Peptic ulcers, open sores in the lining of the stomach, esophagus, or duodenum (the first part of the intestine), are common. Contrary to popular belief, ulcers are not caused by spicy food or stress. Instead, a type of bacteria called Helicobacter pylori is usually to blame. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can also cause ulcers.
Signs and Symptoms
Symptoms may include:
If you experience any of the following symptoms, you should call your doctor immediately:
The lining of the stomach is usually protected from the damaging effects of stomach acid. When that protection fails, an ulcer forms. There are a few different ways this happens.
Cigarette smoking also plays a role in the development of ulcers, but other factors, such as alcohol, stress, and spicy foods have not been proven to promote formation of ulcers. Other causes of ulcers are conditions that can result in direct damage to the wall of the stomach or duodenum, such as heavy use of alcohol, radiation therapy, burns, and physical injury. Preliminary research also suggests a link between the use of medicines called selective serotonin reuptake inhibitors (SSRIs) and peptic ulcers.
Risk factors may include:
First, your doctor will take a detailed history of your symptoms and risk factors, including how long you have had indigestion and pain, how strong the pain is, if you have lost weight recently, what medications (over-the-counter and prescription) you have been taking, your smoking and drinking habits, and if anyone in your family has had ulcers.
As part of the physical exam, your doctor will do a thorough check of your abdomen and chest, as well as a rectal exam, to look for signs of bleeding. A blood test will check to see if you are anemic. These tests help ensure you have not been bleeding unknowingly (called occult bleeding).
If there are no signs of bleeding and your symptoms are mild, your doctor may put you on medication to reduce stomach acid. If your symptoms persist or get worse despite the medication, further testing is needed.
You will have 1 of 2 tests to identify an ulcer:
Your doctor may perform other tests to look for H. pylori, including a blood test checking for antibodies to this organism, a breath test after drinking a substance called urea, and a stool test looking for the bacteria. The breath test, which is the least invasive, is at least 95% accurate.
Preventing NSAID-related ulcers means finding different medications or alternative approaches to relieve your pain. Talk to your doctor about your options. If you have to take NSAIDs for a long time, your doctor may consider prescribing another medication to prevent the development of ulcers. This medicine may include an H2 blocker or a proton pump inhibitor, which reduce stomach acid.
You can also make lifestyle changes that make you less prone to develop an ulcer from either NSAIDs or H. pylori.
The main goals for treating a peptic ulcer include getting rid of the underlying cause (particularly H. pylori infection, use of NSAIDs, and reducing stress levels), preventing further damage and complications, and reducing the risk of recurrence. Medication is almost always needed to alleviate symptoms and must be used to eradicate H. pylori. Surgery is required for certain serious or life-threatening complications of peptic ulcers and may be considered if medications are not working. Even with medications, many lifestyle factors, including making changes in your diet, are important. Certain herbs, acupuncture, or homeopathy may be helpful additions to usual medical care.
Doctors used to recommend eating bland foods with milk and only small amounts of food with each meal. Now we know that such a diet is not needed to treat ulcers. Dietary and other lifestyle measures that should help include:
If you have H. pylori, you will probably be prescribed three medications. "Triple therapy," including a proton pump inhibitor to reduce acid production and two antibiotics, is commonly used to treat H. pylori-related gastritis and ulcers. Bismuth salicylate (Pepto-Bismol) may be used instead of the second antibiotic. This drug, available over-the-counter, coats and soothes the stomach, protecting it from the damaging effects of acid. Two drug regimens are currently being developed.
Some of the same drugs are used for non-H. pylori gastritis, as well as for symptoms (like indigestion) due to ulcers:
Antacids. Available over-the-counter, they may relieve heartburn or indigestion but will not treat an ulcer. Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. Doctors recommend taking antacids at least 1 hour before, or 2 hours after, taking medications. Ask your pharmacist or doctor for more information. Antacids include:
H2 blockers. Reduce gastric acid secretion. They include:
Proton-pump inhibitors. Decrease gastric acid production. They include:
Surgery and Other Procedures
If bleeding from an ulcer does not stop with medication and supportive care (like fluids and blood transfusion), a physician called a gastroenterologist will perform an endoscopy. He first identifies the ulcer and the area that is bleeding, then injects medications to stop the bleeding and stimulate the formation of a blood clot. If the bleeding recurs or you have a perforated ulcer or an obstruction, surgery may be required. About 30% of people who come to the hospital with a bleeding ulcer need endoscopy or surgery.
Nutrition and Dietary Supplements
Following these nutritional tips may help reduce symptoms:
These supplements may also help:
Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting and during treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of ulcers or its symptoms, based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually. For the treatment of ulcers, even if you seek homeopathic remedies as adjunctive care, you should still follow conventional treatment recommendations.
Acupuncture has been used traditionally for a variety of conditions related to the digestive tract, including peptic ulcers. A growing body of scientific evidence suggests that acupuncture can help reduce pain associated with endoscopy.
Chiropractors report, and preliminary evidence suggests, that spinal manipulation may benefit some people with uncomplicated gastric or duodenal ulcers. In one small clinical study, researchers compared the effectiveness of medication to spinal manipulation over a period of up to 22 days. Those who received spinal manipulation had significant pain relief after an average of 4 days, and were completely free of symptoms on average 10 days earlier, than those who took medication. More research is needed to understand when and how chiropractic care might be helpful if you have peptic ulcer disease.
If you are pregnant or breastfeeding, talk to your doctor before taking any medication, including herbs.
Prognosis and Complications
With proper treatment, most ulcers heal within 6 to 8 weeks. However, they may recur, particularly if H. pylori is not treated sufficiently.
Complications from ulcers include bleeding, perforation (rupture) of either the stomach or the intestine, and bowel obstruction. These problems can be very serious, even life threatening. Bleeding occurs in up to 15% of people with peptic ulcers. Obstruction tends to happen where the stomach meets the small intestines. If there is an ulcer at this point, swelling can occur, blocking food from passing through the digestive tract. Vomiting is generally the main symptom.
H. pylori ulcers increase the risk of stomach cancer.
The good news is that the number of ulcers and their complications continue to decline as people seek early treatment for symptoms and the causes, like H. pylori and NSAIDs.
Ayala G, Escobedo-Hinojosa WI, de la Cruz-Herrera CF, Romero I. Exploring alternative treatments for Helicobacter pylori infection. World J Gastroenterol. 2014;20(6):1450-69.
Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol. 2000;95(12):3374-82.
Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. 2000 Dec;29(4):295-301.
Burger O, Weiss E, Sharon N, Tabak M, Neeman I, Ofek I. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Crit Rev Food Sci Nutr. 2002;42(3 Suppl):279-84.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Charpignon C, Lesgourgues B, Pariente A, et al. Peptic ulcer disease: one in five is related to neither Helicobacter pylori nor aspirin/NSAID intake. Ailment Pharmacol Ther. 2013;38(8):946-54.
De R, Kundu P, Swarnakar S, Ramamurthy T, Chowdhury A, Nair GB, Mukhopadhyay AK. Antimicrobial activity of curcumin against Helicobacter pylori isolates from India and during infections in mice. Antimicrob Agents Chemother. 2009 Apr;53(4):1592-7.
El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-esophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54(1):11-7.
Ferri. Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier Mosby; 2016.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4):439-44.
Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4):439-44.
Gorbach SL. Probiotics in the third millennium. Dig Liver Dis. 2002;34(Suppl 2):S2-S7.
Halland M, Young M, Fitzgerald MN, INder K, Duggan JM, Duggan A. Bleeding peptic ulcer: characteristics and outcomes in Newcastle, NSW. Intern Med J. 2011;41(8):605-9.
Han KS. The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea. J Holist Nurs. 2002;20(1):61-80.
Huang KW, Luo JC, Leu HB, et al. Chronic obstructive pulmonary disease: an independent risk factor for peptic ulcer bleeding: a nationwide population-based study. Aliment Pharmacol Ther. 2012;35(7):796-802.
Kang JM, Kim N, Lee BH, et al. Risk factors for peptic ulcer bleeding in terms of Helicobacter pylori, NSAIDs, and antiplatelet agents. Scan J Gastroenterol. 2011;46(11):1295-301.
Khayyal MT , el-Ghazaly MA, Kenawy SA, et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51(7):545-53.
Kim JJ, Kim N, Lee BH, et al. Risk factors for development and recurrence of peptic ulcer disease. Korean J Gastroenterol. 2010;56(4):220-8.
Klausz G, Tiszai A, Lenart Z, et al., Helicobacter pylori-induced immunological responses in patients with duodenal ulcer and in patients with cardiomyopathies. Acta Microbiol Immunol Hung. 2004;51(3):311-20.
Kliegman. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Kumar. Robbins and Cotran Pathologic Basis of Disease, Professional Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2009.
Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009 Mar;104(3):728-38.
Lee SY, Shin YW, Hahm KB. Phytoceuticals: mighty but ignored weapons against Helicobacter pylori infection. J Dig Dis. 2008 Aug;9(3):129-39. Review.
Lowe R, Wolfe M. Bope & Kellerman: Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
Marteau P, Boutron-Ruault MC. Nutritional advantages of probiotics and prebiotics. Br J Nutr. 2002;87(Suppl 2)):S153-S157.
Marteau PR. Probiotics in clinical conditions. Clin Rev Allergy Immunol. 2002;22(3):255-73.
Martin B. Prevention of gastrointestinal complications in the critically ill patient. AACN Adv Crit Care. 2007;18(2):158-66.
McManus TJ. Helicobacter pylori: an emerging infectious disease. Nurs Pract. 2000;25(8):42-46.
Mota KS, Dias GE, Pinto ME, Luiz-Ferreira A, Souza-Brito AR, Hiruma-Lima CA, et al. Flavonoids with gastroprotective activity. Molecules. 2009 Mar 3;14(3):979-1012. Review.
Olafsson S, Berstad A. Changes in food tolerance and lifestyle after eradication of Helicobacter pylori. Scand J Gastroenterol. 2003;38(3):268-76.
Pasina L, Nobili A, Tettamanti M. Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J intern Med. 2011;22(2):205-10.
Qasim A, O'Morain CA. Review article: treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther. 2002;16(Suppl 1):24-30.
Ryan SW. Management of dyspepsia and peptic ulcer disease. Altern Ther Health Med. 2005;11(5):26-9; quiz 30.
Shiao TH, Liu CJ, Luo JC, et al. Sleep apnea and risk of peptic ulcer bleeding: a nationwide population-based study. Am J Med. 2013;126(3):249-55.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Solmaz A, Sener G, Cetinel S, Yüksel M, Yegen C, Yegen BC. Protective and therapeutic effects of resveratrol on acetic acid-induced gastric ulcer. Free Radic Res. 2009 Jun;43(6):594-603.
Sugimoto N, Yoshida N, Nakamura Y, Ichikawa H, Naito Y, Okanoue T, Yoshikawa T. Influence of vitamin E on gastric mucosal injury induced by Helicobacter pylori infection. Biofactors. 2006;28(1):9-19.
Townsend. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012.
Vonkeman HE, Fernandes RW, van de Laar MA. Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers. Int J Clin Pharmacol Ther. 2007;45(5):281-8.
Woodward M, Tunstall-Pedo H, McColl K. Helicobacter pylori infection reduces systemic availability of dietary vitamin C. Eur J Gastroenterol Hepatol. 2001;13(3):233-7.
Zaidi SF, Yamada K, Kadowaki M, Usmanghani K, Sugiyama T. Bactericidal activity of medicinal plants, employed for the treatment of gastrointestinal ailments, against Helicobacter pylori. J Ethnopharmacol. 2009 Jan 21;121(2):286-91.
Review Date: 10/19/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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