Peptic Ulcer Disease (PUD)

A peptic ulcer is a sore in the lining of the stomach or first part of the small intestine called the duodenum. When an individual has chronic peptic ulcers, it is known as peptic ulcer disease (PUD). A healthy digestive tract is coated with a layer of mucus that protects against acid deterioration. If the mucus decreases or the acid increases, an ulcer can result. Some ulcers may be associated with infection from a bacterium called Helicobacter Pylori (H. pylori).

H. pylori can live in the mucus layer and often causes no problems, but sometimes the bacterium can cause inflammation in the stomach lining and slowly produce an ulcer. H. pylori can be transmitted through food, water, and close human contact.

Another cause of PUD is long-term use of anti-inflammatory medicines like aspirin and ibuprofen. And contrary to popular belief, while stress and spicy foods can aggravate ulcers, they do not cause them. If untreated, peptic ulcers may get worse and cause more serious problems.

Symptoms of PUD

Burning stomach pain is the most common symptom of peptic ulcers and may come and go for a few days or weeks. Pain is more bothersome when the stomach is empty and usually recedes after the patient eats. The burning sensation may become worse at night and is almost always worse on an empty stomach. Sometimes, peptic ulcer disease has more severe symptoms.

  • Nausea
  • Vomiting of blood—Blood may appear red or black
  • Unexplained weight loss
  • Loss of appetite
  • Dark blood in the stools or tar-like stools

Risk Factors for PUD

  • Alcohol—Alcohol can wear away the mucus lining of the stomach and gut, and it also increases the amount of stomach acid that is produced.
  • Smoking—Smoking can increase the risk of peptic ulcers for those who are infected with H. pylori.
  • Long-term use of pain relievers and/or nonsteroidal anti-inflammatory drugs (NSAIDs).

Tests to Diagnose PUD

  • H. pylori test--Doctors can test for the presence of H. pylori in the system by a blood sample, stool sample or a breath test. It can also be diagnosed by obtaining a sample of tissue during endoscopy.
  • Endoscopy—an endoscopy is a test that uses a hollow tube with a lens attached. The scope can view the throat, stomach and small intestine and detect an ulcer.
  • Biopsy—if an ulcer is found, a small tissue sample will be removed and examined
  • X-ray—Swallowing barium (a white liquid) before the x-ray helps doctors see details of the esophagus, stomach, and small intestine as well as view the ulcer

Treatments for PUD

Depending on the cause of the peptic ulcer, treatments will vary.

  • Antibiotics—antibiotics can kill the bacterium H. pylori in the digestive system. A two-week treatment should be sufficient, and then antacid medication may be prescribed to control stomach acid.
  • Proton pump inhibitors—these medications reduce stomach acid by blocking the action of cells that produce acid. Examples of brand-name proton pump inhibitors are Prilosec, Prevacid, Aciphex, Nexium and Protonix.
  • H2 blockers—these medications reduce stomach acid, reduce pain and bring healing. Brand-name products are Zantac, Pepcid, Tagamet, and Axid.
  • Antacids—these medications neutralize stomach acid. Side effects can include constipation or diarrhea. Antacids relieve symptoms but do not always produce healing.

If medication does not heal a peptic ulcer, this may be an indication of another issue.

  • An infection other than H. pylori
  • Zollinger-Ellison syndrome—extreme overproduction of gastric acid
  • Stomach cancer
  • Crohn’s disease

Lifestyle Changes to Treat PUD

Along with medication, these lifestyle changes may be helpful in assisting to control the pain of peptic ulcer disease.

  • Wise diet choices—eating plenty of fresh fruits, vegetables and whole grains may promote healing. Processed foods, fried foods and junk food will make it harder to heal.
  • Change your pain reliever—because PUD can be aggravated by using certain pain relievers, talk to your doctor about a different option.
  • Stop smoking—Smoking can affect the mucus lining of the stomach and produce more stomach acid.
  • Avoid alcohol—Alcohol can wear away the mucus layer of the stomach and intestine.
  • Manage stress—Use exercise, mediation, relaxation techniques and recreation to reduce stress and reduce stomach acid production.