Ulcers are sores that are slow to heal or keep returning. They can take many forms and can appear both on the inside and the outside of your body. They can be found on places of your body you can see, such as a leg ulcer found on the skin, or in places you can’t see, such as a peptic ulcer in the lining of your stomach or upper intestine. From your eye to your foot, you can get them just about anywhere on your body.
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori).
Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:
Your doctor may suspect you have an ulcer just by talking with you about your symptoms. Describing your symptoms may lead your doctor to suspect that you have a peptic ulcer, but it will not likely help determine the type, because the symptoms of stomach and duodenal ulcers are so similar. To make a specific diagnosis, your doctor may conduct several tests.
First, your doctor may ask you to take an acid-blocking medication, such as those used to treat heartburn, for a short period of time to see if symptoms improve.
If needed, your doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe or recurring symptoms of ulcers.
If not properly treated, ulcers can lead to serious health problems. There are several ways in which ulcers can be treated, including making lifestyle changes, taking medication, and/or undergoing surgery.
To treat an ulcer, first eliminate substances that can be causing the ulcers. If you smoke or drink alcohol, stop. If the ulcer is believed to be caused by the use of NSAIDs, they need to be stopped.
Ulcer medications can include:Proton pump inhibitors (PPI). Proton pump medications reduce acid levels and allow the ulcer to heal. They include dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole.
If you have H. pylori infection, then antibiotics are also used. There are multiple combinations of antibiotics that are taken for one to two weeks along with a PPI. Bismuth is also part of some treatment regimens.
Some bleeding ulcers can be treated through an endoscope.
Sometimes an operation is needed if the ulcer has created a hole in the wall of the stomach, or if there is serious bleeding that can't be controlled with an endoscope.
Medications are usually used to treat mild-to-moderate ulcers. If the cause is bacterial, antibiotics can help cure the ulcer. For recurrent, severe cases that do not respond to medication, surgery may be necessary.
Although alternative therapies have been shown to aid in the relief of symptoms, they should be used only as supplements to conventional treatment.
You should not treat an ulcer on your own without first seeing your doctor. Over-the-counter antacids and acid blockers may relieve some or all of the pain, but the relief is always short-lived. With a doctor's help, you can find relief from the ulcer pain, as well as a lifelong cure from the disease.
The chief goals of treatment are reducing the amount of acid in the stomach, strengthening the protective linings that come in direct contact with gastric acids, and, if your ulcer is caused by bacterial infection, treating the H. pylori infection with medication. Your doctor will likely prescribe triple therapy, which is a combination of antibiotics, such as amoxicillin and clarithromycin, along with a proton pump inhibitor, such as omeprazole or esomeprazole. Metronidazole can be substituted for amoxicillin in patients who are allergic to penicillin. In patients who have been repeatedly exposed to these antibiotics, or in areas where there is resistance to clarithromycin or metronidazole, quadruple therapy with bismuth, a proton-pump inhibitor, and 2 antibiotics (like metronidazole and tetracycline) is more effective. Regardless of the regimen, all medications should be taken for 10-14 days.
Surgical treatment of peptic ulcers is reserved for ulcer disease unresponsive to medical management or emergency treatment of complications, such as bleeding. If your ulcer is hemorrhaging, the surgeon will identify the source of the bleeding (usually a small artery at the base of the ulcer) and repair it. Perforated ulcers, holes in the entire stomach or duodenal wall, must be surgically closed. This is an emergent procedure.
In some cases, an elective surgery to decrease stomach acid secretion may be necessary. However, you should have an in-depth discussion with your doctor as there are many potential complications associated with the procedures, including ulcer recurrence, liver complications, and ''dumping syndrome,'' which causes chronic abdominal pain, diarrhea, vomiting, and/or sweating after eating.