Is that why your stomach hurts?
You’re sleeping peacefully one night when suddenly, you’re woken up by burning pain in your stomach and chest and feel slightly nauseous. You roll over, trying to ignore the pain, but in the morning, it’s still there. After eating a small breakfast, you notice that the pain eases up some. This pattern repeats for the next several days, so you go to the doctor and find out you have an ulcer. What caused it? How can you get rid of it? Are there ways to prevent it from coming back?
Peptic ulcers are open sores that develop within your digestive system. The two types are gastric ulcers and duodenal ulcers. Gastric ulcers appear on the inside of your stomach. Duodenal ulcers occur on the inside of the upper portion of your small intestines (duodenum). In either case, the acid from your stomach eats away at the inner surface, resulting in the sore. Typically, you have a protective mucous layer that prevents this. However, if you have extra acid or a decreased amount of mucous production, it triggers an ulcer to develop.
There are two main culprits of peptic ulcers. Helicobacter pylori (H. pylori) bacteria naturally occurs in the mucous layer of the intestines, but sometimes it can cause inflammation producing an ulcer. Regular use of certain pain relievers, like aspirin and nonsteroidal anti-inflammatories (NSAIDs), which are ibuprofen, naproxen, and ketoprofen. These can irritate or inflame your stomach lining as well. Other medications, such as steroids, anticoagulants, selective serotonin reuptake inhibitors (SSRIs), alendronate, and risedronate, can increase your chances of developing a peptic ulcer. Certain things can make your ulcers hurt worse and take longer to heal. These include smoking, alcohol, stress, and spicy foods. It’s important to note that these don’t cause an ulcer but irritate an existing one.
Symptoms of a peptic ulcer are burning stomach pain, feeling of fullness/bloating/belching, intolerance of fatty foods, heartburn, and nausea. If you have an empty stomach, your pain may feel worse. This is why the pain is usually worse between meals and at night. Some people don’t have any symptoms. Signs that an ulcer is severe are vomiting (especially vomiting blood, which can be red or black), dark blood in stools (or stools that are black or tarry), trouble breathing, feeling faint, unexplained weight loss, and appetite changes. Most of these are signs of internal bleeding; some indicate a slow blood loss that results in anemia, whereas others are signs of severe blood loss that require a blood transfusion.
Some other complications of peptic ulcers are an obstruction, hole in your stomach wall, and gastric cancer. An obstruction can happen with the ulcer blocks food from passing through your digestive tract. A hole in the stomach wall (perforation) is when the ulcer actually eats a hole through the wall of the intestines. This places you at increased risk of having a severe infection in your abdominal cavity (peritonitis). Your chances of having gastric cancer are higher if you’re infected with H. pylori.
The treatment for peptic ulcers depends on the cause. If your ulcer results from taking NSAIDs or other medications, your doctor will want to reduce or eliminate them. When it comes to ulcers from an H. pylori infection, your doctor will prescribe antibiotics to help get rid of it. These can include amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline, and levofloxacin. Your doctor will help you determine which one will work best. Expect to take it for two weeks along with other medications.
Proton pump inhibitors (PPIs) can reduce stomach acid by blocking the action of the parts of cells that produce acid. Some of these are omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole. All of them are available over-the-counter or prescription. Acid blockers (histamine or H2 blockers) decrease the amount of stomach acid released into your digestive tract. These are also available over-the-counter or prescription and include famotidine, cimetidine, and nizatidine. Antiacids neutralize your stomach acid (this provides relief from symptoms but won’t heal your ulcer). Examples of these are aluminum hydroxide gel, calcium carbonate, magnesium hydroxide, Gaviscon, Gelusil, Maalox, Mylanta, Rolaids, and Pepto-Bismol. Cytoprotective agents help protect your stomach lining and include sucralfate and misoprostol.
If your ulcer doesn’t heal, it’s called refractory ulcer. This can result from not taking your medication as directed, some types of H. pylori being resistant to antibiotics, using tobacco regularly, and regular use of pain relievers. Other possible causes are extreme overproduction of stomach acid, an infection other than H. pylori, stomach cancer, or other diseases that cause ulcer-like sores. To rule these out as possible causes, your doctor will probably recommend an endoscopy.
There are several things you can do to prevent peptic ulcers. One of the most important is to reduce the number of pain relievers you’re taking or try switching to something less irritative to your stomach. If you need to take an NSAID, try to take the lowest dose possible and consider taking additional medications, like an antacid, a proton pump inhibitor, an acid blocker, or a cytoprotective agent. Another good practice is to protect yourself from infections as much as possible. You can do this by washing your hands frequently and thoroughly with soap and water and eating foods that have been cooked thoroughly. It’s also vital to control your stress, not smoke, limit/avoid alcohol, and limit/avoid spicy foods.
Peptic ulcers can be excruciating to have, but the good news is that there are treatment options available to help get rid of them. If you have any questions or concerns about peptic ulcers, please speak with your doctor. If you would like more information, please visit MedlinePlus’ Peptic Ulcer page at https://medlineplus.gov/pepticulcer.html