It is a staple character in so many Hollywood movies… the stressed manager who yells at his employees and then, grabbing his stomach and grimacing, grumbles menacingly about his ulcer.
Stress has long been associated with ulcers, but research now shows there is a deeper cause that will surprise many people. Peptic ulcers are highly correlated with stress, but the deeper root is often a tiny bacterium that lives all around—and even inside—most people on the planet.
What is a Stomach Ulcer?
Peptic ulcer disease is, in the simplest terms, a condition where sores or holes form in the lining of the stomach or the upper portion of the small intestine. Your stomach naturally produces a strong acid that aids in breaking down your food as you digest it. When you are healthy, the mucosal lining of your stomach prevents your stomach acid from eating away at the stomach itself and the surrounding tissue.
The mucosal layer can eventually wear away, though, if there is too much acid present. When this happens, the layers of your stomach or the first part of the small intestine, known as the duodenum, become irritated and inflamed as the peptic acid your stomach produces starts to do damage to your body.
Peptic ulcers are broken into two different categories based on where in the body they occur. Ulcers that occur in the lining of the stomach itself are referred to as gastric ulcers. Duodenal ulcers, on the other hand, occur in the upper section of the small intestine beginning just below the stomach.
What Causes Peptic Ulcer Disease?
There are two main causes of peptic ulcer disease. One is an infection of the stomach lining from the helicobacter pylori bacterium. The second common cause is prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs). These two causes of peptic ulcers work in different ways.
Infections and drug use are the two main causes, but there are other reasons ulcers can form. Zollinger-Ellison syndrome, for example, is a condition in which your body produces an elevated level of stomach acid on its own, which creates conditions similar to an H. pylori infection.
H. pylori infections create irritations and erosions in the lining of the stomach by causing the stomach to continue secreting acid even when there is no food present to be digested. Your stomach is designed to be an acidic environment, but if acid levels are too high for too long, the mucosal lining of your stomach will start to erode.
NSAIDs like ibuprofen, on the other hand, work in a different way. Unlike the excess acid produced by an H. pylori infection, the overuse of NSAIDs interferes with the mucus layer that protects the lining of your stomach. This can slowly destroy your stomach’s ability to maintain its protective layer, eventually leading to irritations and ulcers.
Helicobacter pylori infections are by far the largest cause of peptic ulcers, but these infections often go undiagnosed and are still not fully understood. H. pylori infections are common throughout the world, with rates in industrialized nations being the lowest. Even in countries like the United States, infection rates are considered to be between 20-30%.
What is less well understood is why only a small percentage of those individuals who have an H. pylori bacteria infection end up developing symptoms. Many people become infected during their childhood, and will not develop symptoms until much later in life, if at all.
These drugs include common over-the-counter pain meds like ibuprofen and aspirin and naproxen (Aleve). Short-term or intermittent use of these drugs will not put you in immediate danger of ulcers, but people who suffer from chronic pain or inflammation that have used these drugs on an ongoing basis over long periods of time may begin to do damage to the mucosal lining of their stomach.
Some people may be surprised to know that spicy foods do not cause ulcers. It is possible for spicy foods to make the symptoms of an ulcer more evident, but if you are eating spicy foods and feeling poorly afterward, it is not likely the food itself is the cause.
Symptoms of Stomach Ulcers
Many different gastrointestinal conditions and disorders will cause common symptoms. For some people, symptoms of peptic ulcers may be mild at first, and may not be identified for some time. Even when you are experiencing symptoms severe enough to identify a problem, it can be difficult to pinpoint exactly what is going wrong with your digestive tract. Bloating and gas can come from a variety of conditions, some of which are relatively harmless and others that are life-threatening. This is why it is important to consult your doctor to establish a clear diagnosis rather than attempting to begin treating your ulcer on your own.
Common symptoms of peptic ulcers are listed below:
- lack of appetite
- unexpected weight loss
- abdominal pain, particularly between meals
- blood in your stool
- black, tarry stool
- blood or coffee ground-like material in your vomit
If you are experiencing blood in your stool, or if you are repeatedly vomiting up blood, you should seek medical treatment immediately. Bleeding in the digestive tract is usually a sign of a serious medical condition. This is also true if you are feeling sharp, debilitating pain in your abdomen other than the grinding, gnawing pain which can occur between meals. These symptoms can accompany other, more severe medical conditions and can even be caused by life-threatening illnesses.
How are Stomach Ulcers Diagnosed?
Diagnosing your stomach ulcers can be something of a process. Since many different gastric conditions can share symptoms, your doctor will have to do some careful work to ensure they have diagnosed your illness correctly. Even if you are exhibiting symptoms such as black, tarry stool or blood in your vomit, there is still work to be done to ensure the cause of your discomfort is clearly identified.
Testing your poop, urine and blood are often involved in diagnosing peptic ulcers. It may surprise you to know that breath tests can also be used. This is particularly true if your healthcare provider suspects you may have an H. pylori infection. Measuring the amount of certain gasses emitted in your breath can give a clue as to what is going on inside you, especially when excess amounts of acid are present in your stomach.
Blood tests and stool samples are certainly a way to begin diagnosing your ulcer, but getting a look at what is going on usually means imaging of some kind. X-rays are one way to begin understanding the source of your symptoms. This can also help your doctor rule out other conditions that can have similar symptoms to a stomach ulcer. You may also have to drink a solution containing barium prior to your x-ray to help the organs of your GI tract appear more clearly.
The only sure way to see what is going on in your upper GI tract is to actually see inside you. This requires a procedure called an upper endoscopy. Even if your doctor has confirmed the presence of an H. pylori infection through a breath test or urease sample test, it is possible he or she may still recommend an upper endoscopy just to see the extent of the damage to your stomach lining.
During an upper endoscopy, you are placed under a mild anesthesia (sometimes called twilight anesthesia) while a small, flexible tube containing a camera, light and other tools is threaded down your esophagus and into your stomach. By remotely viewing the images from the camera on a monitor, your gastroenterologist can see the extent of your ulcers. It is also possible to retrieve samples of tissue during an endoscopy for later biopsy.
Treating Stomach Ulcers
Successfully treating your stomach ulcers depends on identifying their root cause. If you are suffering from a Helicobacter pylori infection, treating that infection will be the priority. If drug use or other causes are at play, the focus may shift to lifestyle changes.
In cases where you have too much acid in your stomach, either from an infection or Zollinger-Ellison syndrome, drugs are available to help calm your stomach or reduce the amount of acid your stomach produces. This can include commonly available over-the-counter antacids. Another class of drugs called proton-pump inhibitors (PPIs) may also be useful. These drugs work by interrupting the chemical pathways that the stomach uses to produce acid in the first place.
Simply managing the level of acid is not an ideal long-term strategy for dealing with ulcers, particularly when they are caused by an infection. Killing off the H. pylori bacteria that is causing your stomach acid levels to rise is the first priority. This will likely involve putting you on one or more antibiotics in addition to PPIs or antacids.
For cases such as long-term NSAID use that have broken down the lining of the stomach, a class of drugs called H2 blockers are often used to lower the amount of stomach acid. These drugs include cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid). If these drugs prove ineffective, your doctor may prescribe proton-pump inhibitors as well.
Spicy foods do not cause ulcers, but they can aggravate an already existing condition. If you have been diagnosed with stomach ulcers, you may find that modifying your diet and lifestyle is an important part of bringing relief. Such a diet will likely include healthy, vitamin-rich foods, probiotics such as yogurt and aged cheeses, and whole grains.
Reducing stress, quitting smoking and reducing or eliminating alcohol may also be important steps in letting your body heal from peptic ulcer disease. It will also be important to maintain a healthy level of exercise and be sure you are getting enough sleep.
Talking to Your Doctor About Ulcers
You don’t have to live with the pain and discomfort of ulcers. More importantly, treating the underlying cause of your ulcers and allowing your stomach to begin healing could save your life. H. pylori infections, and the ulcers associated with them, place you at a higher risk of developing stomach cancer. Even if you are not experiencing pain or discomfort from your ulcers now, it is likely your ulcers could return if you do not seek treatment for the underlying cause of your distress.
Sameer Islam. M.D. has spent his career helping people get answers about how to understand, treat and live with many different conditions, including peptic ulcers. Book an appointment today to begin getting answers about your symptoms, your condition and what can be done about it.