12/7/2015

StomachUlcers:Causes,Symptoms&Treatments

StomachUlcers:Causes,
Symptoms&Treatments
byBaharGholipour,StaffWriter|January23,201505:31pmET

What'sinsideofonesixthofthe
world'spopulationandisa
thousandtimessmallerthantheheadofa
pin?It'sHelicobacterpylori,thepesky
bacteriumbehindulcers.
Viewfullsizeimage

Pepticulcersareopensoresthat
developintheliningofthe
esophagus,stomachorthefirstpart
ofthesmallintestine,knownasthe
duodenum.Over25million
Americanswillsufferfromanulcer
atsomepointduringtheirlifetime,
accordingtotheCentersfor
DiseaseControlandPrevention
(CDC).
Mostulcersarecausedbyan
infectionbyHelicobacter
pyloribacteria(H.pylori),andcan
betreatedinabouttwoweekswith

antibiotics,accordingtotheCDC.
"ThetwomostcommoncausesofulcersareH.pylori,abacterialinfection,
andmedications,mostcommonlyaspirinandothernonsteroidalanti
inflammatorymedicines(NSAIDs),andirontablets,"saidDr.Arun
Swaminath,directoroftheInflammatoryBowelDiseaseProgramatLenox
HillHospitalinNewYorkCity.
ThediscoveryofH.pylori'sroleinulcersledtotheNobelPrizein2005for
BarryMarshallandRobinWarren,whowereridiculedwhentheysuggested
theidea,Swaminathsaid.Itisamyththatpepticulcersarecausedby
stressandspicyfood.Butthesefactorsmakesomeonewhoalreadyhas
ulcersfeelevenworse.
"Psychologicalstressprobablyhasnoroleinthedevelopmentofulcers,
thoughbiologicalstresslikebeingaveryillpatientsintheintensivecareunit
candefinitelycontributetoulcers,"Swaminathsaid."Foodsarentreally
thoughttocontributetoulcers,buttheymaymakepatientswithalready
presentinflammationorulcersfeelworsedependingonwhatseaten,"he
said.
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StomachUlcers:Causes,Symptoms&Treatments

Symptoms
Themostcommonsymptomofpepticulcersisaburningpaininthe
stomach,accordingtotheNIH.Typically,thepainstartsbetweenmealsor
duringthenight,andmaystopifyoueatortakeantacidmedications.The
paincomesandgoesforseveraldaysorweeks,andcanbefeltanywhere
fromyournaveluptoyourbreastbone,accordingtoMayoClinic.
Althoughthemostcommonsymptomofulcersispain,theconditioncan
alsopresentasbleeding,oranemia,Swaminathsaid."Therearealotof
otherorgansaroundtheareaofthestomach.Partofthechallengeof
figuringoutwhatiscausingthe'abdominalpain'istoruleinoroutthings
like:pancreatitis,gallstones,Crohnsdisease,orstomachcancer."
Psychologicalstresscancausesymptomsthatmimicthesymptomsof
ulcers,Swaminathsaid.Butbecausestressedoutpeopleareatthesame
riskforfactorsthatreallycanresultinulcers,theyshouldconsulttheir
doctoriftheyhavepersistentsymptoms,hesaid.

Causes
Pepticulcershappenwhentheacidsthathelpdigestfooddamagethewalls
ofthestomachorduodenum.Theinsidesofthedigestivetractiscoated
withamucuslayerthatprotectsagainststomachacid,butinsomepeople
whoareinfectedwithH.pylori,thebacteriagetintothemucosallininginthe
stomach,creatingholesandexposingmoresensitivetissuetostomach
acid.
H.pyloriisacommoninfection,anditispossiblethatthebacteriaisspread
betweenpeoplethroughcontactwithinfectedstool,vomitorsaliva.Italso
maybecontractedfromcontaminatedwaterorfood.AccordingtotheMayo
Clinic,oneinfiveyoungadultsisactuallyinfectedwiththebacteria.Still,for
unknownreasonsitdoesnotresultinulcersineveryone.
Anothercauseistheregularuseofcertainpainrelievers,specifically,
NSAIDssuchasaspirinandibuprofen(Advil).Thesemedications,aswell
asnaproxen(Aleve)andketoprofen,canirritateorinflametheliningofthe
stomachandsmallintestine.Pepticulcersaremorecommoninolderadults
whotakethesepainmedicationsfrequentlyorinpeoplewhotakethese
medicationsforosteoarthritis.
Cigarettes,alcohol,andstresscanexacerbatesymptomsbyfurtherirritating
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StomachUlcers:Causes,Symptoms&Treatments

thestomachlining.
Ifleftuntreated,stomachulcerscancausebleedingfromtheulcerthatcan
leadtoanemia.Thebleedingcanshowupasblackcoloredstool,
Swaminathsaid.

Diagnosis&tests
Doctorsmostcommonlydiagnoseulcersusingendoscopy,Swaminathsaid.
Thisinvolves"takingacameradirectlyintothestomachtolookforulcers
andtakingbiopsiestomakesurethe'ulcers'arentreallycanceror
somethingelse,"hesaid.
Thereareseveralothertestsforthediagnosisofstomachulcers.A
physicianmayuseablood,stool,orbreathtesttodetectthepresenceofH.
pyloriorantibodiestoH.pylori,accordingtotheMayoClinic.
Abreathtestconsistsofdrinkingaglassofliquidthatcontainsaradioactive
substance.ThissubstancereactswithH.pylorisothatwhenanindividual
withstomachulcersblowsintoabag,thebreathwillcontaintheradioactive
carbonintheformofcarbondioxide.
SometimesanXrayexammaybeperformedtovisualizetheulcer.Aliquid
containingametalelementcalledbariumisingestedforthisprocedure.If
anulcerisfound,thephysicianmaythendoanendoscopyinwhicha
flexibletubew

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Treatment&medication
TreatmentofstomachulcersconsistsofkillingH.pylorianddecreasingthe
amountofacidinthestomach.Thisrequiresseveraltypesofmedications.
Physiciansmayprescribeseveralantibioticsatonce,oruseacombination
drugsuchasHelidactokillH.pylori.Helidaccontainstwoantibioticsalong
withanacidreducingdrugandamedicationthatprotectsstomachtissue.
Thedoctorswillalsotrytostopothermedicationsthepatientistakingand
mighthavearoleinworseningtheulcers.
"Mostofthetime,wetrytowithdrawtheoffendingmedication,butthatis
notalwayspossible,forexamplepatientsonaspirinwhohaveheart
arrhythmias,orrecentheartstents,"Swaminathsaid.
"Weputpatientsonhighdosesofthedrugforeightweeksbywhichtime
theareawilltypicallyheal,"Swaminathsaid."Alowdoseiscontinued
indefinitelyiftheoffendingmedicationcantbediscontinued."
Drugscalledacidblockers(forexample,Pepcid)andantacidsmaybe
recommendedtodecreasethelevelsofstomachacid.Othermedicines,
calledprotonpumpinhibitors,suchasPrilosecandPrevacid,areanother
option.Theyworkbyblockingcellularpumpsthatreleaseacidintothe
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stomach.

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