ulcers | Consult-Afya Telehealth

A peptic ulcer is an open sore or raw area in the lining of the stomach or intestine. The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori).

There are two types of peptic ulcers:

Gastric ulcer — occurs in the stomach

Duodenal ulcer — occurs in the first part of the small intestine

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. But if the lining breaks down, the result may be:

Swollen and inflamed tissue (gastritis)

Most ulcers occur in the first layer of the inner lining. A hole in the stomach or duodenum is called a perforation. This is a medical emergency.

The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following factors raise your risk for peptic ulcers:

Drinking too much alcohol

Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)

Smoking cigarettes or chewing tobacco

Being very ill, such as being on a breathing machine

Radiation treatments

Stress

A rare condition, called Zollinger-Ellison syndrome, causes stomach and duodenal ulcers.

Symptoms of Ulcers

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain (often in the upper mid-abdomen) is a common symptom. The pain can differ from person to person. Some people have no pain.

Pain occurs:

In the upper abdomen.

At night and wakes you up

When you feel an empty stomach, often 1 to 3 hours after a meal

Other symptoms include:

Feeling of fullness and problems drinking as much fluid as usual

Nausea

Vomiting

Bloody or dark, tarry stools

Chest pain

Fatigue

Vomiting, possibly bloody

Weight loss

Ongoing heartburn

Exams and Tests

To detect an ulcer, you may need a test called an upper endoscopy (EGD).

This is a test to check the lining of the esophagus (food pipe), stomach, and first part of the small intestine.

It is done with a small camera (flexible endoscope) that is inserted down the throat.

This test most often requires sedation given through a vein.

In some cases, a smaller endoscope may be used that is passed into the stomach through the nose. This does not require sedation.

EGD is done on most people when peptic ulcers are suspected or when you have:

Low blood count (anemia)

Trouble swallowing

Bloody vomit

Bloody or dark and tarry-looking stools

Lost weight without trying

Other findings that raise a concern for cancer in the stomach

Testing for H pylori is also needed. This may be done by biopsy of the stomach during endoscopy, with a stool test, or by a urea breath test.

Other tests you may have include:

Hemoglobin blood test to check for anemia

Stool occult blood test to test for blood in your stool

Sometimes, you may need a test called an upper GI series. A series of x-rays are taken after you drink a thick substance called barium. This does not require sedation.

Treatment of Peptic Ulcer Disease

Your health care provider will recommend medicines to heal your ulcer and prevent a relapse.

The medicines will:

Kill the H pylori bacteria, if present.

Reduce acid levels in the stomach. These include H2 blockers such as ranitidine (Zantac), or a proton pump inhibitor (PPI) such as omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole (AcipHex) or pantoprazole (Protonix).

Take all of your medicines as you have been told. Other changes in your lifestyle can also help.

If you have a peptic ulcer with an H pylori infection,

he standard treatment uses different combinations of the following medicines for 7 to 14 days:

Two different antibiotics to kill H pylori.

PPIs such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium).

Bismuth subsalicylate (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria.

You will likely need to take a PPI for 8 weeks if:

You have an ulcer without an H pylori infection.

Your ulcer is caused by taking aspirin or NSAIDs.

Your provider may also prescribe this type of medicine regularly if you continue taking aspirin or NSAIDs for other health conditions.

Other medicines used for ulcers are:

Misoprostol, a medicine that may help prevent ulcers in people who take NSAIDs on a regular basis

Medicines that protect the tissue lining, such as sucralfate

Prognosis

Peptic ulcers tend to come back if untreated. There is a good chance that the H pylori infection will be cured if you take your medicines and follow your provider’s advice. You will be much less likely to get another ulcer.

Possible Complication Of Ulcers

Complications may include:

Severe blood loss

Scarring from an ulcer may make it harder for the stomach to empty

Perforation or hole of the stomach and intestines

When to See a Doctor

Get medical help right away if you:

Develop sudden, sharp abdominal pain

Have a rigid, hard abdomen that is tender to touch

Have symptoms of shock, such as fainting, excessive sweating, or confusion

Vomit blood or have blood in your stool (especially if it is maroon or dark, tarry black)

You feel dizzy or lightheaded.

You have ulcer symptoms.

Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your provider first.

The following lifestyle changes may help prevent peptic ulcers:

DO NOT smoke or chew tobacco.

Avoid alcohol.

This is a microbiological test to diagnose presence of Helicobacter pylori (H. pylori), a type of bacteria that infects the stomach and doudenum. Can be tested using stool, blood, urea breath test and bacterial culture. Many people with H. pylori will never have symptoms of infection. But for others, the bacteria can cause a variety of digestive disorders.

These include gastritis (inflammation of the stomach), peptic ulcers (sores in the stomach, small intestine, or esophagus), and certain types of stomach cancer.

There are different ways to test for an H. pylori infection. They include blood, stool, and breath tests. If you are having digestive symptoms, testing and treatment may help prevent serious complications.

Other names: H. pylori stool antigen, H. pylori breath tests, urea breath test, rapid urease test (RUT) for H. pylori, H. pylori culture

What the H. pylori test used for?

H. pylori tests are most often used to:
Look for H. pylori bacteria in the digestive tract

Find out if your digestive symptoms are caused by an H. pylori infection

Find out if treatment for an H. pylori infection has worked

Why do I need an H. pylori test?

You may need testing if you have symptoms of a digestive disorder. Since gastritis and ulcers both inflame the lining of the stomach, they share many of the same symptoms. They include:
Abdominal pain
Bloating
Nausea and vomiting
Diarrhea
Loss of appetite
Weight loss

An ulcer is a more serious condition than gastritis, and symptoms are often more severe. Treating gastritis in early stages may help prevent the development of an ulcer or other complications.

What happens during H. pylori testing?

There are different ways to test for H. pylori. Your health care provider may order one or more of the following types of tests.

Blood test

Checks for antibodies (infection-fighting cells) to H. pylori
Test procedure:
A health care professional will take a blood sample from a vein in your arm, using a small needle.
After the needle is inserted, a small amount of blood will be collected into a test tube or vial.

Urea Breath test,

Checks for infection by measuring certain substances in your breath
Test procedure:
You will provide a sample of your breath by breathing into a collection bag.

After that, you will swallow a pill or liquid containing a harmless radioactive material.

You will provide another sample of your breath.

Your provider will compare the two samples. If the second sample has higher than normal carbon dioxide levels, it is a sign of an H. pylori infection.

Stool tests.

Your provider may order a stool antigen or a stool culture test.
A stool antigen test looks for antigens to H. pylori in your stool.

Antigens are substances that trigger an immune response.
A stool culture test looks for H. pylori bacteria in the stool.

Samples for both types of stool tests are collected in the same way. Sample collection usually includes the following steps:
Put on a pair of rubber or latex gloves.

Collect and store the stool in a special container given to you by your health care provider or a lab.

If collecting a sample from a baby, line the baby’s diaper with plastic wrap.

Make sure no urine, toilet water, or toilet paper mixes in with the sample.

Seal and label the container.
Remove the gloves, and wash your hands.

Return the container to your health care provider.

Endoscopy.

If other tests did not provide enough information for a diagnosis, your provider may order a procedure called an endoscopy.

An endoscopy allows your provider to look at your esophagus (the tube that links your mouth and stomach), the lining of your stomach, and part of your small intestine.

During the procedure:
You will lie down on an operating table on your back or side.

You will be given medicine to help you relax and prevent you from feeling pain during the procedure.

Your provider will insert a thin tube, called an endoscope, into your mouth and throat. The endoscope has a light and camera on it. This allows the provider to get a good view of your internal organs.

Your provider may take a biopsy (removal of a small sample of tissue) to examine after the procedure.

After the procedure, you will be observed for an hour or two while the medicine wears off.

You may be drowsy for a while, so plan to have someone drive you home.

Will I need to do anything to prepare for testing?
You don’t need any special preparation for an H. pylori blood test.

For breath, stool, and endoscopy tests, you may need to stop taking certain medicines for as long as two weeks to a month before testing. Be sure to talk with your health care provider about all medicines you are currently taking.

For an endoscopy, you may need to fast (not eat or drink) for about 12 hours before the procedure.

Are there any risks to testing?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There is no known risk to having breath or stool tests.

During an endoscopy, you may feel some discomfort when the endoscope is inserted, but serious complications are rare. There is a very small risk of getting a tear in your intestine.

If you had a biopsy, there is a small risk of bleeding at the site. Bleeding usually stops without treatment.

What do the results mean?

If your results were negative, it means you probably don’t have an H. pylori infection. Your provider may order more tests to find out the cause of your symptoms.

If your results were positive, it means you have an H. pylori infection. H. pylori infections are treatable. Your health care provider will probably prescribe a combination of antibiotics and other medicines to treat the infection and relieve pain.

The medicine plan can be complicated, but it’s important to take all the medicines as prescribed, even if your symptoms go away.

If any H. pylori bacteria remain in your system, your condition can worsen. Gastritis caused by H. pylori can lead to a peptic ulcer and sometimes stomach cancer.

Is there anything else I need to know about H. pylori testing?
After you’ve been treated with antibiotics, your health care provider may order repeat tests to make sure all the H. pylori bacteria is gone.

Tag ulcers

Peptic Ulcers