What is peptic ulcer disease?
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach (gastric ulcers) or the first part of the small intestine, called the duodenum (duodenal ulcers)
What causes ulcers?
Ulcers can be caused by:
- Infection with a type of bacteria called Helicobacter pylori (H pylori). This is responsible for about 80% of stomach ulcers and about 95% of duodenal ulcers.
- Use of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen and many others. Even coated aspirin can cause ulcers.
- Very rarely, excess acid production from gastrinomas. These tumours of the acid-producing cells in the stomach - increase acid output - a phenomenon seen in Zollinger-Ellison syndrome
What are the symptoms of an ulcer?
An ulcer may or may not produce symptoms. When symptoms occur, they include:
- A gnawing or burning pain in the middle or upper stomach between meals or at night
- Nausea or vomiting
In severe cases, symptoms can include:
- Dark or black stool (due to bleeding)
- Vomiting blood (which may look like "coffee grounds")
- Weight loss
- Severe pain in the mid- to upper abdomen
How serious is an ulcer?
Although ulcers often heal on their own, you shouldn't ignore the warning signs. If not properly treated, ulcers can lead to serious health problems, including:
- Perforation (a hole in the wall of the stomach)
- Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine.
Taking NSAIDs can cause any of the above without warning. The risk is of particular concern for the elderly and for people with a prior history of peptic ulcer disease.
Who is more likely to get ulcers?
You may be more likely to develop ulcers if you:
- Are infected with the H pylori bacterium
- Take NSAIDs such as aspirin, ibuprofen naproxen
- Have a family history of ulcers
- Have another illness, such as liver, kidney or lung disease
- Drink alcohol regularly
- Are 50 or over
How are ulcers diagnosed?
Your doctor may suspect an ulcer diagnosis just by talking with you about your symptoms. To confirm the diagnosis, however, you will need to have one or more tests:
- A urea breath test - your breath is tested for carbon dioxide after drinking a special solution containing a chemical that is digested by H pylori
- A stool antigen test - to look for H pylori excreted in faeces
- A blood test to look for antibodies to H pylori
- An upper endoscopy. This involves inserting a small, illuminated tube (endoscope) through the throat and into the stomach and duodenum to look for abnormalities. A biopsy of a suspected ulcer site or other abnormal area may be taken at the same time, and the tissue sample can also be tested for H pylori.