Ulcers (Duodenal, Esophageal, Gastric, and Peptic)
Small, open craters or sores that develop in the lining of the stomach or small intestine are commonly referred to as ulcers. (Less often, ulcers form in the esophagus, especially in the lower portion that may be exposed to stomach acids.) Technically, however, those that develop in the stomach are gastric ulcers, and those that form in the section of small intestine just below the stomach are duodenal ulcers. Doctors usually add the term peptic because such ulcers develop only in the areas of the digestive system that come in contact with pepsin, an enzyme that breaks down proteins.
At one time, researchers thought that an overabundance of pepsin and other digestive juices was the cause of ulcers, but studies have since shown that most ulcer patients do not have this problem. Indeed, many have lower than normal levels of stomach acid.
Doctors theorize that hereditary factors, such as a thin or overly fragile protective mucous membrane lining the stomach and duodenum, may be involved. In addition, research has linked the presence of a bacterium called Helicobacter pylori to the incidence of ulcers. Whatever the cause, ulcers can be exacerbated by poor dietary habits, excessive stress, caffeine, smoking, and heavy drinking. They are also worsened by aspirin and other non-steroidal anti-inflammatory drugs.
Studies reveal that 1 in 10 persons will develop one or more ulcers at some point. They can occur at any age, but duodenal ulcers typically develop between ages 40 and 50, and gastric ulcers between ages 50 and 60. Many ulcers heal within a year, often without any special treatment or without even making their presence known.
Symptoms vary considerably. Some patients experience abdominal burning or a gnawing sensation, usually just under the breastbone. This type of ulcer pain typically occurs when the stomach is empty. Other sufferers complain of feeling bloated or nauseated after eating, and still others describe a feeling of persistent hunger.
Often, an acute episode of bleeding is the initial lip-off. This may manifest itself as vomiting fresh, bright red blood or material that resembles coffee grounds. The stools may be bloody, maroon, or tarry and black, also indications of intestinal bleeding. Severe bleeding can lead to shock, a medical emergency characterized by a drop in blood pressure, rapid heartbeat, and cold, clammy skin. Chronic loss of small amounts of blood can result in anemia.
The ulcer may perforate the stomach or intestinal wall, allowing the contents to spill into the abdominal cavity. The first sign of a perforation is sudden, intense, unrelenting abdominal pain. This also is a medical emergency, as it can lead to peritonitis, a life-threatening inflammation of the abdominal lining
Intestinal obstruction is still another complication of ulcers, usually the result of accumulated scar tissue that narrows the passage between the stomach and duodenum. Symptoms include distended stomach, intense pain, and vomiting of partially digested foods.
Diagnostic Studies and Procedures
Endoscopy, a procedure in which a long, thin, flexible viewing instrument is inserted into the stomach or duodenum by way of the mouth and esophagus, is the major diagnostic tool. This examination allows a doctor to view the lining of these organs, take pictures of suspicious areas, and collect samples of tissue and intestinal fluids.
An upper GI series is another diagnostic procedure. It entails taking X-rays after the patient has swallowed barium, a chalky substance that makes the intestines more visible on film.
Medical Treatments
Drug Therapy. A number of different medications are used to treat ulcers. Antacids reduce the acidity of digestive juices, alienating pain and inflammation and promoting healing. Most antacids are available without prescription; common ingredients include aluminum hydroxide, calcium carbonate, magnesium hydroxide, and sodium bicarbonate. Histamine (H2) blockers work by hindering the action of chemicals that can trigger inflammation and pain. Examples include cimetidine (Tagamet) and ranitidine (Zantac). Antibiotics clear up infection from harmful bacteria, especially H. pylori, sometimes found in the lining of the f stomach or intestine. Antacids or other anti-ulcer drugs may be prescribed along with the antibiotics. Coating agents form a barrier over the ulcer to protect it from acid and allow it to heal; sucralfate (Carafate) is a coating agent. Certain antacids containing aluminum also perform this function. Prostaglandin agents such as misoprostol (Cytotec) protect the lining of the stomach from the side effects of aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs.
Surgery. Most ulcers do not require surgery unless there are serious complications, such as obstruction, perforation, or hemorrhaging. The extent of the operation depends upon the complication. For a bleeding ulcer, perhaps only the blood vessel needs to be tied, although the ulcer may be taken out at the same time. In other cases, part of the stomach may be removed.
Alternative Therapies
Biofeedback Training. Biofeedback, in which machines are used to identify specific body responses and to learn ways to control or change them, may be useful in treating stress-related ulcers.
Herbal Medicine. Numerous herbs, including cayenne, catnip, chamomile, licorice, sage, and slippery elm, are said to alleviate ulcer symptoms. These herbs may be taken either as leas or in capsule form.
Meditation and Hypnosis. Although stress itself probably does not cause ulcers, it certainly aggravates them. Thus, many doctors who specialize in treating ulcers recommend meditation, yoga, self-hypnosis, deep breathing, and other relaxation techniques.
Naturopathy and Nutrition Therapy. In the past, diets for ulcer patients relied heavily on milk, rice, mashed potatoes, and other bland foods.
Naturopaths now believe that milk has a rebound effect; while it neutralizes stomach acid, the calcium and protein contains stimulate the production of more acid. Many now recommend drinking the juice of raw cabbage to dilute stomach acids. Small, frequent meals are advocated and, when symptoms are severe, soft foods, with a switch to baby foods if bleeding occurs. To prevent constipation, fiber such as psyllium seed or guar gum may be added to the regimen.
Iron supplements may be prescribed to overcome anemia caused by chronic or severe bleeding. Zinc is said to promote ulcer healing, and vitamin A emulsion or capsules are believed to protect the mucous membranes of the stomach and intestines.
Self-Treatment
Learn to slow down and be patient; ulcers often take a year or more to heal. In the meantime, strive for a healthy lifestyle that stresses regular exercise, a balanced diet, ample sleep, and time to relax and enjoy life.
Avoid aspirin and other non-steroidal anti-inflammatory drugs unless you need them for arthritis or another medical problem. In such cases, ask your doctor about taking either an alternative medication or the drug in a coated (enteric) form that passes through the stomach without being broken down. If this is not feasible, investigate taking a protective medication, such as an antacid or coating agent.
If you smoke, make every effort to stop -- there is a definite association between smoking and ulcers. Also, do not drink coffee, even decaffeinated types; coffee in all forms stimulates acid production. Abstain from alcohol as well; it irritates the intestinal lining and prevents healing. Spicy foods probably do not exacerbate ulcers, but you should avoid any that seem to provoke symptoms.
Some patients who undergo ulcer surgery develop a condition called dumping syndrome, which is marked by abdominal distress, lightheadedness, sweating, diarrhea, and sometimes vomiting an hour or so after eating. The symptoms are caused by an overly rapid emptying of the stomach contents into the duodenum. To avoid this problem, eat small, frequent meals, limit your intake of sweets, and avoid drinking fluids at mealtime.
Other Causes of Ulcer Symptoms
Stomach or intestinal pain may signify diverticular disease, gallstones, irritable bowel syndrome, inflammatory bowel disease, or even stomach cancer.