"If you guys don't stop yelling, you'll give me an ulcer!"
"There's been so much stress at work lately, I'm sure I'll get an ulcer."
"Don't worry so much. Do you want an ulcer?"
When people talk like this, it sounds like ulcers are easy to give and easy to
get. It also sounds like stress is to blame. But is that the real story?
What Is an Ulcer?
An ulcer is a sore, which means it's an open, painful wound. Peptic ulcers
are ulcers that form in the stomach or the upper part of the small intestine, called
the duodenum (pronounced: doo-uh-DEE-num).Peptic ulcers are actually
What Causes an Ulcer?
For almost 100 years, doctors believed that stress, spicy foods, and alcohol caused
most ulcers. Now we know that most peptic ulcers are caused by a particular bacterial
infection in the stomach and upper intestine, by certain medications, or by smoking.
In 1982, two doctors — Barry Marshall and Robin Warren — discovered
a certain kind of bacteria that can live and grow in the stomach. Both doctors went
on to win the Nobel Prize for their discovery. The medical name for these bacteria
is Helicobacter pylori (or H. pylori, for short). Today doctors
know that most peptic ulcers are caused by an infection from H. pylori.
Experts believe that 90% of all people with ulcers are infected with H. pylori.
But strangely enough, most people infected with H. pylori don't develop an
ulcer. Doctors aren't completely sure why, but think it may partly depend upon the
individual person — for example, those who develop ulcers may already have a
problem with the lining of their stomachs.
It's also thought that some people may naturally secrete more stomach acid than
others — and it doesn't matter what stresses they're exposed to or what foods
they eat. Peptic ulcers may have something to do with the combination of H. pylori
infection and the level of acid in the stomach.
How Ulcers Form
When H. pylori bacteria do cause ulcers, here's how doctors think it happens:
Bacteria weaken the protective coating of the stomach and upper small intestine.
Acid in the stomach then gets through to the sensitive tissues lining the digestive
Acid and bacteria directly irritate this lining resulting in sores, or ulcers.
Although H. pylori are responsible for most cases of peptic ulcers, these
ulcers can happen for other reasons, too. Some people regularly take pain relievers
known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen,
that fight inflammation in the body and are used to treat long-term painful conditions
like arthritis. If taken in high daily doses over a long period of time, NSAIDs can
cause ulcers in some people.
Smoking also is associated with peptic ulcers. Smoking increases someone's risk
of getting an ulcer because the nicotine in cigarettes causes the stomach to produce
more acid. Drinking a lot of alcohol each day for a period of time can also increase
a person's risk of ulcers because over time alcohol can wear down the lining of the
stomach and intestines.
In certain circumstances stress can help cause ulcers. But this usually only happens
when illness involving severe emotional or physical stress is involved — such
as when someone too sick to eat for a long period of time.
Ulcers occur because of uncontrolled increased acid production in the stomach and
changes in the immune system (the body system that fights infection). With any illness
where the body's ability to heal is challenged (such as when someone has serious burns
from a fire), there is a risk for developing ulcers.
Signs and Symptoms
Stomach pain is the most common symptom of an ulcer. It usually feels like sharp
aches between the breastbone and the belly button. This pain often comes a few hours
after eating. It can also happen during the night or early in the morning, when the
stomach is empty. Eating something or taking an antacid medication sometimes makes
the pain go away for awhile.
Other symptoms of ulcers can include:
loss of appetite
sudden, sharp stomach pains
frequent burping or hiccuping
vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which
only happens with severe ulcers, call a doctor right away)
bloody or blackish bowel movements (this could indicate a serious problem, so
call a doctor right away if you see this)
Anyone who thinks he or she may have an ulcer needs to see a doctor. Over time,
untreated ulcers grow larger and deeper and can lead to other problems, such as bleeding
in the digestive system or a hole in the wall of the stomach or duodenum, which can
make someone very sick.
How Are Ulcers Diagnosed?
In addition to doing a physical examination, the doctor will take
a medical history by asking about any concerns and symptoms you have, your past health,
your family's health, any medications you're taking, any allergies you may have, and
other issues. If you have stomach pain or other symptoms of an ulcer, the doctor will
perform some tests to help make the diagnosis.
One test is called an upper gastrointestinal (GI) series. This
is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that
links the mouth to the stomach. A person drinks a whitish liquid called barium while
getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.
Another common procedure to look for an ulcer is called an endoscopy
(pronounced: en-DOSS-kuh-pee). During this test, the doctor uses an endoscope, a skinny,
lighted tube with a special camera on the end.
A person getting an endoscopy is given anesthesia and will have no memory of the
procedure. For an endoscopy, the doctor gently guides the endoscope into the throat
and down into the esophagus, and finally into the stomach and upper intestines. The
doctor is able to look at the inner lining of these organs from the camera on a television
screen and can even take pictures. Tissue can be removed during an endoscopy and then
tested for H. pylori bacteria.
A doctor can also do a blood test for H. pylori bacteria. This may be
important if an ulcer is found in the upper GI series. The blood test can be done
right in the doctor's office. Sometimes a bowel movement or a person's breath can
also be specially tested to check for the H. pylori bacteria.
How Are Ulcers Treated?
Ulcers caused by H. pylori bacteria are generally treated with a combination
Usually two antibiotics to kill the H. pylori bacteria are taken every
day for about 2 weeks.
Antacids — acid blockers or proton pump inhibitors — are given for
2 months or longer to lessen the amount of acid in the stomach and help protect the
lining of the stomach so the ulcer can heal.
Doctors are not totally certain how H. pylori bacteria are transmitted
from person to person. The bacteria have been found in saliva, so kissing may be one
way. They also may be spread through food, water, or contact with vomit (puke) that
has been infected with the bacteria.
The best advice in ulcer prevention is to always wash your hands after you use
the bathroom and before you eat and to take good care of your body by exercising regularly
and not smoking or drinking.