Ulcer Disease

Causes

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

• Infection with a type of bacteria called Helicobacter pylori (H. pylori)
• Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.
• Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome).

Symptoms

• Abdominal pain
  
  • May wake you at night
  • May be relieved by antacids or milk
  • May occur 2 to 3 hours after a meal
  • May be worse if you don''t eat
• Nausea
• Abdominal indigestion
• Vomiting, especially vomiting blood
• Blood in stools or black, tarry stools
• Unintentional weight loss
• Fatigue

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding)
• Vomiting blood (that can look like "coffee-grounds")
• Weight loss
• Severe pain in the mid to upper abdomen

How Serious Is an Ulcer?

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:

• Bleeding
• Perforation (a hole through the wall of the stomach)
• Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine.

Taking NSAIDs can cause any of the above symptoms without warning. The risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.

Who Is More Likely to Get Ulcers?

You may be more likely to develop ulcers if you:

• Are infected with the H. pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen, or naproxen
• Have a family history of ulcers
• Have another illness such as liver, kidney, or lung disease
• Drink alcohol regularly
• Are 50 years old or older

Treatments

For people with Helicobacter pylori infection, the main goal is to get rid of the bacteria that causes the infection. Many different medicines work. They usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics.

After you finish your medicines, your doctor will likely order a test to make sure that the H. pylori infection is gone.

Those who do not have an H. pylori infection may be prescribed ulcer-healing medications such as antacids, H2 receptor antagonists, or proton pump inhibitors. Long-term treatment may be needed.

If the ulcer bleeds, endoscopy can control bleeding in most cases.

Surgery may be recommended for persons who do not respond to medicines or endoscopy. Surgical procedures for gastric ulcers include:

• Vagotomy -- cuts the vagus nerve, which controls the stomach''s production of gastric acid 
• Partial gastrectomy -- removes part of the stomach

Self-help measures include eating several small meals a day at regular time periods and avoiding the following:

• Smoking
• Tea, coffee, and soft drinks containing caffeine
• Alcohol
• Aspirin and NSAIDs

Sources

http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease

http://www.nytimes.com/health/guides/disease/gastric-ulcer/overview.html?inline=nyt-classifier