Peptic ulcer disease involves the development of ulcers (sores) mostly in the stomach or in the first portion of the small intestine called the duodenum. These ulcers are caused mostly by the loss of balance between the gastric acid and the protective lining of the stomach and duodenum. This can be caused by a bacterial infection (Helicobacter pylori), certain medications (especially anti-inflammatory agents such as ibuprofen, naproxen, aspirin and others), and occasionally by overproduction of acid.
The typical symptom is pain in the mid upper abdomen and it is usually associated to other symptoms such as nausea, vomiting, a decrease in appetite, and occasionally fatigue and weight loss. It may also be painless and present with anemia from persistent microscopic bleeding (mixed in the stools).
If the ulcer is deep enough, it may affect a large blood vessel in the gastric or duodenal wall and cause fast bleeding manifested by vomiting dark fluid (coffee ground appearance) or passing black stools (“digested blood”). This fast blood loss may cause weakness, dizziness and even lost of consciousness. Other complications include perforation of the stomach or duodenal wall (causing more severe pain and requiring surgery) and formation of strictures (narrowed area) from scarring of large or recurrent ulcers.
The diagnosis of a suspected peptic ulcer can be done with an X-Ray using a liquid contrast agent that delineates the shape of the stomach and duodenum, or with an endoscopic procedure (endoscopy). An endoscopy is the passage of a flexible tube through the mouth into the stomach. This flexible tube, called an endoscope, has a light source and a camera that allows us to see directly into the stomach and duodenal wall for a more accurate diagnosis. An endoscopy also allows us to take samples (biopsies) to rule out infection by Helicobacter pylori and most importantly to rule out stomach cancer which may also have an ulcer-like shape and similar symptoms. This is especially important if there are what we call “alarm signs” such as weight loss, anemia, and passage of blood (either in vomiting or in the stools). Helicobacter pylori infection can also be detected with a breath test (blowing into a balloon) and with a blood test (which detects exposure to the bacteria but usually remains positive even after Helicobacter pylori has been eliminated).
The treatment of peptic ulcers consists in medications to decrease the production of acid allowing the ulcer to heal. If there is evidence of infection by Helicobacter pylori it should be treated to prevent recurrences. This is usually achieved with a 7 to 14 day treatment with a combination of antibiotics and acid suppressive medicines. Anti-inflammatory medications should be avoided if that was the cause of the ulcer. Bleeding from ulcers can be controlled with an endoscopy usually cauterizing the bleeding blood vessel or applying special designed clips. Surgery is required when endoscopy fails or in perforated ulcers.
Our group (South Texas Gastroenterology Associates) consists of six gastroenterologists all trained in endoscopic procedures as well as in the management of peptic ulcer disease and all digestive disorders.
Rafael Amaro, M.D.