Understanding Stomach Ulcers

Common wisdom used to be that eating spicy foods caused ulcers. Now we know differently. “Although certain foods might irritate an ulcer you already have, ulcers are not caused by spicy foods, a rich diet, or even stress,” says Shivi S. Siva, MD, a gastroenterologist with Northwell Health and assistant clinical professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

Simply put, a peptic ulcer is an open sore in the stomach or first part of the small intestine (called the duodenum). However, explains Siva, the location of the pain doesn’t always necessarily match the location of the ulcer. Instead, she adds, it’s the timing of symptoms that can tip off which type you have. “Usually, the pain of a duodenal ulcer will improve after meals, while eating may be a trigger for the pain in gastric ulcers.”

According to Siva, the main sources of ulcers include:

• Bacteria – H. pylori, a spiral-shaped bacteria, damages the stomach’s protective mucous coating. Once the lining is weakened, powerful stomach acids (which are intended to break down food) can get through and eat into the walls of the stomach or duodenum. Experts don’t know the exact reason why a person gets infected with H. pylori, but it may be transmitted through saliva, vomit, or fecal matter, says Siva. H. pylori may also spread through contaminated food or water.
• Pain relievers – Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin can dampen the stomach’s ability to protect itself against acid. Taking too many NSAIDs for too long can lead to inflammation of the stomach lining, which may lead to an ulcer.

Some ulcers aren’t deep or large enough to cause any grief, while others feel like a dull or burning ache in the stomach, or anywhere between the belly and the breastbone. Additionally, ulcers may also cause bloating, nausea and vomiting, as well as the loss of appetite.

The greatest risk for bacteria-related ulcers is age. That’s because while you can get H. pylori at any time, older people have a higher prevalence of it. Other risk factors for peptic ulcers include:

• Taking NSAIDS for a long time and/or at high doses
• Being a woman
• Using corticosteroids and NSAIDs at the same time
• A history of peptic ulcers
• Heavy alcohol use (for men, that’s more than four drinks a day and for women it’s more than three drinks a day)
• Smoking

If you think you may have a peptic ulcer, Siva recommends making an appointment with your gastroenterologist. Untreated ulcers can lead to internal bleeding and they can even burn through the wall of the stomach, which can lead to infection. Your doctor will take a health history and listen to your symptoms, and will likely also want to perform a physical exam to check for bloating, listen to your stomach for bowel sounds, and check for tenderness or pain within the abdomen.

To confirm an ulcer diagnosis, they may also order a series of diagnostic tests, including:

H. pylori testing – Stool tests are the most common tool used by doctors to determine if you have H. pylori infection. These tests can also be used to determine if you have cleared the bacteria after treatment, however Siva notes that medications like proton pump inhibitors, antibiotics, and other acid suppressing medications can interfere with the accuracy of the test, so your doctor will want to complete the test four to six weeks after you’ve completed your course of antibiotics for the initial infection.

Another common method of testing for H. pylori infections is what’s called a breath test. In this test, you blow into a bag, then eat or drink something that contains a harmless radioactive material and blow into a second bag, allowing for the two samples to be compared. A higher than normal carbon dioxide level in the second sample means you have an H. pylori infection. Again, proton pump inhibitors, antibiotics, and other acid suppressing mediations can interfere with the accuracy of this test.

Endoscopy – This test helps allows examination of your esophagus, stomach, and small intestine. The doctor inserts a small, flexible tube with a camera attached into your mouth and down through the esophagus. If you have an ulcer, your doctor will take a small tissue sample to identify its root cause.

While you may turn to over-the-counter antacids like Tums or Alka-Seltzer, or bismuth subsalicylate products like Pepto-Bismol to relieve your symptoms, the reality is that while these remedies may provide immediate relief from your pain or discomfort, they don’t address the problem long term. Instead, you’ll want to schedule time with your doctor to find the root cause of your symptoms and develop a treatment plan to heal any potential ulcers.

If H. pylori is present, you’ll be given a combination of antibiotics to kill the bacteria, as well as a proton pump inhibitor, which reduces the amount of acid the stomach produces. “Ulcers usually take two to eight weeks to heal, depending on their size and location,” says Siva. After that time, your doctor may do another endoscopy to make sure the ulcer has healed if the ulcer was considered to be large.

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