Ulcers are holes that form in the lining of the upper part of the gastrointestinal (GI) tract. When they occur in the stomach, they are called gastric ulcers. If they form in the first part of your small intestine, the duodenum, they are referred to as duodenal ulcers.
“An ulcer is a wound in the lining of the stomach or duodenum, but really any part of the gastrointestinal tract can ulcerate,” explains Patrick I. Okolo, III, MD, MPH, chief of endoscopy at Johns Hopkins Hospital and assistant professor of gastroenterology and hepatology at Johns Hopkins University School of Medicine in Baltimore. “It’s a chronic injury where the lining has been disrupted. However, when people refer to an ulcer they are usually referring to peptic ulcer disease.” The word peptic refers to digestion. A peptic ulcer is the umbrella term for all types of GI ulcers.
Technically an ulcer is at least 0.5 centimeters wide, but can be much larger. Duodenal ulcers mainly occur in people between 20 and 50 years old and gastric ulcers typically appear in people over age 40. Duodenal ulcers are about four times more common than gastric ulcers.
Ulcer: How It Forms
Your stomach is a very hostile environment because of the acids that help in digestion, acids that are as toxic as car battery acid. The lining of your stomach and duodenum usually is well-protected from these acids by a layer of mucus.
Peptic ulcer disease begins when a weakness in your stomach or intestinal lining allows acid to create an erosion or sore in the lining. It is the most common type of stomach disease, according to the American Gastroenterology Association.
“We know that ulcers occur because there has been a disruption in the balance of factors that injure the digestive tract and those factors that protect it from injury,” says Dr. Okolo.
Basically, the factors that injure your stomach lining become stronger or more numerous than those that protect it.
The cause of about two out of every three ulcers is the bacterium Helicobacter pylori. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin are another common ulcer cause; they damage the protective mucus layer of the GI tract.
At first you may only feel mild discomfort (technically referred to as “epigastric pain”) in the pit of your stomach, about halfway between your ribs and your navel.
Without treatment, your ulcer can continue to grow, become very painful, and may bleed. If not treated early, it may eat entirely through the lining of your stomach or intestine (this is called a perforated ulcer) and need surgery to repair. At its worst, a perforated ulcer may lead to significant bleeding and death.
If you have multiple recurrent ulcers, they can cause swelling and scarring as they heal, which may one day cause problems with your digestion. You may:
• Lose your appetite and be unable to eat a normal amount
• Start vomiting because of a complete blockage by scar tissue
• Shed pounds unintentionally
The good news is that if you work with your doctor to care for your ulcer, it will heal before any severe complications occur.
Treating an ulcer often involves medications that reduce or neutralize your stomach acid. While stomach acid may not be the root cause of your ulcer, stomach acid can aggravate ulcers and prevent healing.
Ulcer Treatment: Antacids
Over-the-counter calcium carbonate antacids are often used to relieve immediate symptoms associated with ulcers, such as the burning sensation in your stomach. The three most popular brands are Tums, Maalox, and Mylanta. Another kind of antacid is aluminum/magnesium trisilicate (Gaviscon).
These medications all work by slightly changing the pH balance in your stomach to reduce the acidity. However, if you find that you have to take them all the time to be comfortable, you need to see your doctor for diagnosis and treatment.
Ulcer Treatment: The Advent of Proton Pump Inhibitors
Recent advances in ulcer treatment have made it possible for most patients to find relief without surgery or the fear of recurring ulcers. The development of medications called proton pump inhibitors (PPI) has made treatment and healing much easier than in the past.
“Since the advent of these new PPI drugs, the rate of ulcer surgery has fallen dramatically in the United States,” says Patrick I. Okolo, III, MD, MPH, chief of endoscopy at Johns Hopkins Hospital and assistant professor of gastroenterology and hepatology at Johns Hopkins University School of Medicine in Baltimore.
Dr. Okolo says that, before PPIs, surgery was often used to remove the part of the stomach that stimulated acid production. “However, these drugs are so effective that we can achieve the same results with medications alone and avoid surgery.”
PPIs prevent your body from making stomach acid at its normal level, thereby giving ulcers a chance to heal. These drugs include:
• Omeprazole (Prilosec, Zegerid)
• Lansoprazole (Prevacid)
• Rabeprazole (Aciphex)
• Pantoprazole (Protonix)
• Esomeprazole (Nexium)
With the exception of omeprazole (Prilosec OTC), which is available over the counter, these drugs require a prescription. “All of the experience suggests that you can take these medications for a very long time,” says Okolo, although you may only need them for the two to three months it takes to heal an ulcer.
There are various types of medications your doctor may prescribe, including PPIs, but each requires that you follow two guidelines to ensure healing: Take all medications as recommended by your doctor, and be patient. It may take up to three months to fully heal your ulcer.
Ulcer Treatment: H2 Receptor Antagonists
H2 receptor antagonists reduce acid production and may be used for up to six weeks to help heal ulcers, often in combination with antibiotics to treat a Helicobacter pylori infection, the main cause of peptic ulcers.
These drugs include:
• Cimetidine (Tagamet)
• Ranitidine (Zantac)
• Famotidine (Pepcid)
• Nizatidine (Axid)
Ulcer Treatment: Bismuth Subsalicylate
Medications containing bismuth subsalicylate (like Pepto-Bismol) have been in use for years. Your doctor may recommend using these while your ulcer is healing as they coat the ulcer and protect it from irritation. An unfortunate side effect is the tendency for this drug to give your tongue and stool a black appearance.
Ulcer Treatment: A Prescription for Prevention
Depending on your personal health situation, your doctor may recommend continued drug therapy to prevent new ulcers. A study of 68 healthy volunteers who were taking low doses of aspirin to prevent heart disease showed that taking proton pump inhibitors or H2 receptor antagonists helped prevent the development of ulcers from the aspirin.
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are the second-leading cause of peptic ulcers. So while you are letting an ulcer heal, it’s important to avoid NSAIDs whenever possible. Others in this drug class include ibuprofen (Motrin, Midol) and naproxen (Naprosyn, Anaprox, Aleve).
Be sure your doctor knows about any and all drugs you are currently taking and how to best take the medications you have been prescribed to heal your ulcer.