Why Choose Cedars-Sinai Marina del Rey Hospital for Peptic Ulcers Treatment?
The well-trained specialists and surgeons at Cedars-Sinai Marina del Rey Hospital provide a wide variety of treatment options for peptic ulcers. Our doctors focus on each patient's unique needs and aim to improve their quality of life. Our highly skilled medical professionals can provide guidance and assistance in helping you choose the best and most suitable treatment option for your specific condition.
Peptic Ulcers are breaks in the inner lining of the stomach, duodenum, or esophagus caused by erosive gastric acid secretion, which is involved in the digestive process. If treatment is postponed, an ulcer can cause bleeding to a greater or lesser extent. In severe cases, an untreated ulcer can also create complications, such as gastric outlet obstruction and perforation of the stomach, duodenum, or esophagus lining.
Sudden excessive bleeding of a peptic ulcer can result in internal hemorrhage, which is a medical emergency and should be attended to immediately. Patients are urged to seek medical help if they notice one or more of the following symptoms:
Drugs for Peptic Ulcers
Most peptic ulcers that do not cause any other complications are treated with medication. If the ulcer is caused by an excessive use of nonsteroidal anti-inflammatory drugs, the patient will be prescribed a combination of:
- Stomach acid suppression medication, such as proton pump inhibitors (PPIS).
Alternatively, if infection with Helicobacter pylori the cause of the ulcer, the aim of the treatment will be to eradicate the bacteria. There are a series of treatment options to do this, including:
- H2 blockers (cimetidine, famotidine, or ranitidine), which help reduce the production of gastric acid in the stomach
- A combination of two or more antibiotics, such as amoxicillin, clarithromycin, or tetracycline, and bismuth subsalicylate, which can also be effective in eliminating Helicobacter pylori along with antibiotics
If addressed promptly, symptoms of peptic ulcers should improve within one to two weeks of treatment.
Other Types Of Treatments for Peptic Ulcers
When complications such as excessive bleeding, gastric outlet obstruction, or perforation of the stomach lining occur, other types of treatment are required. Internal bleeding as a result of peptic ulcers can be life-threatening if medical help is not immediately sought.
- Blood transfusions are often necessary
- In approximately 75% of cases, the patient recovers after the lost blood is replaced without any surgical procedure
Other methods of treatment when internal hemorrhage cannot be stopped after a blood transfusion are:
- Injecting medicine directly into the ulcer
- Applying metal clips or heat therapy to the ulcer
Surgical Treatment for Peptic Ulcers
If the previously mentioned methods fail, or if perforation of the stomach lining occurs, surgery is required.
Peptic ulcers may cause peritonitis, a severe and potentially life-threatening inflammation of the abdominal lining that can result in perforation of the stomach or intestine. Peritonitis is generally signaled by serious symptoms that the patient cannot ignore due to their intensity. Some of the most common symptoms are:
Peritonitis is a medical emergency that requires immediate attention and surgical intervention.
Most peptic ulcers can be effectively treated with medication if the symptoms are addressed as soon as the patient notices them. The duration of recovery is typically between four and eight weeks. Most symptoms should subside within the first two weeks of treatment, when the patient is usually prescribed a combination of antibiotics and acid-suppressing medicine. After that, treatment will consist of only acid-suppressing medicine until the patient is completely recovered.
By definition, peptic ulcers include all types of ulcers that are exposed to pepsin, an enzyme which breaks down protein. Pepcin can be found in the digestive systems of both humans and animals, as it is the main component of gastric juices. Depending on their location within the digestive system, peptic ulcers can be divided into one of three types:
Gastric and Duodenal Ulcers
Both gastric and duodenal ulcers can result from an infection of Helicobacter pylori bacteria, or by an excessive amount of nonsteroidal anti-inflammatory drugs. Both exhibit very similar symptoms. Pain is usually what helps distinguish one type from the other. While the patient may experience pain and discomfort shortly after a meal with a gastric ulcer, symptoms caused by duodenal ulcer generally occur when the stomach is empty and may often be alleviated by eating. Nevertheless, diagnosing any type of peptic ulcer should never be based solely on factors such as pain. If a peptic ulcer is suspected, further tests and examinations are necessary for a conclusive diagnosis.
Another difference between gastric and duodenal ulcers is their healing time. Generally, gastric ulcers require a longer recovery period than duodenal ulcers. For this reason, a duodenal ulcer that does not show any sign of healing and is unresponsive to treatment could indicate a more serious condition, such as duodenal cancer. In this case, a biopsy is recommended in order to confirm or infirm the presence of cancerous cells in the ulcer.
Esophageal ulcers are a rare type of peptic ulcer. The most common cause of esophageal ulcers is chronic gastroesophageal reflux disease (GERD), a condition in which gastric acid flows back into the esophagus and irritates the lining. Other infections and factors which may lead to the development of this type of ulcer include:
- Candida species
- Herpes virus (HSV)
- Human papillomavirus (HPV)
- Frequent vomiting
- Excessive intake of nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen
A weakened immune system can also increase the risk of esophageal ulcers when one or more of the previously mentioned causes are present. The main symptoms of esophageal ulcers are heartburn, difficulty swallowing, nausea, vomiting, coughing, abdominal pain, weight loss, and painful or uncomfortable swallowing. Esophageal ulcers are treated similarly to gastric and duodenal ulcers.
Symptoms of Peptic Ulcers
Peptic ulcers may not show any symptoms early on, but as they grow they can cause symptoms such as:
- Pain, discomfort, or a burning sensation in the upper region of the abdomen that may or may not decrease after eating
- Changes in appetite
- Blood in vomit and/or stool
- Chest pain
- Unexplained weight loss
- Bloating or feeling full
Diagnosis of Peptic Ulcers
Physical exams and the analysis of a patient’s medical history are not enough to diagnose peptic ulcers. Therefore, a series of tests are required in order to assign a proper diagnosis. These tests include:
Endoscopy: During this procedure, a thin hollow tube with a light attached (endoscope) is introduced through the patient’s mouth into the stomach or small intestines, allowing the doctor to determine whether a peptic ulcer is present or not.
Endoscopic Biopsy: If an ulcer is indeed detected during an endoscopy, a biopsy may also be performed. A biopsied tissue sample can be examined for the Helicobacter pylori bacteria or, in the case of duodenal ulcers, for cancerous cells.
Upper Gastrointestinal Series (barium swallow): The patient will first ingest a white liquid containing barium. The digestive tract will then become more visible on an imaging test, making a potential ulcer be easier to identify. A series of X-rays will be performed to confirm or infirm the presence of a peptic ulcer.
Laboratory Tests for Helicobacter pylori: If a Helicobacter pylori infection is suspected, its diagnosis may require a series of laboratory examinations, such as blood, stool, or breath tests. The latter is generally considered to be the most accurate method of detecting the presence of the bacteria. The breath test involves the patient ingesting a food or a drink containing radioactive carbon, which Helicobacter pylori will subsequently break down in their stomach if they are present. If the breath sample contains carbon dioxide, this is a clear indication that an infection is present.
Risk Factors of Peptic Ulcers
The following factors may increase one’s risk of developing a form of peptic ulcer. If the patient is already diagnosed, these risk factors are very likely to slow down or interfere with the recovery process:
Frequent intake of nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen: Long-term use of such medication can irritate and damage the gastrointestinal lining. The risk for peptic ulcer is even higher when these drugs are taken in combination with corticosteroids.
Excessive alcohol consumption: One of the effects of alcohol on the digestive system is irritation and erosion of its inner lining. Production of gastric acid also increases when one ingests alcohol, further affecting the gastrointestinal tract.
Smoking: Similar to alcohol consumption, smoking increases the risk of developing peptic ulcers. Although it does not directly affect the secretion of gastric acid, it does have a significant impact on the upper segments of the digestive system and can worsen preexistent ulcers to a great extent.
Infection with Helicobacter pylori: It is estimated that approximately two-thirds of the world's population has the heliobacter pylori bacteria in their digestive system. However, only 10% of those infected develop peptic ulcers. It is worth noting that the previously mentioned factors can further increase a person’s chances of developing gastric or duodenal ulcers if they already carry the bacteria.
A family history of peptic ulcers: Having a relative who has one or multiple cases of ulcers can increase one’s risk of developing ulcers in their lifetime.
Hypersecretory conditions: Chronic hypersecretory conditions, such as GERD, which involves an excessive production of gastric acid, are also among the risk factors for peptic ulcers, since a higher amount of acid in the gastrointestinal tract can irritate and erode its lining.
Causes of Peptic Ulcers
Peptic ulcers can be the result of one or a combination of the following factors:
- Long-term use of nonsteroidal anti-inflammatory medication, such as aspirin or ibuprofen
- Excessive alcohol consumption
- Helicobacter pylori infection
- Hypersecretory conditions such as GERD
Up until recently, it was believed that certain lifestyle and dietary choices, such as the consumption of caffeine and spicy food, could cause peptic ulcers. This is considered to be a myth. There is no scientific evidence to support the claim that a specific type of diet can cause peptic ulcers.
Although the standard treatment for peptic ulcers (antibiotics and stomach acid suppression medication) has proven to be very effective, there are also natural remedies which are believed to speed up and facilitate the healing process. Some of the most commonly used natural remedies for peptic ulcers include:
- Flavonoids: These naturally occurring compounds with gastroprotective properties can be found in fruits and vegetables such as legumes, soybeans, apples, kale, berries, red grapes, and green tea.
- Deglycyrrhizinated licorice: This remedy can help inhibit the growth of Helicobacter pylori in the digestive system.
- Probiotics: Bacteria and yeast that can be found in fermented foods such as sauerkraut, yogurt, and buttermilk are said to speed up the recovery process for patients with ulcers.
- Honey: A food with natural antibacterial properties and rich in antioxidants, which can reduce the growth of Helicobacter pylori.
- Cayenne Pepper: This seemingly counterintuitive remedy has proven to be effective in alleviating gastric ulcers due to its ability to inhibit the production of gastric acid, stimulate the secretion of alkali, and also boost mucus secretion, thus promoting a more rapid healing process.
Avoid long-term intake of nonsteroidal anti-inflammatory medication: Limiting your use of aspirin, ibuprofen, and other drugs in this category places you at a lower risk of developing peptic ulcers, as the gastrointestinal lining will not be subjected to unnecessary irritation and inflammation caused by the frequent intake of medication.
Limit your alcohol consumption: Since excessive and frequent alcohol consumption can increase the production of gastric acid and thus cause irritation of the stomach and intestinal lining, it is recommended not to drink more than one or two alcoholic beverages per day.
Do not mix medication with alcohol: Combining the previously mentioned risk factors can only aggravate their effects on the digestive system.
Avoid or quit smoking: Smoking has been proven to be a major factor in the development of esophageal ulcers. It is recommended to be completely avoided, or at least strictly limited.
Practice good hygiene: In order to avoid infection with Helicobacter pylori, maintaining healthy hygiene habits is essential. Wash your hands properly with soap and water before eating and after using the restroom, do not share eating utensils and glasses, and avoid overcrowded spaces when possible.