What is it
A peptic ulcer is a craterlike sore in the stomach or intestinal lining. It’s called a gastric ulcer when it occurs in the stomach, and a duodenal ulcer when it occurs in the first 12 inches of the small intestine. (Peptic refers to pepsin, an enzyme in the area of the digestive system where ulcers develop.)
Duodenal ulcers are about three times more common than gastric ulcers and are most likely to affect men. Gastric ulcers are more common in people between 60 and 70 years of age, perhaps because of heavy aspirin use for arthritis management; symptoms are similar to duodenal ulcers. A third type, the esophageal ulcer, is relatively rare and is generally caused by alcohol abuse and/or reflux esophagitis resulting from heartburn.
Up to 10 percent of Americans will have an ulcer at some point in their lives. Although most ulcers occur in people over 30, children may get them as well. Even after the pain has subsided and the ulcer has healed, it’s common for them to recur. Fortunately, the high rate of ulcer recurrence has been significantly reduced since the introduction of short-term drug regimens that combat the bacterial organism involved in causing ulcers.
- Pain is the distinguishing stomach ulcer characteristic. In most instances there is generally a burning or gnawing feeling in the upper abdomen, sometimes below the breastbone, which may resemble heartburn. The pain is usually mild to moderate in severity and can last from 30 minutes to several hours.
- Often the pain occurs between meals and may be relieved by eating or by taking antacids, though in some people with gastric ulcer, eating food aggravates the pain. The pain may also awaken you at night or early in the morning. It may come and go for no apparent reason; many people experience multiple-week cycles of pain and non-pain.
- Less common symptoms include nausea, vomiting, and loss of appetite and weight.
What causes it
Many factors contribute to ulcers. For years a stressful lifestyle and a high-fat or spicy diet were blamed for ulcers. More recently, a common bacterium was implicated. In 1982 Australian researchers Barry Marshall and Robin Warren discovered that a bacterium called Helicobacter pylori (H. pylori) was present in more than 90 percent of duodenal ulcers and more than 73 percent of all gastric ulcers. Scientists theorize that the H. pylori organism contributes to ulcer formation by weakening the stomach’s protective mucous membrane, so that even small amounts of stomach acid can cause new ulcers or delay the healing of existing ones.
Experts are cautious about saying that the bacteria cause ulcers. Other factors, such as heredity and smoking, seem to be involved, and not everybody who is infected with H. pylori develops ulcers. Also, some people get ulcers apparently without being infected as, for example, those who take large doses of aspirin over long periods. Nevertheless, as a result of the H. pylori finding, and a confirmation by the National Institutes of Health in 1994, stomach and duodenal ulcers are now considered infectious diseases that are highly treatable with antibiotics, which also prevent recurrence in most cases.
It’s not known how the bacterial infection spreads, but researchers think it’s transmitted orally. Young children and adolescents, when they carry the bacteria, may be more infectious than adults. According to researchers, it’s unlikely that one adult can transmit the bacteria to another. But infected children may transmit it to adults and other children.
Once an ulcer develops, several secondary factors may aggravate it. People who often take large doses of aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs) are at risk for ulcers, because these drugs may damage the stomach lining, and then digestive acid makes the lesion worse and interferes with healing.
Cigarette smoking is another factor that promotes ulcers, though it’s not clear how. Smoking definitely slows an ulcer’s healing. Food has also been blamed coffee, tea, cola beverages, and spicy foods, as well as alcohol. But no food has ever been shown to promote ulcers.
Emotional stress, chronic anxiety, and even an “ulcer-prone personality” have all been blamed, too. But calm, happy people as well as tense unhappy ones get ulcers. There is no ulcer personality. Nevertheless, a recent study at the Centers for Disease Control and Prevention in Atlanta did suggest that people who perceive their lives as stressful may be somewhat more likely to get ulcers.
What if you do nothing
Ulcers are not contagious, nor do they cause cancer, but they are usually painful. Rarely are ulcers life-threatening, but ulcers that go untreated can sometimes progress and lead to serious complications such as bleeding. In severe cases an ulcer eats a hole in the wall of the stomach or duodenum, and bacteria can spill through this perforation into the abdominal cavity, or peritoneum. This causes peritonitis, an inflammation of the abdominal cavity and wall that usually requires hospitalization. Therefore, you should always see a doctor if you suspect you have an ulcer.
Ulcer symptoms should be evaluated by a doctor. Prescription medications are the most effective form of treatment.
The following measures can help you avoid ulcers, or at least reduce the risk of them.
Be careful with NSAIDs
If you must take aspirin, ibuprofen, or other NSAIDs regularly, take the smallest possible dose and always take it with food. If you are prone to ulcers and you must take NSAIDs, your doctor may recommend you take your NSAID with an antacid and/or one of several medications that may help prevent the recurrence of NSAID-induced ulcers.
A diet rich in fiber is recommended because it is thought to reduce the likelihood of developing a duodenal ulcer by enhancing the development of mucin, which protects the intestinal lining.
Quit smoking, if you smoke
The nicotine in cigarettes may prevent the pancreas from secreting enzymes that protect the intestinal lining. Smoking also slows the healing of existing ulcers and is a cause of ulcer recurrence.
Be careful of what you eat
Though no food is known to cause ulcers, it won’t hurt to avoid foods that seem to give you indigestion or cause pain. Many spicy foods as well as those that have a high fat content are common problems.
Drink in moderation
If you drink alcohol, drink moderately and never on an empty stomach. Although alcohol consumption and ulcers are not directly linked, ulcers are common in people who have cirrhosis of the liver, an ailment that is associated with excessive alcohol consumption.
Reduce stress in your life
Stress has not been proved to be a cause of ulcers, but it can irritate existing ones.