Peptic ulcer

A peptic ulcer is an ulcer of the stomach or duodenum. The duodenum is the first part of the small intestines. It is the tube that food goes through when it leaves the stomach. Peptic means talking about the stomach.

Gastric ulcers are peptic ulcers in the stomach.

Duodenal ulcers are peptic ulcers in the duodenum.

Global statistics

Deaths from peptic ulcer disease per million persons in 2012

     0-7     8-11     12-16     17-19     20-25     26-32     33-40     41-53     54-72     73-132

Disability-adjusted life year for peptic ulcer disease per 100,000 inhabitants in 2004.

     no data      less than 20      20–40      40–60      60–80      80–100      100–120      120–140      140–160      160–180      180–200      200–220      more than 220

The lifetime risk for developing a peptic ulcer is approximately 5% to 10%. Men and women are equally as likely to have them.

The amount of deaths was much higher until the last decades of the 20th century, then dropped.

Deaths caused by peptic ulcer deaths globally in 2015 was 267,500.

Causes

Helicobacter pylori under microscope

Most ulcers are caused by an infection from bacteria. This bacteria is called Helicobacter pylori. 90% of gastric ulcers and 75% of duodenal ulcers are from Helicobacter pylori infection.

Other things can make ulcers worse. But these things are less important than Helicobacter pylori. These other things are:

• Drugs called NSAIDs, medicine used for pain and inflammation. Aspirin, ibuprofen, and naproxen are NSAIDs.
• Smoking cigarettes
• Old age
• Stress from diseases or injuries like pneumonia and burns

Symptoms and signs

The most frequent symptom is pain in the stomach. Pain is usually in the top of the abdomen below the ribs. Some people also feel pain go up to the chest.

Other symptoms are:

• Vomiting
• Blood in vomit – this can be red. This can also look like coffee grounds
• Black stools
• Waves of Pain or Burning

Vomiting red blood while having other symptoms is a serious sign.

Diagnosis

• Endoscopy – looking inside a person's stomach with a camera that goes through their mouth and down to their stomach
• Test on the air someone breathes out to look for Helicobacter pylori infection
• Blood test to look for Helicobacter pylori infection
• Feces antigen test
• Small sample taken from the affected body area or the ulcer
• X-Ray: imaging of the GI tract. Ulcers in the body can be found this way, also called an upper GI series

The best way is endoscopy. But this costs more money. Endoscopy is done by a medical specialist called a gastroenterologist (a doctor who knows much about the digestive system.)

A good thing about endoscopy is finding other diseases if there is no peptic ulcer. The symptoms of peptic ulcer can be from other diseases. Endoscopy can diagnose these other diseases.

Treatment

Treatment often entails the use of antibiotics to kill H. pylori; reducing or stopping the use of NSAIDs; and reducing or blocking the effects of stomach acid to assist in the ulcer's healing. Antacids such as Proton Pump Inhibitors (PPIs) or H-2 Blockers may be used to reduce stomach acid, or cytoprotective agents such as sucralfate or misoprostol may be used to protect the stomach lining from the acid.

Peptic Ulcer Media

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  Duodenal ulcer A2 stage, acute duodenal mucosal lesion (ADML)

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  An endoscopic image showing deep gastric ulcer.

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  Endoscopic image of a small gastric ulcer with visible blood vessels, a potential warning sign for upper gastrointestinal bleeding

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  Endoscopic image of gastric ulcer, biopsy proven to be gastric cancer.

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  A biopsy sample of a stomach ulcer that was diagnosed as stomach cancer

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  Micrograph showing erosive gastric ulcer. (H&E stain)

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  Peptic ulcer treatment: pharmacology of drugs