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Peptic Ulcer Disease

Known as stomach ulcers or, less commonly, as duodenal ulcers—these are a sore or a break in the lining of the stomach or the lining of the first part of the small intestine (the duodenum).  Ulcers are named after the area in which they are located.  If the ulcer is in the stomach it is known as a gastric ulcer, or if the ulcer is located in the duodenum it is called a duodenal ulcer.

It is extremely difficult to say whether someone has an ulcer or not based on symptoms.  Years ago the belief was that ulcers would cause a gnawing discomfort in the pit of the stomach that would tend to be worse with an empty stomach and would temporarily be relieved with eating or drinking milk.  However, today with many people getting relatively easy access to endoscopic tests to look for ulcers, we find this is most often not true.  Indeed, we may accidentally find an ulcer when doing a test for an altogether different reason where the patient may have none of those classic symptoms.

Ulcers occur when something damages the wall of the stomach or duodenum and causes a break in its lining.  Fluids secreted in these organs, especially acid in the stomach, can cause that break to enlarge or have difficulty healing over.  

By far, the two most common causes are:

  • Long-term NSAID (Non-Steroidal Anti-Inflammatory Drug) use:  Over-the-counter NSAIDs include aspirin products, ibuprofen products, naproxen sodium products, and magnesium salicylate which is pretty much just found in an old back pain remedy still available called Doan’s Pills.  In addition, there are a large number of prescription NSAIDs, too numerous to list here.

  • Colonization of the stomach with a bacterium called H. pylori (Helicobacter pylori):   This bacterium lives in water and is literally ubiquitous in the environment.  To give an idea just how common it is, the World Health Organization (WHO) estimates that one out of every three people in North America has this bacterium in their stomach and fully half of the people in the entire world!  Having it in your stomach does not guarantee that it will cause problems, but if an ulcer is found, it is a reason to look for this, since getting rid of it will help an ulcer to heal.

A common misconception is that stress or spicy foods are the cause; however, while these do not cause the issue they may exacerbate the condition.

To find out the cause of your condition the provider may test your stool, blood or do a procedure called an upper endoscopy (EGD) to look inside your stomach and duodenum.

It is important to be treated for this condition as the symptoms will worsen if left untreated.  Treatment may be as simple as a change in the medicine you take or taking an antibiotic. Surgery may be necessary if ulcers don’t heal, but this is much less common than it was years ago.  Treatment would be trying to identify the underlying cause of your condition.