A peptic ulcer is a break in the lining of the stomach or upper part of the small intestine. Mucus membrane defenses break down against strong stomach acids and enzymes. We used to think that ulcers were chiefly due to stress. We now know that a specific bacterium causes most ulcers. Another cause is long term use of arthritis medications. Ulcers are also more common in smokers.

Most patients with ulcers have pain in the area of the stomach. It is usually not severe. Patients have described it as gnawing, dull, aching, or like hunger. It can come and go over time or during the day. The pain may be worse on an empty stomach. Other symptoms include nausea and vomiting, loss of appetite, and black, tarry stools. Ulcers can be present without symptoms. The first sign for many patients is bleeding.

Ulcers require medical care, especially if there is bleeding. An x-ray study or upper endoscopy is used to confirm an ulcer. This involves sending a long, flexible tool through the mouth. It carries both camera and surgical tools. For ulcers in the stomach, the procedure includes a biopsy. A biopsy is removal of a small piece of tissue. It is done to rule out cancer and confirms an infection. For ulcers in the upper small intestine, cancer is not a risk and biopsy is not necessary. Stomach ulcers require a second endoscopy about 3 months after the start of treatment.

If infection is present, a course of antibiotics will usually eliminate it. It is very important to comply with the antibiotic instructions completely. Treatment for the ulcer includes drugs that reduce acid output, such as Tagamet, Zantac or Axid. The healthcare provider may prescribe antacids and a medication to coat the surface of the ulcer to aid healing. Some people receive a long-term maintenance dose of acid inhibitors. There are medications that reduce ulcer relapse for those who must continue taking arthritis medications.

There are several habit changes that help ulcers heal and prevent relapse. Eat balanced meals at regular intervals. The diet need not be bland or restrictive. Avoid extremely spicy foods. A high fiber diet is helpful. Avoid coffee and other drinks with caffeine. Quit smoking and consume alcohol in moderate amounts only. Avoid aspirin and other drugs that irritate the stomach. Although it is not proven, reducing stress probably helps.

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