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Peptic Ulcers

Peptic ulcers occur when the lining of the digestive tract becomes corroded by the acidic contents of the stomach.  These ulcers occur in three parts of the digestive system: the esophagus, the stomach and the duodenum.  Ulcers affect millions of people worldwide--some of who may never even know it.  Fortunately, there are several types of treatment, including medications, which can help patients deal with this condition.  And, if caught and treated before serious complication occur, ulcers rarely require surgery.

Ulcers are formed when potent stomach acid burns a hole into the lining of the digestive tract.  In addition to the major role of acid as a cause of ulcers, the following may also contribute to their formation:

bulletHelicobacter pyloridus (H. Pylori): Scientists now believe that H. Pylori bacteria is a major cause of peptic ulcers.  It is unclear what role H. Pylori plays in ulcer formation; however, billions of people are infected with this bacteria, 10-15% of which develop ulcers.  Antibiotic treatment eliminating the presence of this bacteria has proven to be effective for healing ulcers and preventing their recurrence.
bulletNonsteroidal Anti-Inflammatory Drugs (NSAIDs): these drugs interfere with prostaglandins, a naturally-occurring substance in the body, which helps to protect the stomach lining from acid.  Examples of NSAIDs are: ibuprofen (Motrin), naproxen and etodolac.
bulletSmoking: cigarette smoking is a cause of ulcer formation and makes ulcer treatment ineffective.  Smoking can also lead to ulcer complications such as bleeding, perforation and stomach obstruction, which are for more serious and require extensive treatment including surgery. 

There is no concrete evidence that diet contributes directly to the formation of ulcers.  Thus, coffee, alcohol, spicy foods and caffeine may not cause ulcers; however, these types of food do promote the production of stomach acid which can aggravate existing ulcers. 

Symptoms

In many cases, people can have ulcers without any symptoms.  Oftentimes, symptoms can come and go-especially after meals or with the help of antacids.  Common symptoms include:

bulletAbdominal burning
bulletHunger pains 1-3 hrs. after meals or in the middle of the night

Pain in your digestive tract can also be a sign of an ulcer, although this symptom is a poor indicator of an ulcer's existence or severity.  Pain can also be a sign of something more serious like cancer.  Oftentimes, there may be no pain associated with ulcers and the patient may heal without treatment-- unless the condition has resulted in complications.  There are 3 major types of complications resulting from ulcers:

bulletUlcer bleeding.  This complication may result in black stools, weakness and vomiting blood. Immediate treatment is necessary to stop the bleeding and to replace lost blood.
bulletUlcer perforation.  This occurs when the ulcer burns through the entire stomach wall.  This results in abdominal infection and severe abdominal pain and requires immediate surgery.
bulletGastric obstruction: usually occurring at the junction of the stomach with the small intestine (pyloric canal).  This complication is characterized by abdominal pain, vomiting of improperly digested food, loss of appetite and weight loss.  Upper endoscopy can be used to determine the cause of the obstruction and medications such as cimetidine (Tagamet) can be used to remove it.  Some types of gastric obstruction can be caused by cancer.  In repeated cases, surgery or tube suction of the stomach may be used to remove the obstruction.

Diagnosis

There are two types of procedures commonly used to diagnose ulcers:

bulletBarium upper GI x-ray.  In this procedure the patient swallows barium, a white, chalky substance, which is visible by x-ray.  Watching the barium move through the digestive tract allows the physician to determine the location of an ulcer.  This procedure is very simple and causes the patient little or no discomfort; however; it is not extremely effective.
bulletEGD-esophagogastroduodenoscopy (upper endoscopy).  This procedure is much more effective than the barium upper GI.  While the patient is sedated, a thin viewing tube is inserted into the digestive tract and the esophagus, stomach and duodenum are examined for ulcers.  This procedure can also be used to remove tissue samples to be tested for H. Pylori infection and cancer.

Treatment

The main purpose of ulcer treatment is to relieve pain and prevent complications such as obstruction, perforation and bleeding.  Thus, the first step individuals should take, both to prevent ulcer formation and to treat existing ulcers, is to monitor their risk factors: NSAIDs and cigarettes.  Special typs of treatment are available for patients who must use NSAIDs for other medical conditions.  However, patients who are undergoing any ulcer treatment are strongly advised to quit smoking as this will greatly enhance the healing effects of treatment as well as protect the patient against the recurrence of ulcers.

Medication are also available to treat ulcers.  The first type, which is usually available without prescription, is antacids such as Maalox and Mylanta.  These types of medication offer temporary relief of symptoms associated with ulcers.  Side effects vary depending on the type of antacid.  Magnesium based antacids usually result in diarrhea, while aluminum containing antacids result in constipation.

Another type of mediation available is H2 Blockers.  H2 Blockers work by preventing the interaction of histamine with stomach cells.  Histamine is a protein used to promote acid production.  Continuous use of this medication is generally not harmful to the patient and side effects such as headache, lethargy, breast swelling and impotence are not common.  Although H2 Blockers such as cimetidine, nizatidine and famoltidine may be effective at reducing acid production, they are not effective at treating or healing ulcers that are caused by H. Pylori infection; this must be treated with a combination of antibiotics.

There are a few drugs now available that are more potent and effective than H2 Blockers at healing ulcers.  For example, Prilosec is a drug commonly used to treat esophageal ulcers, which are much more sensitive than other types of peptic ulcer and require a complete shutdown of stomach acid production.  Medications such as Sucralfate and Misoprostol are used to strengthen and protect the lining of the stomach and are especially effective at healing ulcers that are caused by the use of NSAIDs.  These two drugs are not recommended for pregnant women and women of childbearing age.

In order to eliminate the existence of H. Pylori bacteria, which can be an extremely difficult and somewhat daunting task, a combination of antibiotics must be used.   Antibiotics such as amoxicillin, tetracycline, metronidazole and clarithromycin are commonly prescribed in combination with H2 Blockers, Pepto-Bismol or Prilosec in order to treat H. Pylori infection.  Eliminating this bacteria can also prevent the recurrence of ulcers as well as decrease the risk gastric cancer.

"Peptic Ulcer Disease."  Focus on Digestion. com.  17 Aug. 1998. 
<
http://www.focusondigestion.com>.  25 Mar. 2002.

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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