ulcers

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Ulcers


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Overview

An ulcer is a crater-like lesion on the skin or mucous membrane of the mouth, stomach, and other body areas. There are several different types of ulcers including peptic ulcers, mouth ulcers, skin ulcers, and pressure ulcers.

Peptic ulcers are sores on the lining of the stomach or duodenum (the first part of the small intestine)



Symptoms

A burning stomach pain is the most common symptom of peptic ulcers. The pain usually feels like a sharp ache between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for awhile.



Symptoms

Other symptoms of ulcers can include:

-- loss of appetite

-- sudden, sharp stomach pains

-- nausea

-- frequent burping or hiccuping



Symptoms

-- weight loss

-- vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)

-- bloody or blackish bowel movements (this could indicate a serious problem, so call a doctor right away if you see this)



Symptoms

Over time, untreated ulcers grow larger and deeper and can lead to other problems, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, which can make someone very sick.

http://www.nlm.nih.gov/medlineplus/pepticulcer.html

http://kidshealth.org/teen/diseases_conditions/digestive/ulcers.html#



Diagnosis

In addition to doing a physical examination, a doctor will ask about your symptoms, past health, family's health, any medications you're taking, any allergies you may have, and other issues. If you have stomach pain or other symptoms of an ulcer, the doctor will perform some tests to help make the diagnosis.



Diagnosis

One test is called an **upper gastrointestinal (GI) series**

. This is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a whitish liquid called barium while getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.



Diagnosis

Another common procedure to look for an ulcer is called an **endoscopy**

. Tissue can be removed during an endoscopy and then tested for H. pylori bacteria.



Diagnosis

A doctor can also do a blood test for H. pylori bacteria. This may be important if an ulcer is found in the upper GI series. Sometimes a bowel movement or a person's breath can also be specially tested to check for the H. pylori bacteria.




Treatment

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.



Treatment

Antibiotics are typically prescribed to kill the H. pylori bacteria in the body. If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:

-- Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl)



Treatment

-- Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)

-- Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria



Treatment

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.



Treatment

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Methods used to stop the bleeding include injecting medicine, or applying metal clips to the ulcer. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a tear (perforation).



Treatment

Antacids are given for 2 months or longer to lessen the amount of acid in the stomach and help protect the lining of the stomach so the ulcer can heal.


http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm



Causes

Ulcers can be caused by inflammation or infection. Peptic ulcers appear when the acids that help you digest food damage the walls of the stomach or duodenum.



Causes

For almost 100 years, doctors believed that stress, spicy foods, and alcohol caused most ulcers. Now we know that most peptic ulcers are caused by a particular bacterial infection in the stomach and upper intestine, by certain medications, or by smoking.



Causes

Most peptic ulcers are caused by an infection from H. pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory medicines like aspirin and ibuprofen. It is thought that some people may naturally secrete more stomach acid than others — and it doesn't matter what stresses they're exposed to or what foods they eat. Peptic ulcers may have something to do with the combination of H. pylori infection and the level of acid in the stomach.



Causes




Risks

Although H. pylori are responsible for most cases of peptic ulcers, these ulcers can happen for other reasons. Some people regularly take anti-inflammatory drugs, such as aspirin or ibuprofen, that fight inflammation in the body and are used to treat long-term painful conditions like arthritis. If taken in high daily doses over a long period of time, NSAIDs can cause ulcers.



Risks

Smoking also is associated with peptic ulcers. Smoking increases someone's risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more acid. Drinking a lot of alcohol for a period of time can also increase a person's risk of ulcers because over time alcohol can wear down the lining of the stomach and intestines.



Risks

In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick to eat for a long period of time.



Risks

Ulcers occur because of uncontrolled increased acid production in the stomach and changes in the immune system. With any illness where the body's ability to heal is challenged (such as when someone has serious burns from a fire or goes through radiation), there is a risk for developing ulcers.




Prevention

Doctors are not yet sure how the bacteria H. pylori are transmitted from person to person, but many believe that to prevent the spread of the bacteria one should avoid the spreading of saliva (sharing food/drinks, kissing, etc.).



Prevention

The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before you eat and take good care of your body by exercising regularly and not smoking or drinking.


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