Ulcers were believed to be caused by stress, smoking, anxiety, and/or a diet rich in spicy foods. However, research has shown that most ulcers are caused by a spiral-shaped bacterium known as
Helicobacter pylori (H. pylori). The other common cause of ulcers is nonsteroidal anti-inflammatory drugs (NSAIDs).
When we eat, food passes down the esophagus (throat) and into the stomach. There, hydrochloric acid and pepsin (an enzyme) continue the digestive process that started with the saliva in your mouth. Next, food passes to the duodenum (small intestine) where the digestive process continues. An ulcer is an area of stomach or duodenum that has been damaged by the digestive enzymes and stomach acid.
causes ulcers is not yet fully understood. We do know that:
bacteria can live in the stomach because they attach to cells and produce an enzyme that stops the corrosive effects of stomach acid.
The bacteria damages the protective mucous layers of both the stomach and the duodenum.
Not everyone who has the
bacteria will develop an ulcer.
Being infected with the bacteria is also a risk factor for developing stomach cancer.
An ulcer that goes untreated can cause several problems in the abdomen, such as:
Internal bleedingPerforation (a hole) in the stomach or duodenum allowing food and bacteria to spill into the abdomen and cause infection and irritationBlockage of the opening between the stomach and duodenum due to chronic inflammation that leads to swelling and scarring
The story behind the discovery of the
bacteria and its relationship to ulcers is an unusual one. In 1982, two Australian researchers, Drs. Barry Marshall and Robin Warren, detected
in the stomach lining of people suffering from
. When further study demonstrated the presence of
in nearly 100% of patients with duodenal ulcers and 80% of people with stomach ulcers, Drs. Marshall and Warren proposed that
might be the cause.
When their hypothesis was met with a great deal of skepticism, Dr. Marshall ingested a teaspoonful of
bacteria. Within 24 hours, he developed severe gastritis. Further research by Dr. Marshall, Dr. Warren, and others established that
does in fact cause 50% of stomach ulcers and 90% of the much more common duodenal ulcers.
Of the ulcers that are not caused by
H. pylori, most are caused by NSAIDs (nonsteroidal anti-inflammatory drugs), such as
ibuprofen, and naproxen. NSAIDs block the production of mucous in the stomach that protects the lining from the damaging effects of the stomach acid.
The most common symptom of an ulcer is a chronic burning pain in the upper part of the abdomen. The pain is usually between the breastbone and the naval and it can last from minutes to hours. Pain often occurs in the middle of the night, upon waking, and/or 2-3 hours after a meal. It may be relieved by eating or taking antacid medicines. Less common symptoms include:
NauseaVomiting—can be bloody or appear like coffee grounds if the ulcer is bleedingLoss of appetiteLoss of weightBloody or black stool caused by bleeding from the ulcerWeakness
It is important that ulcers be properly diagnosed. The symptoms common to ulcers can also be caused by a number of other conditions. In addition, ulcers caused by
and those caused by NSAID are treated somewhat differently.
The two most commonly used tests for diagnosing an ulcer are:
—an examination of the esophagus, stomach, and duodenum using a small, flexible tube-like instrument containing a camera that is inserted through your throatUpper GI series
—x-rays of the esophagus, stomach, and duodenum are taken after you drink a chalky substance that outlines the shape of the digestive tract
A test for the presence of
is done to determine whether the ulcer is caused by
bacteria. There are several methods used to detect it including a blood test, a breath test, or a lab analysis of the biopsied tissue sample. These tests differ in sensitivity for detecting the presence of bacteria in your system.
Treatment involves removing the underlying cause of the ulcer and healing the ulcer.
One common treatment approach involves taking antibiotics to eliminate the bacteria along with an acid suppressor and sometimes a bismuth-containing medication such as Pepto-Bismol. This method is often effective in killing the bacteria, healing the ulcer, and preventing it from returning.
To prevent NSAID-caused ulcers, try to avoid using NSAIDs in large doses for long periods of time. Unfortunately, researchers do not yet know how to prevent the development of
in the digestive tract. Some recommended precautions are to: Wash hands thoroughly after using the bathroom and before eatingEat food that has been washed and cooked Drink water from a clean source
and peptic ulcers. National Digestive Diseases Information Clearinghouse website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/. Updated October 30, 2013. Accessed March 10, 2014.
Helicobacter pylori and cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/h-pylori-cancer. Updated September 5, 2013. Accessed March 10, 2014.
Helicobacter pylori infection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 7, 2014. Accessed March 10, 2014.
International Agency for Research on Cancer. Schistosomes, liver flukes and Helicobacter pylori.
Peptic ulcer disease. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed. Updated January 21, 2014. Accessed March 10, 2014.
Press release: The Nobel Prize in physiology or medicine 2005. Nobel Prize website. Available at: http://www.nobelprize.org/nobel_prizes/medicine/laureates/2005/press.html. Published October 3, 2005. Accessed March 10, 2014.
Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer.
N Engl J Med. 2001;345(11):784-789.
Last reviewed March 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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