A peptic ulcer is a sore that develops in the lining of the stomach, esophagus or upper section of the intestine. The stomach is a muscular and strong organ that crushes and grinds food. This is combined with digestive juices such as bile acids, hydrochloric acid, and enzymes such as pepsin. The lining of the stomach is covered in a mucus layer to protect it from these juices. The lining is also protected by prostaglandins, which are hormone-like substances related to muscle contractions. If there is an imbalance in the digestive juices, the stomach lining can be damaged, and an ulcer or open sore will form.
There are two primary types of ulcers, the duodenal ulcer in the first segment of the intestine, and the gastric ulcer in the stomach. Peptic ulcers can form in the esophagus just above the stomach, but this is rare.
Peptic ulcers are generally caused by Helicobacter pylori bacterial infections and the long-term use of NSAIDs (or nonsteroidal anti-inflammatory drugs) like naproxen, aspirin, and ibuprofen.
H. pylori is carried by approximately 40% of Americans, and almost 50% of the world will have this bacteria in their digestive tracts. The bacteria is believed to spread through contaminated drinking water and food or contact with bodily fluids such as saliva from an infected person. However, the source of the infection is relatively unknown.
Most people who have this bacteria will never suffer from the ulcers it can cause. The reason for this is unknown. However, the bacteria can remain dormant in the digestive tract without causing any symptoms for years. Of the people who have peptic ulcers, more than half of them will be infected with this bacteria.
The other common cause of peptic ulcers is the long-term use of NSAIDs. People who take these drugs every day or several times each week are more likely to develop peptic ulcers. This is particularly true for people aged 70 and older. Women are also more likely to develop peptic ulcers due to this than men. People with two or more medical conditions or who take other medication as well are also at a greater risk of developing a peptic ulcer.
Peptic ulcers can also be caused by the condition of Zollinger-Ellison Syndrome, but this is rare. This syndrome increases the production of gastrin due to a tumor in the intestine or pancreas.
There are other factors that can also play a role in the development of a peptic ulcer, including:
- Drinking excessive amounts of alcohol
- Eating spicy foods
The Signs and Symptoms
The majority of people who have peptic ulcers do not have any symptoms. Of the people who do have symptoms, the most common is a dull and burning pain. This pain can occur anywhere in the abdomen between the breast bone and the naval.
The pain also comes and goes over time while occurring a few hours after eating. It can also happen during the night, but more often when the stomach is empty. It could be temporarily relieved by eating or using antacids.
Some of the other signs of a peptic ulcer include:
- Unintended weight loss
- Loss of appetite
There are some symptoms that require immediate medical treatment. These include sharp and sudden or persistent pain in the stomach, and black or bloody stool or bloody vomit. Vomit that looks like coffee grounds should also be looked at by a doctor.
The Testing for Peptic Ulcers
Diagnosing a peptic ulcer can be done using a few tests. These tests will also help identify the cause, check for any complications, and determine the best treatment method.
The Laboratory Tests
To detect an infection of Helicobacter pylori, one or more tests can be done. A stool antigen test and urea breath test are the most common and highly recommended to check for this infection. They also provide treatment evaluations. These tests are also regularly performed because they are non-invasive and fast. It is important to note that the urea breath test will not be recommended for young children. It is best for children to have the stool antigen test done.
There are some tests that require endoscopy, which is the use of a flexible and small tube with a light and camera attached. This will be used to view the upper digestive tract. A small sample of the digestive tract tissue may be removed during the procedure. This type of test is less common because of its invasive nature.
- The Stool Antigen Test
To complete this test, a stool sample is required. The specimen will be used to detect the presence of H. pylori antigens.
To complete this test, a healthcare professional will take a sample of your breath by asking you to breathe into a bag. This will be the baseline for the tests. You will then have to drink a liquid that contains the substance urea and then wait 15 minutes.
During this waiting time, if there is any H. pylori in your digestive tract, it will be broken down by the urea and turned into carbon dioxide. The carbon dioxide will then be expelled from the body in your breath.
The medical professional will then take a second breath sample.
Both these samples will be sent to a laboratory for testing. If the second breath sample has a higher level of carbon dioxide, you may have a bacterial infection in your digestive tract.
- The H. Pylori Antibody Test
The antibody test is not recommended by the American College of Gastroenterologists, the American Society for Microbiology, or the Infectious Diseases Society of America for routine H. pylori infection testing. It should also not be used for treatment evaluation because it cannot distinguish between past and present infections. There are few healthcare providers who still order this test, and most laboratories have stopped offering it.
If the test is done and the results are negative, you are unlikely to have this bacteria in your digestive tract. However, if it is positive, a stool antigen or urea breath test should be conducted to confirm this.