An ulcer is a slow-healing or recurrent and often painful sore that can develop inside or outside your body and is caused by a variety of conditions and infections. There are many different ulcer types, from mouth ulcers to venous ulcers, with peptic ulcers being the most common.
A peptic ulcer is caused by a break in the inner lining of the esophagus, stomach, duodenum, or other areas of the gastrointestinal tract. According to the Centers for Disease Control and Prevention (CDC), 25 million Americans will suffer from a peptic ulcer and its associated symptoms at some point in life.
It is essential to get our ulcer info straight and define the causes, symptoms, and treatments. First, we’ll cover the basics on peptic ulcers, and then get acquainted with the other ulcers to know.
What Is a Peptic Ulcer?
A peptic ulcer is an open sore located on the inside lining of the stomach and upper portion of the small intestine that causes stomach pain—one of the primary symptoms. These painful open sores develop when acid in the digestive tract corrodes the inner portion of the stomach or small intestine. If the mucous layer that shields against the corrosive effects of acid decreases and the amount of acid increases, a peptic ulcer is likely to grow.
Causes of peptic ulcer disease include:
- Helicobacter: The bacterium Helicobacter pylori (H. pylori) can reside in the mucous layer surrounding and protecting tissues in the stomach and small intestine. H. pylori bacteria might trigger inflammation in the stomach, which can eventually give rise to a peptic ulcer and potentially even stomach cancer. Scientists do not have a clear explanation for how H. pylori is transmitted, but proposed theories include close contact and through food and water.
- Pain relievers: Over-the-counter pain relievers and prescription anti-inflammatory drugs that include ibuprofen and naproxen sodium such as Advil and Aleve can irritate your stomach and intestinal lining if used frequently.
- Other medications: When taken along with non-steroidal anti-inflammatory drugs (NSAIDs), medications such as anticoagulants, steroids, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate (Fosamax), and risedronate (Actonel), can cause a peptic ulcer.
- Smoke, alcohol, stress: People with H. pylori are more likely to develop a peptic ulcer if they smoke. Alcohol can also irritate your stomach’s mucous lining and increase the production of stomach acid. Untreated stress can make a peptic ulcer worse.
Common ulcer symptoms include abdominal pain, bloating, fatty food intolerance, heartburn, and nausea. Stomach acid and having an empty stomach make the pain worse, and the discomfort is more intense between meals and at night.
Another sign of peptic ulcer is a gnawing hunger, occurring shortly after eating. This hunger may be accompanied by a burning pain in the area between the belly and breastbone.
It is important to mention that, according to Mayo Clinic, nearly three-quarters of people with peptic ulcers do not have symptoms, while in some rare cases severe symptoms of peptic ulcers such as vomiting, dark blood in stools, trouble breathing, appetite changes, and unexplained weight loss can occur.
Types of Peptic Ulcers
Peptic ulcers have been further categorized according to type: gastric ulcer, duodenal ulcer, and esophageal ulcer. Let’s take a look at each.
A gastric ulcer occurs when a peptic ulcer is located in the stomach. The causes are similar to the ones mentioned above, but the symptoms of a stomach ulcer are more specific. The most common symptom is a burning sensation or pain in the middle of the abdomen right between the chest and belly button—the discomfort is more intense when the stomach is empty, and it can last for a few minutes to several hours. Other symptoms include a dull pain in the stomach, weight loss, appetite loss, nausea, bloating, acid reflux, heartburn, anemia due to internal bleeding, and vomiting.
Similar causes can produce a duodenal ulcer, which is a peptic ulcer located in the duodenum, the first part of the small intestine. Some of the symptoms of a duodenal ulcer are different from those of a gastric ulcer. The most common symptom is pain in the upper abdomen that usually comes and goes. It occurs before meals or when you are hungry. Other symptoms include bloating, retching, and feeling sick.
This type of peptic ulcer occurs in the lower end of your esophagus (the tube that unites your throat with your stomach). Along with the aforementioned causes, an esophageal ulcer can also be brought on by gastroesophageal reflux disease or GERD. GERD triggers acid reflux, which causes stomach contents to move backwards into the esophagus.
An esophageal ulcer typically manifests as a burning pain in the chest that can range from mild to severe. Other symptoms of an esophageal ulcer include indigestion, acid reflux, nausea and vomiting, bloating, a dulled appetite, difficulty swallowing, a dry cough, and a sour taste in the mouth.
The most dangerous type of ulcer, a bleeding ulcer is caused by a peptic ulcer that has been left untreated. Unfortunately, its progression can advance so slowly that symptoms aren’t noticeable. The first sign of a slow-bleeding ulcer is anemia and its accompanying symptoms: paler than normal skin, windedness during exercise, fatigue, reduced stamina, and lightheadedness.
Sticky black, dark red or maroon stool as well as bloody vomit with a coffee ground consistency are signs that you have an ulcer that is bleeding intensely. It is imperative to seek immediate medical treatment, as a rapidly bleeding ulcer can be life-threatening.
Peptic Ulcer Diagnosis
To diagnose an ulcer, your health care provider will conduct a medical history intake and physical exam. If the results suggest the possibility of an ulcer, the doctor will likely order more specific testing including:
- Laboratory tests: Laboratory tests can identify a H. pylori infection. Of the blood, stool, or breath tests that can be used, the latter is the most definitive. The patient eats or drinks a substance containing radioactive carbon. If there is an infection, the breath sample contains the radioactive carbon.
- Endoscopy: In an endoscopy, an endoscope is inserted down your throat and esophagus and into your stomach and duodenum to get a good look at the upper digestive system. If an ulcer is detected, a biopsy is taken for further examination. Endoscopy is usually recommended for older patients who have experienced bleeding, recent weight loss, or trouble eating and swallowing.
- Upper GI (gastrointestinal) series: A sequence of X-rays of the esophagus, stomach, and small intestine generates pictures of the upper digestive system. An upper GI series requires swallowing a white liquid (a barium swallow) that coats the digestive tract so that an ulcer shows up on the images.
Peptic Ulcer Treatments
Ulcer treatments are determined by the cause. The main objective is typically to kill the helicobacter, if present, and eliminate or reduce pain medications, if possible. Ulcer treatments include:
- Antibiotics: Antibiotics such as Amoxil and Biaxin are used to treat a helicobacter pylori infection. The type of antibiotic used depends on your location and the rates of antibiotic resistance. The treatments with antibiotics usually last around two weeks. Additional medications are used to decrease stomach acid.
- Medications: These medications, which include proton pump inhibitors (PPIs), suppress acid production and encourage healing, but come with undesirable side effects with long-term use, including a higher probability of hip, wrist, and spine fractures. Acid blockers (H2 blockers) such as Zantac and Pepcid also reduce stomach acid and encourage healing. Other medications, called cytoprotective agents, may be used to protect the lining of your stomach and small intestine.
How to Treat Stomach Ulcers with Amino Acids
The nonessential amino acid glutamine can be used to reduce inflammation. It’s also the main source of energy for the cells of your intestinal lining and stomach lining. According to the University of Michigan, glutamine first came onto the stage as a treatment for peptic ulcers over 40 years ago, when it proved to successfully treat the condition in a preliminary trial. Since then, glutamine has been shown to help prevent stress ulcers from severe burns.
In 2009, scientists set out to prove that glutamine can help treat an ulcer. They fed the control group of mice a standardized diet that offered up 1.9% glutamine and the experimental group of mice the same diet but enhanced with supplemental glutamine for a total of 6.9% glutamine. After 2 weeks, the mice were separated into two more groups. Results from week 20 revealed that the mice fed the supplemental glutamine had much less inflammation.
Lead researcher Susan Hagen, associate director of research in the Department of Surgery at BIDMC and associate professor of surgery at Harvard Medical School, explained to the Harvard Gazette: “Because many of the stomach pathologies during H. pylori infection [including cancer progression] are linked to high levels of inflammation, this result provides us with preliminary evidence that glutamine supplementation may be an alternative therapy for reducing the severity of infection.”
Some doctors recommend taking 500 to 1,000 mg of glutamine 2 or 3 times daily as a treatment for peptic ulcers. If you are experiencing gnawing hunger that won’t quit or any burning or abdominal pain, schedule an appointment with your doctor to determine the cause and see if some extra glutamine can help soothe the burn.
Other Types of Ulcers
Ulcers can show up inside and outside the body, and not just in the stomach, duodenum, or esophagus. Other ulcer types include the following.
A stress ulcer is a group of lacerations located in the esophagus, stomach, or duodenum that usually comes on suddenly. This type of ulcer is triggered by physical stress that may come in different forms, including serious long-term illness, surgical procedure, trauma that occurs to the brain or body, severe burns, or injury to the central nervous system.
While a peptic ulcer may be worsened stress, aggravating the symptoms, which include a burning sensation, pain to the touch, and extreme sensitivity, a peptic ulcer exacerbated by stress is not the same as a stress ulcer.
Damaged arteries can reduce blood flow to tissue and create arterial, or ischemic, ulcers. These types of ulcers typically form on the outer side of your feet, ankles, tips of the toes, and heels due to the stress and strain of walking and footwear.
One of the main signs of an arterial ulcer is an open wound that looks “punched out.” Other symptoms include:
- Black, red, or yellow sores
- Hair loss in the affected area
- Localized pain
- A wound that does not bleed
- Skin that’s cool to the touch due to lack of circulation
It’s important to seek treatment for arterial ulcers, as serious complications such as infection, tissue necrosis, and amputation can arise. Your health care provider will attempt to restore blood circulation either surgically or medically. The healing process is a lengthy one.
Venous ulcers are leg ulcers that develop primarily due to damaged veins (venous valves) that increase pressure in the veins and compromise blood flow back to your heart. They show up as open wounds on your leg, below your knee, or on the inner side of your ankle.
While venous ulcers aren’t usually painful, when they become infected or increase in severity symptoms can include:
Treatment of venous ulcers centers on increasing blood flow to the area. Depending on the severity and whether an infection is involved your doctor may suggest antibiotics, medications, surgery, compression therapy, or a combination of all.
We’ve all had a canker sore at some time or other. Mouth ulcers can show up when you:
- Brush your teeth too hard
- Bite the inside of your cheek
- Are exposed to a food allergy
- Undergo hormonal changes
- Have a vitamin deficiency
- Are fighting a bacterial infection or medical condition
Fortunately, mouth ulcers don’t stick around for too long and should be gone in a matter of weeks. If a mouth ulcer hangs around for longer than 2 weeks or causes an inordinate degree of pain, then it’s time to seek medical advice. Likewise if the ulcers show up on your lips, you have trouble eating or drinking, or you have a fever or diarrhea consult a medical professional.
Genital ulcers are often a symptom of a sexually transmitted infection (STI) and show up, as the name suggests, on the genital areas: the vagina, the penis, the anus, or surrounding areas. But genital ulcers can also be caused by an inflammatory disease, a skin reaction to new products, or trauma.
While the sore will be visible, you might also notice:
- A rash or bumps
- Swollen glands in the groin region
- Pain or itching
Treatment depends on the cause. An STI will be treated with antibiotics or antivirals, while an underlying condition will determine a different course of treatment.