ULCER, PEPTIC (Duodenal Ulcer; Gastric Ulcer)

General Information

DEFINITION--An ulcer is a small erosion in the gastrointestinal tract. The most common type, duodenal, occurs in the first 12 inches of small intestine beyond the stomach. Ulcers that form in the stomach are called gastric ulcers. An ulcer is not contagious or cancerous. Duodenal ulcers are almost always benign, while stomach ulcers may become malignant.

BODY PARTS INVOLVED--Gastrointestinal tract.

SEX OR AGE MOST AFFECTED--Both sexes (duodenal more common in males); all ages, but most common in adults.

SIGNS & SYMPTOMS

> Pain that has the following characteristics:

A burning, boring or gnawing feeling that lasts 30 minutes to 3 hours (often interpreted as heartburn, indigestion or hunger). Pain is usually in the upper abdomen, but occasionally below the breastbone. Pain occurs in some persons immediately after eating; in others, it may not occur until hours later. It frequently awakens one at night. Pain comes and goes. Weeks of intermittent pain may alternate with pain-free periods. Pain may be relieved by drinking milk, eating, resting or taking antacids.

• Appetite and weight loss (with duodenal, may be weight gain, as person eats more to ease discomfort).
• Recurrent vomiting; blood in the stool; anemia.

CAUSES--The exact cause has not been fully established. An ulcer can develop wherever stomach acid comes in contact with the gastrointestinal lining--especially the lower end of the esophagus, the stomach and the duodenum. A person with an ulcer usually has an overactive stomach that manufactures too much hydrochloric acid.

RISK INCREASES WITH

• Family history of ulcers; smoking; excess alcohol consumption (possibly).
• Use of nonsteroidal anti-inflammatory medications (e.g., aspirin) or corticosteroids.
• Zollinger-Ellison syndrome.
• Improper diet, irregular or skipped meals.
• Type O blood (for duodenal ulcers).
• Stress does not cause an ulcer, but may be a contributing factor.
• Chronic disorders such as liver disease, emphysema, rheumatoid arthritis may increase vulnerability to ulcers.

HOW TO PREVENT--Avoid as many risk factors as possible.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory blood and stool studies, endoscopy (See Glossary), x-ray studies with barium meal and sometimes, mucosal biopsy (See Glossary) to rule out cancer.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis; doctor's treatment.
• Hospitalization for bleeding ulcer or severe perforation or obstruction.
• Surgery or other treatments (endoscopic cautery, direct injection of medications and use of lasers) for complications in some patients.

POSSIBLE COMPLICATIONS

• Perforation (erosion of the ulcer through the intestinal wall) with consequent infection or bleeding into the abdomen.
• Hemorrhage into the intestine.

PROBABLE OUTCOME--Most ulcers heal within 2 to 6 weeks with treatment.

How To Treat

GENERAL MEASURES--

• Reduce your use of aspirin or nonsteroidal anti-inflammatory medications.
• Don't smoke.
• Check your stool daily for bleeding. If the stool is black, save a sample for analysis.
• Reduce stress in your life (see How to Cope with Stress in Appendix).
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Antacids to neutralize excess stomach acid.
• H-2 blockers to reduce stomach acid.
• Medications to coat the ulcer area.
• Antibiotics for the bacteria infection.

ACTIVITY--Resume your normal activities as soon as symptoms improve.

DIET--

• Eat a balanced diet of 3 regularly scheduled meals a day. A bland diet is not necessary.
• Avoid caffeine and any food that seems to make symptoms worse. Don't drink alcohol.

Call Your Doctor If

• You have symptoms of an ulcer.
• Vomiting begins that is bloody or looks like coffee grounds.
• Stool is bloody, black or tarry-looking.
• Diarrhea begins that may be caused by antacids.
• Pain is severe, despite treatment.
• You are unusually weak or pale.