Ulcers

Ulcers

Siamak Tabib (Gastroenterologist, Cedars-Sinai Medical Center, Los Angeles, CA) gives expert video advice on: When should I see my doctor about pain related to an ulcer?; What are the treatments for peptic ulcers? and more...

What is an "ulcer"?

An ulcer is a wound that takes place in the lining of the intestines. It can take place in the upper gastrointestinal tract, the esophagus or the stomach. Ulcers can also take place in the small intestine or the large intestine. Ulcers can be painful and, if they are deep enough, they can erode into blood vessels that feed that area of the stomach, esophagus or intestines, and as a result, cause bleeding to occur.

What causes ulcers?

Ulcers generally are the result of infections. About 90% of stomach and small intestinal ulcers that we find are related to a bacterial infection called Helicobacter Pylori. The other 10% of the ulcers we find are generally because of medication, namely non-steroidal anti-inflammatory medications that can cause inflammation, irritation and ulcers, in the stomach, in the esophagus and in the small intestine.

What is a "peptic ulcer"?

Peptic ulcer generally refers to an ulcer in the upper gastrointestinal cavity, mainly either the stomach or the small intestine.

What causes a peptic ulcer?

A peptic ulcer is generally caused by a bacterial infection known as a helicobacter pylori, which can be picked up in our childhood. Certain areas of the world are more endemic to this bacterium, but nowadays we find it pretty much everywhere, including the United States. This bacteria usually is harmless, however, when coupled with either medications or potentially stress in the body, it can be the culprit for ulcers. Other types of reasons to have ulcers include medications, such as anti-inflammatory agents which are available very widely over the counter, such as aspirin or aspirin related products. Certainly, as we discussed, stress can cause this type of ulceration, but usually stress is coupled with either this infection or with certain medications that can do it.

If there is any pain in the abdomen that doesn't go away after a short period of time, or persists and is related to indigestion or heartburn, then one should see their doctor immediately as it may relate to an ulcer. Even if there isn't a lot of heartburn associated, but there are symptoms of pain and discomfort, then one needs to see one's physician because it could be a more serious condition concerning an ulcer and letting go could turn it into a big problem.

How are peptic ulcers diagnosed?

In order to be diagnosed with a peptic ulcer, the first key element is to obtain a very good history from our patients; find out what they have been doing the last few days, or even the last few weeks. What kind of medicines have they been taking? Have they been taking any pain relieving medications? Have they travelled anywhere recently? Have they eaten certain types of food that may have been upsetting to their stomach? Blood tests can be performed in order to check for the body's memory for a certain type of infection called H. pylori that can promote ulcers. Blood tests can also be performed to make sure that one has not had any bleeding, or recent bleeding, that can account for a certain degree of anaemia within the body. Stool studies can be checked for the presence of blood which can account for possibly a bleeding ulcer. Radiographic studies, such as a study called an upper GI barium study can be performed, where one drinks a liquid substance and pictures are taken by X-ray in order to localise a potential ulcer in the stomach. Or, ultimately, an upper endoscopy procedure can be performed, where a camera is used to take a look inside at the lining of the oesophagus, the lining of the stomach, and also to look at the beginning of the small intestine in order to evaluate the presence of ulcers and potentially to treat bleeding ulcers or ulcers that may bleed in the near future, in order to prevent any major complications.

What are the treatments for peptic ulcers?

The treatment of an ulcer is reliant on what has caused the ulcer in the first place. If it's because of certain types of anti-inflammatory medications, the first thing to do is to stop those medications. We have very powerful medicines that heal the lining of the stomach or the intestine where the ulcer has formed by reducing the amount of acid that is present in that area. These are both available over the counter and by prescription, and patients typically need to take these medicines for approximately two weeks, sometimes even longer. Sometimes, however, ulcers can be related to a bacterial infection that, once found, can be treated with appropriate antibiotics, as well as acid reducing agents.