HealthyCanada.com

Overview

Peptic ulcer disease occurs when stomach acid penetrates the stomach and/or duodenal lining and causes sores or erosions that may bleed lead to anemia and/or cause abdominal pain. An estimated 10 to 20 per cent of Canadians will develop an ulcer at sometime in their life.

Causes

People used to think stress anxiety worry or eating certain types of food caused ulcers. Now doctors know most ulcers are the result of bacterial infection. Back in the early 1980s doctors discovered that a corkscrew shaped bacterium called Helicobacter pylori (H. pylori) caused approximately 80-85% of duodenal ulcers and about 60-80% of gastric ulcers.

H. pylori lives and multiplies within the mucous layers that protect the lining of your stomach and upper intestine. An ulcer begins when the bacterium weakens the lining of your stomach or upper small intestine. Once that happens the acid in your stomach seeps through to the sensitive tissue that lines your digestive system underneath. The combination of acid and bacteria can irritate your sensitive tissues causing sores or ulcers to form.

H. pylori is a very common gastrointestinal infection all around the world. But strangely enough not everyone infected with this bacterium will necessarily develop stomach problems. While one-third of Canadians are infected with H. pylori only 10-20% of them will actually develop ulcers.

Although H. pylori is the culprit in most cases it's not the sole cause. Other factors that can contribute to and aggravate ulcers include:

Pain relievers

Many people with conditions such as chronic arthritis take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin ibuprofen and naproxen to help relive their pain. If taken for long periods of time NSAIDs can irritate the stomach's lining and small intestine. As a result stomach acid can erode the lining causing bleeding and ulcers.

Excessive alcohol

If you drink too much alcohol the mucous lining of your stomach and intestines can erode causing inflammation and bleeding. Doctors still aren't sure whether alcohol alone can contribute to the development of an ulcer or other factors such as H. pylori bacteria or the use of NSAIDs need to be present.

Smoking

When you smoke the nicotine you inhale increases the volume and concentration of your stomach acid·increasing your risk of developing an ulcer. Smoking may slow the healing process of ulcers as well.

Severe stomach pain that feels like sharp aches between your breastbone and belly button is the most common symptom of ulcers. Most people will start to feel discomfort a few hours after eating. Others may feel pain during the night or first thing in the morning·usually on an empty stomach. Many people notice once they eat something their pain subsides. You should see your doctor if you're experiencing stomach pain or any of these other symptoms:

• Loss of appetite
• Constant burping
• Unexplained weight loss
• Bloody or blackish bowel movements
• Nausea or vomiting (call your doctor immediately if you see blood in your vomit)

Only your doctor will be able to determine whether the pain you're experiencing is in fact an ulcer. A common test used to check for ulcers is called an upper gastrointestinal (GI) series. Your doctor will ask you to drink a white liquid called barium while taking an X-ray of your stomach duodenum and esophagus. If you have an ulcer the barium will be pinpoint its location.

Another widely used procedure for diagnosing ulcers is called an endoscopy (en-dass-kah-pee). Your doctor will insert a very thin tube with a camera on the end down your mouth. The tube will go past your throat and through your esophagus until it reaches your stomach and upper intestine. The camera will allow your doctor a bird's eye view of what's happening in your digestive system. Tissue of your stomach and upper intestine can be removed during this procedure and then tested for the H. pylori bacteria.

Other possible tests for ulcers include taking blood examining stool samples as well as testing your breath for H. pylori bacteria.

If your doctor determines you have an ulcer that is caused by H. pylori he or she will most likely prescribe medication that will not only kill the bacteria but also reduce the level of acid in your stomach to encourage healing. The following medications are commonly used to treat ulcers:

Antibiotics

The use of antibiotics in the treatment of ulcers is only effective if you follow your doctor's instructions precisely. The most commonly prescribed antibiotics to treat H. pylori include amoxicillin clarithromycin metronidazole or tetracycline. You'll most likely have to take antibiotics for 1 to 2 weeks and other medication prescribed along with antibiotics will have to be taken for a longer period of time.

Acid blockers

To quicken the healing process it's important that the amount of acid in your system be reduced. Acid blockers also known as histamine (H-2) blockers help reduce the amount of hydrochloric acid released into your digestive system. When the amount of acid is lowered it makes it easier for your ulcer to heal and also helps relieve your pain. Acid blockers can be prescribed or purchased over-the-counter. Prescription-strength acid blockers are the most effective.

Surgery

You will only need surgery if an ulcer fails to heal you have complications or a perforation or obstruction in the stomach develops. If you have surgery the surgeon may remove the ulcer altogether or "oversew" it with tissue taken from another part of the intestine. Other options include tying off the bleeding artery or cutting off the nerve supply to the base of the stomach.

Ulcers are difficult to prevent because they are caused by such a common bacteria. But if you don't smoke limit or avoid alcohol and reduce your use of NSAIDs you may lower your chances of developing one.