Stomach Ulcer

Stomach ulcers are also known as “Peptic Ulcer Disease” or PUD for short.  Although we use the term “stomach ulcer”, some ulcers are actually in the first part of the small bowel, but are treated the same as the stomach ulcers, because they are due to the same disease process.

PUD can be a common cause of abdominal pain and can be confused for many different issues such as chest pain, esophageal reflux, gallbladder disease and pancreatitis.  It can be difficult at times to distinguish a stomach ulcer from one of these other problems.

Fortunately, over the last 2 decades, stomach ulcer treatments have radically changed for the better.  Stomach ulcers commonly required an operation prior to the advent of a medication called a “Proton Pump Inhibitor” or “PPI” for short.  PPIs block the acid production of certain cells in the stomach.  This can greatly reduct the chance of ulcer formation, and reduce the complications from ulcers such as bleeding, obstruction and perforation of the stomach.  Not all ulcers are due to high acid, but the PPIs help reduct and prevent many stomach ulcers.

Some ulcers can present as mild burning pain just below the breast bone.  The pain can last hours and usually is several hours after eating (when the stomach is empty), but can be at any time during the day or night.  Ulcers can present mild, moderate or severe pain.

Some ulcers are due to a specific bacteria which breaks down the stomach lining.  This bacteria is called “Helicobacter Pylori” or “H.Pylori” for short.  (As you can see, doctors like using short names!)  If you have H. Pylori, the bacteria needs to be eradicated with antibiotics or it’s likely the ulcer will come back in the near future.

Most ulcers can be diagnosed with a simple history of the problem.  If it seems likely you have a stomach ulcer, your doctor may prescribe you a PPI.  A blood test can be taken to test for H.Pylori.  If the blood test is positive, it should be treated with an antibiotic in addition to the PPI.  Sometimes an upper endoscopy is required to confirm the diagnosis of PUD.

If left untreated, ulcers can go on to cause bleeding, obstruction or perforation.  There is a specific blood vessel in the first part of the small bowel (duodenum), that is often eroded into by the ulcer.  If this happens, life threatening bleeding can ensue.  Thus making it important not to disregard any abdominal pain in this area.   Ulcers can also inflame the tissue in the last portion of the stomach or small bowel so much so that it acts to completely obstruct the food passage.  Usually nausea and vomiting is associated with this type of a problem.  Finally, ulcers can erode through the wall of the stomach or duodenum and cause a perforation.  This can be life threatening as well if not treated promptly as infection of the abdominal cavity can lead to sepsis and death.

On a lighter note, PUD can be easily treated with PPIs and antibiotics most of the time, and only is life threatening if not tended to in a reasonable timeframe.  So, if you ever have upper abdominal pain that isn’t going away, you should definitely see a doctor so you can avoid the complications of PUD.

I hope this helped clear up some questions you may have had about stomach ulcers.

-Dr. Buck