medications can cause problems. Many people take more than the recommended dosage of aspirin, ibuprofen and other over-the-counter pain medications. It is understandable – the medications ease arthritis pain, so those sufferers tend to increase the dose over time, and the elderly are particularly susceptible to this gradual increase. But the side effects of the medication include irritating or inflaming the stomach lining, leading to ulcers.
3) Other prescription medications – While pain relievers are the chief culprit, there are other medications that can cause issues, most of them bisphosphonates like Actonel, Fosamax and potassium supplements used to combat osteoporosis.
4) Spicy foods don’t cause ulcers. You didn’t get the ulcer from too many tacos or slathering on the Sriracha sauce. But once you have an ulcer, these foods, which can cause a rise in stomach acid, may aggravate the condition.
5) Smoking and drinking – These can also aggravate an ulcer by increasing stomach acid or generating bacteria.
Diagnosis and Treatment
Because some ulcer pain can wax and wane, people may use the "hoping and praying" method before consulting a doctor about stomach issues. This means ulcers can be fairly advanced by the time sufferers seek medical attention. The consequences include internal bleeding that leads to anemia; severe blood loss that may require hospitalization; infection that spreads to other parts of the body; creating an abdominal cavity infection called peritonitis, which is potentially life-threatening; and generating scar tissue that blocks the digestive tract, causing vomiting and weight loss.
Doctors will do a complete physical and require diagnostic blood, breath and stool tests to determine whether the patient has an ulcer.
The breath test requires ingesting something with radioactive carbon inserted in it. H. pylori will break it down in the stomach. After a period, the patient will be asked to blow into a sealed bag. The radioactive breath sample will be measured for carbon dioxide, which will indicate H. pylori’s presence.
The digestive tract will be examined to determine whether the pain is generated by conditions other than an ulcer, such as a tumor or blockage. An endoscopic examination requires the doctor to put a thin tube equipped with a lens down the throat to look at the esophagus, stomach and small intestine. The tool can grab small tissue samples that are examined for the presence of H. pylori. This procedure is particularly recommended if the patient is older, has bleeding, or there is difficulty in eating or swallowing.
Another potential test is the barium upper gastrointestinal series. This requires swallowing a white liquid containing barium. The liquid coats the digestive tract, making an ulcer visible on X-rays.
If an ulcer is discovered, there are several treatment options:
1) Antibiotics – This is an effective way to kill H.pylori. The typical regimen calls for two weeks of antibiotics, along with antacids to tamp down stomach acid.
2) Acid blockers – Proton pump inhibitors reduce stomach acid by blocking cells that produce acid. They are highly effective and are credited with the decline in ulcers reported because they are available over the counter. The medications include omeprazole (sold commercially as Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole (Aciphex) and pantoprazole (Protonix). These medications can only be taken for a short time because they may weaken bones and increase risks of fractures.
3) Antacids – These reduce stomach pains but have the side effects of constipation or diarrhea, depending on the body’s reaction and the main ingredients of the medication.
4) Cytoprotective agents – These help protect the tissues lining the stomach and small intestine and are sold under the names Carafate and Cytotec. Many patients are familiar with over-the-counter Pepto-Bismol, which is a cytoprotective agent formally known as bismuth subsalicylate.
Presuming the ulcer has not perforated the stomach lining and escaped elsewhere into the body, healing should occur in about a month.