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Peptic ulcer

NHS Direct Online Health Encyclopaedia

Introduction Ulcers are sores or holes in the lining of an organ. They look like small, red craters. Peptic ulcer is the collective name for duodenal ulcers or stomach ulcers. The stomach produces acid to break down food during the digestive process. The stomach and upper part of the small intestine (duodenum), are protected from the acid by a lining of sticky fluid (mucus). If this lining is damaged, the sensitive tissue underneath is exposed to acid. Irritation of the wall tissue in the stomach and duodenum may cause an ulcer to form. Duodenal ulcers are more common than gastric ulcers and usually occur in people aged 20 to 45, particularly men. Gastric ulcers are more common in people over the age of 50. Approximately 1 in 8 people in the UK develop a peptic ulcer at some time in their lives.

Symptoms Some people do not experience any symptoms and may not realise they have a peptic ulcer. Mild symptoms may also be mistaken for indigestion or heartburn. If you do have symptoms, they may include the following: Pain, or a burning sensation (similar to indigestion) in the upper abdomen and sometimes the lower chest. The pain from a duodenal ulcer can be worse when the stomach is empty and is relieved by eating, but then recurs a few hours afterwards. Pain caused by a gastric ulcer is often made worse by eating. Difficulty in swallowing or regurgitation (bringing up swallowed food into the mouth). Bloating, retching and feeling sick, particularly after eating. Vomiting and nausea Loss of appetite and weight loss Severe ulcers may be very painful and bleed. If you experience any of the following symptoms, you should consult your GP immediately: Vomiting blood: if an ulcer bleeds or if the blood is partially digested, the vomit may look like ground coffee. Black or tar-like stools, which contain blood from a bleeding ulcer. Sudden and severe abdominal pains. These symptoms can indicate a serious problem. The ulcer may have burrowed through the stomach or duodenal wall, or it may be blocking the path of food trying to leave the stomach. Sometimes the stomach acid or the ulcer itself breaks a blood vessel in the lining of the stomach or duodenum.

Causes Helicobacter Pylori (H. Pylori) Most ulcers are caused by the bacterium, Helicobacter Pylori (H. Pylori). H. Pylori is a very common infection in humans and is present in about half of all middle-aged people in the UK, although few develop ulcers. Scientists are not sure why H. Pylori does not cause ulcers in every infected person. It is probably linked to the characteristics of the infected person and the type of H. Pylori. H. Pylori is spread through food and water. It has also been found in saliva, so may be spread through mouth to mouth contact such as kissing. Most people are infected during childhood, but the infection is becoming much rarer due to better standards of hygiene. Nearly all children in developing countries are infected with the bacterium due to unsanitary living conditions. H. Pylori lives in the sticky mucus that coats the lining of the stomach and duodenum. It produces an enzyme called urease, which neutralises stomach acid. This causes the stomach to produce more acid and increases the risk of irritation to the delicate stomach lining. The bacteria weaken the protective mucus, making it less able to protect the lining of the stomach and duodenum. H. Pylori bacteria can also attach themselves to stomach cells, further weakening the stomach's defence mechanisms and causing inflammation in the affected area. Medical treatment to completely clear H. Pylori from the stomach is needed to prevent ulcers coming back. Non-steroidal anti-inflammatory drugs (NSAIDs) Drugs such as aspirin and ibuprofencan make the stomach vulnerable to the damaging effect of acid. These type of drugs are available over-the-counter and are commonly taken to treat minor aches and pains. They interfere with the stomach's ability to produce mucus, as well as affecting blood flow to the stomach and the bodys ability to repair cells. Prescription-only NSAIDs that are used to treat arthritic conditions can also irritate the stomach lining and have a similar effect. Genetic factors Some people have a family history of peptic ulcers, which suggests that genetic factors may be involved in their development. Smoking and drinking alcohol Smoking and drinking can contribute to the development of peptic ulcers because they irritate the stomach lining and reduce mucus production. Stress Stress probably does not cause ulcers, but does worsen symptoms if an ulcer is present. Stressful situations worsen symptoms because the stomach produces more acid in response to stress.

Diagnosis Infection with H. Pylori causes your body to produce antibodies to fight off the infection. These can be detected by taking a blood sample. Peptic ulcers may also be diagnosed by a procedure called a gastroscopy (or upper gastro-intestinal endoscopy). This is when a flexible instrument is passed into the stomach so that the lining can be seen. During the gastroscopy, a biopsy of the stomach lining may be taken to look for evidence of H. Pylori infection and check for stomach cancer, which can cause similar symptoms. An X-ray examination (involving a Barium meal) can also be used, but it does not offer the opportunity to take tissue samples. Alternatively, a breath test may be done. This involves drinking a substance that is normally broken down by H. Pylori. If the bacterium is present, it is changed into a chemical that can be detected with a breathalyser.

Treatment H. Pylori is a bacterium, so it is normally treated with antibiotics to clear the infection. H. Pylori can be difficult to get rid of because it is hard to get high concentrations of antibiotics into the mucus lining. It is normal to take more than one type of antibiotic, as well as drugs to control the production of acid in the stomach. If long-term treatment with aspirin or another non-steroidal anti-inflammatory drugs (NSAIDs) is the cause, ulcer healing drugs and additional drugs to protect the lining of the stomach and duodenum are advised. Occasionally surgery is recommended if the ulcer does not respond to medication. This may include one of the following options: Vagotomy: cutting the vagus nerve that links the stomach to the brain. This reduces acid production. Antrectomy: removal of the lower part of the stomach that produces the hormone that causes the stomach to produce digestive juices. Pyloroplasty: enlarging the opening into the duodenum and small intestine to allow the contents of the stomach to move more freely. Severe blood loss from a bleeding or perforated ulcer is a medical emergency and requires immediate medical attention. A technique using heat (cauterisation) may be used to seal blood vessels during a gastroscopy to stop bleeding. Alternatively, an injection of drugs may be given. If bleeding is very severe or the ulcer has a hole in it, (a perforated ulcer) surgery and a blood transfusion may be necessary.

Prevention Smoking and drinking excess alcohol leads to a greater risk of developing an ulcer. Stop smoking and limit your alcohol intake to reduce the risk of developing an ulcer. Find out how much you'll save by kicking the habit Stay healthy with this safe drinking guide Some people have a high sensitivity to aspirin and other NSAIDs and should seek advice on alternative medications.

Glossary   Blood Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Brain The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Tissue Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Stomach The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Blood vessel Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Antibody Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.

Enzyme Enzymes are proteins that speed-up and control chemical reactions, such as digestion, in the body.

X-ray An x-ray is a painless way of producing pictures of inside the body using radiation.

Biopsy A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Blood transfusion A blood transfusion involves transferring blood into a person using a tube that goes directly into a vein in the arm.

Bacteria Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

Genetic Genetic is a term that refers to genes- the characteristics inherited from a family member.

Stool Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.

Heartburn Heartburn, also known as indigestion, is a painful, burning discomfort felt in the chest, usually after eating.

Loss of appetite Loss of appetite is when you do not feel hungry or want to eat.

Pain Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Inflammation Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Ulcer An ulcer is a sore break in the skin, or on the inside lining of the body.

Ache An ache is a constant dull pain in a part of the body.

Vomit Vomiting is when you bring up the contents of your stomach through your mouth.

Nausea Nausea is when you feel like you are going to be sick.

Antibiotic Antibiotic s are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.

Anti-inflammatory Anti-inflammatory medicines reduce swelling and inflammation.

Last Updated: 24/01/2006 18:21:33

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