What A Gastroenterologist Wants Patients To Know About Peptic Ulcer Disease

Many of us are familiar with stomach bloat and indigestion, particularly after eating a large meal or too much fried food. You pop an antacid, or maybe drink something fizzy for relief. Sometimes, however, the feeling that your stomach is on fire can be a symptom of something worse — a peptic ulcer. Peptic ulcers (or stomach ulcers) can make you feel bloated or extremely full, or you could experience heartburn or nausea. Some people with peptic ulcers might not know they have them because they have no symptoms. In more severe cases, peptic ulcers could make you feel faint or make it difficult to breathe. 

Dr. Kenneth Brown is a renowned gastroenterologist in Plano, Texas, and the host of the Gut Check Project podcast. He tells us why we should be concerned if we have symptoms of a peptic ulcer as well as the risk factors for developing them. "Peptic ulcers are open sores that can develop in the upper part of the digestive tract, causing various symptoms such as stomach pain, upset stomach, and internal bleeding," Dr. Brown explains.

Dr. Brown says that there are two types of peptic ulcers to be aware of: gastric and duodenal. Gastric ulcers form on the stomach's lining, and duodenal ulcers occur in the lining of the small intestine. Although peptic ulcers can heal on their own, some people develop peptic ulcer disease. If your stomach pain is accompanied by vomiting or dark stools, you should see a doctor to prevent further complications.

"One of the most serious complications of peptic ulcers is internal bleeding, which can cause dark or bloody stools and lead to anemia if severe enough," Dr. Brown explains. "Another dangerous complication is perforation, which occurs when the ulcer gets so deep that it creates a hole in the stomach or intestine, leading to infection or even sepsis." Other complications include infection or blockage of the digestive tract.

Diagnosing a peptic ulcer could require blood tests, imaging tests, or an endoscopy. Dr. Brown adds that it's important to detect and treat a peptic ulcer disease early before it becomes dangerous.

For the most part, the treatments for peptic ulcers are non-invasive, and people can recover fully from them. "Treatment options may include medications to reduce stomach acid, antibiotics to fight infection, and lifestyle changes such as avoiding certain foods and drinks that can irritate the ulcer," Dr. Brown explains. "In some cases, endoscopic treatment may be necessary to repair the ulcer."

Brown says the two most common causes of peptic ulcers are bacterial infection and frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs). "Helicobacter pylori [bacteria] can increase the amount of acid in the stomach and small intestine, cause inflammation of the lining of the digestive tract and break down the protective mucus layer," Dr. Brown explains. Just because you have these bacteria in your stomach, however, it doesn't necessarily mean you'll develop ulcers.

Dr. Brown says that NSAIDs contribute to ulcers because they irritate the stomach's lining and can change the digestive tract's protective mucus layer. He adds that the type of NSAIDs, how frequently you take them, and how long you take them can determine your risk of peptic ulcers. You're also more at risk for peptic ulcers if you smoke cigarettes, or have a family member who has them. Dr. Brown notes that while alcohol use doesn't cause peptic ulcers, it can slow their healing.

Although many people believe that stress causes ulcers, Dr. Brown says the research shows conflicting arguments. "While there is some evidence that psychological factors such as stress, anxiety, and depression may contribute to the development of ulcers, impaired healing, and increased recurrence, the exact relationship is not yet fully understood," he explains. That's because there are many other potential contributing factors to peptic ulcer disease, and stress is often difficult to measure in research.