Understanding Peptic Ulcers

What are peptic ulcers?

Peptic ulcers are open sores in the upper part of the digestive tract that can cause stomach pain or stomach upset, and can lead to internal bleeding.

Types of peptic ulcers

There are two types of peptic ulcers:  gastric ulcers form on the lining of the stomach, while duodenal ulcers form on the lining of the upper part of the small intestine. In some cases, peptic ulcers heal without treatment, but these tend to recur.

Symptoms of peptic ulcers

Although some people with peptic ulcers do not have any symptoms, the others who have peptic ulcers may experience these symptoms:

• Upper abdominal pain/discomfort (burning/hunger-like feeling)
• Feeling full quickly during meals
• Stomach pain/belching/feeling bloated after meals
• Heartburn/acid reflux
• Nausea
• Vomiting (presence of blood in severe cases)
• Blood in the stools (stool appears black/tar-like)

How do peptic ulcers form?

1. Acid erodes the lining of the digestive tract. This can happen when there is excess acid in the system, or when the mucus lining is broken down, making it more susceptible to damage.

2. Bacterial infection caused by Helicobacter pylori, a type of bacteria living in the digestive tract. It can cause an increase in the amount of acid in the stomach and small intestine, inflammation of the lining of the digestive tract, and breakdown of the protective mucus layer — all of which can contribute to peptic ulcers.

3. Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin, ibuprofen and naproxen, can cause changes in the mucous layer of the digestive tract leading to peptic ulcers

4. Other risk factors such as family history, cigarette smoking and alcohol consumption (alcohol abuse can interfere with ulcer healing)

How is it diagnosed?

Gastroscopy: A thin, flexible tube is inserted into the mouth and into the upper digestive tract. The tube has a tiny light source and camera that projects images of the digestive tract onto a monitor.  A biopsy can also be taken for further testing.

H. pylori testing: If a biopsy is done, the sample will be tested for infection. If not, a stool sample or breath test will be taken to test for infection.  Blood tests are also available, but may be less reliable.

Barium swallow: This involves drinking a thick substance containing barium while X-rays are taken; the barium allows the digestive tract to be seen more clearly. This procedure is less invasive but also less accurate than a gastroscopy.