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peptic ulcer disease

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Ulcer in the duodenum (small intestine)

Stomach ulcer

Alternative Names
PUD, gastric ulcer, stomach ulcer, duodenal ulcer

Peptic ulcer disease occurs when the lining of the oesophagus, stomach, or duodenum is worn away by stomach acid and other factors.

What is going on in the body?
Peptic ulcer disease most commonly occurs in the upper part of the small intestine, called the duodenum. It also occurs in the stomach. Ulcers less commonly occur in the oesophagus. The oesophagus is the food tube that connects the mouth to the stomach. Peptic ulcer disease can be caused by different factors in different people.

What are the signs and symptoms of the condition?
This condition may cause no symptoms at all in some people. Common symptoms include:
  • stomach pain, also known as epigastric pain
  • burning or gnawing pain in the stomach, the chest, or the back
  • blood in the stool
  • black, tar-like, or maroon-coloured stool, which indicates bleeding from the ulcer
  • nausea
  • vomiting
What are the causes and risks of the condition?
Stomach acid is thought to play a role in causing peptic ulcer disease. A bacterial infection known as H. pylori may also be important in causing a person's ulcer. Ulcers may also be caused by the use of certain analgesics. Each of these factors breaks down the natural protective lining of the digestive tract. Inherited factors are also thought to play a role in ulcer formation.

Untreated peptic ulcer disease may cause a hole in the digestive tract, bleeding, inflammation, or abnormal connections between abdominal organs.

What can be done to prevent the condition?
Prevention of peptic ulcer disease includes:
  • avoiding or limiting use of aspirin and a group of medications called non-steroidal anti-inflammatory drugs or NSAIDs
  • taking enteric-coated aspirin with meals, if aspirin is needed daily
  • avoiding alcohol and tobacco
Certain conditions cause a high risk of developing peptic ulcer disease. People with these conditions may be given medication to prevent ulcers. For example, burn victims are commonly given medication to prevent ulcers.

How is the condition diagnosed?
The history and physical examination may be enough to diagnose an ulcer. X-ray tests or endoscopy can confirm the diagnosis. Endoscopy is a procedure that involves putting a thin telescope into the mouth. This telescope can be moved down into the stomach and bowels. This procedure allows the doctor to directly see any ulcers that are present. The doctor may take samples of the stomach contents to test for H. pylori infection.

What are the long-term effects of the condition?
Most people will be cured with proper medical treatment. However, if ulcers are severe or complications occur before treatment, surgery may be needed. Surgery may be the only solution for people with severe ulcers.

What are the risks to others?
There are no risks to others.

What are the treatments for the condition?
Treatment of peptic ulcer disease depends on the cause. If aspirin or other medications are the cause, then these medications must be stopped. Smoking and alcohol should be stopped as well, because they can delay healing. Medications are given to help protect the lining and allow faster healing. Most of these medications work by neutralising stomach acid or preventing it from being made. If an infection with a bacteria called H. pylori is present, antibiotics are given. Surgery may be needed for severe ulcers that bleed, don't respond to medication, or cause a hole in the gut. With the newer medication surgery is being preformed less and less.

What are the side effects of the treatments?
All medications have side effects, such as allergic reactions and stomach upset. Other side effects depend on the medications used.

The risks of surgery include bleeding, infection, and even death in rare cases. The results of untreated peptic ulcer disease are often more serious, however. If not treated, ulcers may become larger or begin to bleed. This can lead to very serious problems, including death.

What happens after treatment for the condition?
With proper diagnosis and treatment, peptic ulcer disease can often be cured. A cure means that there is complete healing of the ulcer.

How is the condition monitored?
A follow-up X-ray test or endoscopy can confirm that an ulcer is healed. Endoscopy can also make sure stomach cancer is not present, which sometimes causes an ulcer. A breath test can confirm the cure of a bacterial infection.

If symptoms return, a doctor should be contacted.

Author: David J. Craner, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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