Peptic ulcers are holes in the lining of the stomach and
duodenum, usually caused by a
bacterial infection of
Helicobacter pylori. The stomach produces hydrochloric acid and
enzymes, including pepsin, that break down and digest food. A mucous layer coats the stomach and protects it from the
acid. Prostaglandins also aid in protecting the lining. When these defenses are not performing their job properly, acid
and pepsin eat away at the lining, forming an open sore called an ulcer.
H. pylori is a urease-enzyme-producing bacterium that decreases the stomach’s ability to produce mucous, making it prone to acid-damage and peptic ulcers. Although
H. pylori infection is found in many people, it does not cause ulcers in all of them. Not all ulcers are caused by this bacteria. Long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), such as aspirin, naproxen, and ibuprofen can also cause peptic ulcers.
The most common symptom of petic ulcer is abdominal pain that is dull, comes and goes over a period of time, may occur a few hours after eating or during the night, and is relieved by food and/or antacids. Weight loss, bloating and nausea are lesser indicators. Symptoms that require immediate medical attention include sharp, sudden, persistent stomach pain, bloody or black stools, or bloody vomit or vomit that looks like coffee grounds.
The laboratory diagnosis of peptic ulcers caused by H. pylori can be performed using a variety of different methods and specimen types. The most common laboratory test for diagnosing peptic ulcers is a blood test for the presence of antibodies to H. pylori. The presence of H. pylori antibodies means you have been infected at some time with this organism. A stool sample may be collected to look for the H. pylori antigen; however, this test is not appropriate for individuals who have blood in their stool. A breath test is also available that detects the enzyme activity of H. pylori. Some invasive procedures may be used to diagnose an ulcer. These include an upper GI series that involves taking x-rays of the GI tract and endoscopy, in which a tiny camera on the end of a thin tube is fed through the mouth, down the esophagus, to the duodenum. If tissue is removed from the stomach during the endoscopy (a biopsy), it may be examined in the lab for the presence of active H. pylori infection and associated stomach damage (gastritis).
Peptic ulcers are rarely fatal, but if they penetrate the stomach or duodenal wall (perforation), break a blood vessel (hemorrhage), or block food leaving the stomach (obstruction), they can be very serious. Treatment usually involves a combination of antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced.
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