Peptic ulcer and H. pylori

A peptic ulcer is a sore in the lining of the digestive tract. Often a source of discomfort and pain, an ulcer can even cause bleeding. A peptic ulcer can form in the stomach or the upper part of the small intestine.

Causes and triggers

The stomach secretes acid that is necessary for food digestion. Since the acid is highly irritating, our bodies produce a protective mucus layer. Ulcers are more likely to form when this protective layer is compromised.

There are two common causes of peptic ulcers and they are:

• The use of anti-inflammatories (e.g., Advil, Motrin, Aleve)
  • These types of medications break down the protective mucus layer, resulting in the formation of ulcers in some. Dosage and treatment duration play a role in determining an individual's risk of developing an ulcer. The occasional use of low doses is less irritating than the regular use of high doses.
• Infection with the Helicobacter pylori (H. pylori) bacteria
  • H. pylori is present in approximately 50% of the world's population. The majority of those infected with the bacteria will never have any symptoms or related health problems. It can, however, lead to ulcers and is one of the main causes of stomach cancer.

Other factors can also contribute to peptic ulcer formation or delay healing, including:

• Age, the use of certain medications, having already had an ulcer
• Genetics
• Smoking
• Drinking alcohol
• Stress

While not all ulcers cause symptoms, the following symptoms may occur:

• Pain, discomfort or a burning sensation in the stomach
• Feeling full quickly when eating
• Heartburn or reflux
• Nausea and more rarely vomiting
• Blood in the stools (may cause stool to appear black)

Treatment

When an ulcer is diagnosed, your healthcare provider will first try to determine if it is caused by H. pylori. If it is, several medications will be needed to treat it. Treatment usually lasts two weeks and involves antibiotics. Once treatment is completed, a test will probably be repeated to confirm that the infection is gone. Eliminating H. pylori will help the ulcer to heal, prevent ulcers from coming back, and reduce the risk of complications.

If the bacteria is not responsible for the infection, a different treatment approach will be required. The goal will be to reduce stomach acid production in order to give the ulcer a chance to heal. This treatment may last several weeks and often involves a proton pump inhibitor (PPI) (e.g., Pantoloc, Losec, Dexilant). If an anti-inflammatory is used, switching to another pain reliever (e.g., acetaminophen) is usually recommended.

Individuals at risk of developing an ulcer who must take an anti-inflammatory may be advised to use medication that protects the stomach (e.g., misoprostol or a PPI) as a preventive measure.

Other methods of symptom relief include:

• Quitting smoking
• Limiting your alcohol intake
• Eating a balanced diet with plenty of fruits, vegetables, and fiber
• Taking antacids

When should I see a medical professional?

• If you have severe symptoms, especially if you are taking an anti-inflammatory.
• If your symptoms persist or recur in spite of taking over-the-counter medication.
• If you vomit blood or have blood in your stools.