Peptic ulcer

Diagnosis

To diagnose an ulcer, your doctor will typically begin by taking your medical history and conducting a physical examination. They may then recommend several diagnostic tests, including:

• Laboratory tests for H. pylori: These tests aim to determine whether the bacterium H. pylori is present in your body. Your doctor may use a blood, stool, or breath test, with the breath test being the most accurate. For the breath test, you consume a substance containing radioactive carbon, which is broken down by H. pylori in your stomach. Afterwards, you blow into a sealed bag, and if you’re infected, your breath sample will contain radioactive carbon in the form of carbon dioxide. It’s important to inform your doctor if you’re taking antacids before the H. pylori testing, as they can lead to false-negative results.
• Endoscopy: In this procedure, your doctor examines your upper digestive system using a flexible tube with a lens called an endoscope. The endoscope is inserted through your throat and into your esophagus, stomach, and small intestine. By visual inspection, your doctor can identify ulcers. If an ulcer is found, a small tissue sample (biopsy) may be taken for further examination in a laboratory. This biopsy can also determine the presence of H. pylori in your stomach lining. Endoscopy is particularly recommended if you are older, show signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing. Even if your symptoms improve, a follow-up endoscopy should be performed after treatment to ensure ulcer healing.
• Upper gastrointestinal series (barium swallow): This series of X-rays provides images of your esophagus, stomach, and small intestine. You will be asked to swallow a white liquid containing barium, which coats your digestive tract and enhances the visibility of ulcers during the X-ray procedure.

Treatment

Although ulcers have the potential to heal on their own, it is crucial not to ignore the warning signs. Without proper treatment, ulcers can lead to severe health complications such as bleeding, stomach wall perforation, and gastric outlet obstruction. If you experience ulcer-related bleeding, your doctor may perform an endoscopy procedure to treat it. This can involve injecting medications into the ulcer, using a clamp, or cauterizing (burning) the tissue to stop the bleeding.

For most individuals, ulcers are treated with medications, which include:

• Proton pump inhibitors (PPIs): These drugs block acid production and promote healing. Examples of PPIs are omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium), and pantoprazole (Protonix). Prolonged use of high-dose PPIs may increase the risk of fractures in the hip, wrist, and spine. Consult your doctor about the potential benefits of calcium supplements.
• Histamine (H-2) blockers: Also known as acid blockers, reduce stomach acid production, relieving ulcer pain and aiding in healing. Famotidine (Pepcid AC), cimetidine (Tagamet HB), and nizatidine (Axid AR) are common acid blockers available both by prescription and over the counter.
• Antibiotics: If Helicobacter pylori (H. pylori) bacteria are present in the digestive tract, a combination of antibiotics may be prescribed to eradicate the infection. Antibiotics such as amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline, and levofloxacin may be used. The specific antibiotics chosen will depend on your location and current antibiotic resistance rates. Additionally, you may need to take a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol) to reduce stomach acid. The treatment duration is typically two weeks.
• Antacids: These medications neutralize stomach acid, providing rapid relief from ulcer symptoms. Antacids are available over the counter and can cause constipation or diarrhea as side effects. However, they are primarily used for symptom relief rather than ulcer healing.