Ulcers are sores that develop when the skin or mucous membrane on a bodily surface erodes away. Ulcers most commonly occur in the lining of the stomach, small intestine, and mouth, though it is possible for them to develop in other parts of the body. Ulcers of the stomach, also known as Peptic Ulcer Disease (PUD) are especially common. An estimated 10-15% of Americans will develop a peptic (stomach) ulcer at some point in their lives. Ulcers are typically treatable with medications, dietary restrictions, and lifestyle changes. If ulcers progress too far before they are detected, they may cause serious complications or require surgical intervention. The majority of patients with ulcers can continue to live normal lives after receiving treatment.
What Is Ulcers
What Causes Ulcers
The most common ulcers, peptic ulcers, are caused by an erosion of the mucous membrane that lines the stomach. This erosion is most often caused by an infection of the stomach by a type of bacteria known as Heliobacter pylori or H.pylori. Though H.pylori infection is the most common cause of ulcers, ulcers may also be caused by long-term over-consumption of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and naproxen. It was long believed that ulcers are caused by stress and poor diet, though these factors are now believed to be more influences than causes. Stress and poor diet can worsen an ulcer, but they cannot cause an ulcer.
Risk Factors For Ulcers
The following factors can increase your risk of developing an ulcer and/or worsen an existing ulcer:
- Excessive stress
- Long-term alcohol or drug abuse
- Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen
- Highly acidic diet
- Smoking cigarettes or chewing tobacco
- A weakened immune system, either from an existing disease or treatment for an existing disease (such as radiation therapy)
- Sex. Men are slightly more likely than women to develop ulcers.
Your doctor will most likely use a combination of the following diagnostic tests to determine whether or not the source of your symptom is an ulcer:
- Physical examination and medical history, including current symptoms. If your doctor suspects an ulcer based off your reported symptoms/physical exam, he or she may begin treatment immediately. You may also be referred to a gastrointestinal specialist for further testing.
- Breath urea test, in which patients are given urea, a chemical that H.pylori digest into carbon dioxide and ammonia, in either pill or drink form. H.pylori infection is suggested when urea waste products are evident in the breath following the consumption of the urea.
- Stool antigen test, in which the stool is analyzed for the presence of H.pylori-specific antigens.
- Blood tests, in which the blood is tested for the presence of certain H.pylori-specific antibodies (immune proteins).
- Gastroscopy, in which a camera is inserted into the stomach through the esophagus. This allows the doctor to get a clearer picture of the location and size of the ulcer. This can be done with or without anesthesia and may require up to 24 hours of recovery time.
Symptoms of Ulcers
The following may be symptoms of an ulcer:
- Pain in the upper abdomen that is either better or worsened by the consumption of food. This is the main symptom of ulcers and
- Bloating or feeling full quickly after eating or drinking small quantities
- Excessive hunger/feelings of an empty stomach
- Bloody or dark stools
- Vomiting, possibly with blood
- Unexplained weight loss
- Chest pain
The prognosis for ulcers depends largely on the stage in which the ulcer is detected. According to a 2003 study published in the World Journal of Surgery, mortality rates for ulcers that have progressed to the stage of bleeding and/or perforation (tearing through the stomach wall) can be as high as 10%. Most ulcers that have not progressed to this stage are treatable, though it may take more than 8 weeks for the ulcer to heal completely.
Living With Ulcers
The following tips can help you live more comfortably with ulcers:
- Don’t drink or smoke. Both can aggravate the ulcer and slow the healing process.
- Avoid highly acidic foods such as citric fruits, tomatoes, coffee, and chocolate.
- Eat smaller quantities of food more frequently, to avoid over-filling the stomach or letting it go empty.
- Stay away from NSAID pain relievers such as ibuprofen and naproxen and instead try acetaminophen. However, consult with your doctor before acetaminophen as it can cause serious complications and may interact with other medications/conditions.
- Minimize stress through stress-management techniques such as yoga, meditation, guided imagery or through personal hobbies. Stress can exacerbate the ulcer and prevent the natural healing process.
There currently aren’t any regulations for screening for ulcers. Ulcers are typically only detected after the patient reports abdominal pain/ other ulcer symptoms or shows signs of abdominal pain during a physical exam. Patients who are at a high risk for stomach ulcers or those that have previously had ulcers may want to visit the doctor more frequently to monitor for the presence of ulcers and/or H.pylori infection.
The following steps can help to prevent the development of ulcers:
- Don’t smoke. Smoking can increase your risk of developing an ulcer
- Avoid regular use of aspirin and NSAID pain-relievers, which can erode the lining of the stomach and cause ulcers.
- Avoid excessive consumption of caffeine, alcohol, and spicy/acidic foods. These substances can worsen an ulcer or make an individual more susceptible to developing an ulcer.
- Manage stress levels through exercise, personal hobbies, or techniques such as yoga, meditation, and guided therapy. Stress was long thought to be the cause of ulcers but is now understood to be more of an influence, as high levels of stress can increase susceptibility to ulcers.
- Visit your doctor regularly for checkups, especially if you have had ulcers in the past. Report any pain or potential symptoms of ulcers.
Medication And Treatment
A combination of the following medications are typically used to treat ulcers:
- H.pylori eradication therapy. Ulcers that are known to be caused by an H.pylori bacterial infection are typically first treated with a course of antibiotics (such as clarithromycin, amoxicillin, and metronidazole) to rid the stomach of the bacteria. The course of antibiotics typically lasts around 2 weeks. Courses of antibiotics may be repeated if the infection is not eradicated by the end.
- Proton pump inhibitors, which work to reduce the size of the ulcer by slowing the production of stomach acid.
- Histamine H2-receptor antagonists or H-2 blockers, which also slow the production of stomach acid by interfering with the reception of histamine, a chemical that would typically trigger the production of stomach acid.
- Bismuth is a compound that helps to slow the growth of bacteria, including the H.pylori responsible for most cases of ulcers.
In addition to medications, an ulcer treatment plan will most likely recommend the following lifestyle changes:
- Eat a low-acid diet free of caffeine an alcohol. Highly acidic foods, caffeine, and alcohol can all worsen ulcers and prevent healing.
- Manage stress levels through exercise, therapy, or mind-body techniques such as yoga, meditation, and guided imagery.
- Avoid taking aspirin and NSAID pain relievers, such as ibuprofen and naproxen.
Complementary and Alternative Treatment
Alternative treatments can be very effective in the treatment of ulcers, especially for purposes of stress management. These include:
Biofeedback therapy, in which the mind learns read and work with the signs of the body in order to reduce pain, stress, and anxiety.
Acupuncture, a form of traditional Chinese medicine in which thin needles are inserted at points around the body to restore the bodily flow of energy. Acupuncture has been proven to decrease stress and anxiety, and can also help to restore proper digestion.
Herbal therapy, either in supplement or tea form. The following are herbal therapies frequently used in the treatment of ulcers:
- Despite being spicy, small amounts of cayenne pepper can act as a local anesthetic and decrease abdominal pain. One quarter teaspoon of cayenne can be steeped in one cup of hot water to make cayenne tea.
- Deglycyrrhizinated Licorice (DGL) which has soothing effects on the stomach and can aid in the ulcer healing process.
- Aloe has a soothing effect on the stomach. It can be consumed in gel-form or in supplement form. Be sure to purchase aloe that is fit for consumption, since many aloe products are intended for use only on the skin.
Yoga is a form of mind and body exercise that has potential to decrease stress and prevent many gastrointestinal diseases. For the best effect, yoga should be practiced for at least 20 minutes a day, every day. The breathing exercises associated with yoga, known as pranayama, can be especially helpful in reducing the severity of gastrointestinal disease as they work to strengthen the diaphragm/chest muscles and also reduce stress/anxiety.
Meditation/guided imagery, which can be effective means of stress reduction and management. Meditation can be conducted independently or in a group setting. Guided imagery typically is conducted in a group setting or one on one with a therapist, though pre-recorded audio files of guided imagery are available.
If you are caring for someone with ulcers, consider the following:
- Encourage a healthy diet low in acidic foods, spicy foods, caffeine, and other foods that may aggravate the ulcer.
- Educate yourself on ulcers and the available treatment methods so that you can be an informed companion for your loved one at doctors visits and throughout the healing process
- Do your best to help them to remain calm. Some sources of stress are unavoidable, but all stress that can be avoided should be, as this will help speed up the healing process.
- Be sensitive to your loved one’s needs and wants while still following the doctor’s treatment plan.
- Encourage exercise and/or hobbies to help with stress management.
When To Contact A Doctor
Contact a doctor if you experience any of the following symptoms:
- Bloody or persistent vomiting
- Bloody or dark, tar-colored stools
- Chest pain**
- Abdominal pain
- Unexplained weight loss
- Persistent nausea
- Sudden changes in appetite
**Call emergency services, this could be a sign of a heart attack.
Questions For Your Doctor
Questions For A Doctor
You may want to ask your doctor the following questions:
- What is the cause of my ulcer?
- How serious is my ulcer?
- Where is my ulcer located?
- What treatment methods are available?
- What are the side effects?
- How long will it take me to fully heal?
- Should I make any lifestyle changes? Should they be temporary or lasting?
- What is your opinion on alternative treatment methods?
- Is my condition likely to occur in my family/children?