How Are Peptic Ulcers Diagnosed
Your healthcare provider will look at your past health and give you a physical exam. You may also have some tests.
Imaging tests used to diagnose ulcers include:
- Upper GI series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe , stomach, and the first part of the small intestine . You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray.
- Upper endoscopy or EGD . This test looks at the lining of your esophagus, stomach, and duodenum. It uses a thin lighted tube called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your health care provider can see the inside of these organs. A small tissue sample can be taken. This can be checked for H. pylori.
You may also have the following lab tests to see if you have an H. pylori infection:
When To See The Doctor
Peptic ulcers will get worse if theyre not treated, so contact your doctor if you have symptoms or any signs that you could have one. Unfortunately, a lot of the time the way people find out they have an ulcer is by developing bleedstheyre taking a lot of aspirin or NSAIDS and they either start vomiting blood or have black tarry stool, says Marcus.
Your doctor may be able to diagnose a peptic ulcer by talking with you about your symptoms. Be sure to disclose the frequency of NSAID use.
However, some tests are usually used to confirm the diagnosis. For instance, to see if you have an H. pylori infection, your doctor will test your blood, breath or stool. They may also look inside your stomach and duodenum by doing an endoscopy or X-ray. An endoscopy is a procedure where a lighted tube is inserted through the throat and into the stomach to check for abnormalities.
What Causes A Peptic Ulcer
Causes of peptic ulcers include
- long-term use of nonsteroidal anti-inflammatory drugs , such as aspirin and ibuprofen
- an infection with the bacteria Helicobacter pylori
- rare cancerous and noncancerous tumors in the stomach, duodenum, or pancreasknown as Zollinger-Ellison syndrome
Sometimes peptic ulcers are caused by both NSAIDs and H. pylori.
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Diagnosis Of A Stomach Ulcer
Diagnosing a stomach ulcer is done using a range of methods, including:
- Endoscopy a thin flexible tube is threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer.
- Barium meal a chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable.
- Biopsy a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found.
- C14 breath test this checks for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women.
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Fast Facts On Stomach Ulcers
- Stomach ulcers are common in the West and easy to treat but can become serious.
- The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs .
- The classic symptom of a stomach ulcer is indigestion.
- Treatment for stomach ulcers normally focuses on removing the cause.
The classic symptom of a stomach ulcer is indigestion, also called dyspepsia.
Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.
Acid reflux or gastroesophageal reflux disease may cause heartburn. It occurs slightly higher up from the stomach, and people will feel it in the lower part of the chest.
Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague.
An ulcer also tends to produce a burning or dull pain in the center of the abdomen. People sometimes describe the pain as a biting or gnawing pain. Some individuals may describe a hungry sensation.
Individuals may also be able to relieve pain by eating, drinking, or taking antacids.
Some stomach ulcers go unnoticed and show no typical indigestion-type pains. These ulcers are less common, and doctors tend them after they have started bleeding.
Some ulcers can cause a hole in the stomach wall. Health experts call this perforation, which is a severe condition.
Stomach ulcer symptoms often change over time and can be difficult to spot.
Dietary changes can help prevent stomach ulcers from developing.
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Key Points About Peptic Ulcers
What Is Stomach Ulcer Surgery
Peptic ulcer surgery is an operation for repair of stomach damage that’s caused by an ulcer. A stomach ulcer is an erosion on the inside of the stomach lining, and it is also referred to as a peptic ulcer or a gastric ulcer. It can develop slowly, and you may have more than one at a time.
Approaches used in stomach ulcer surgery include:
- Laparotomy: An open procedure with a large abdominal incision
- Minimally invasive laparoscopic surgery: Involves a small abdominal incision and the use of a camera-equipped surgical device for visualization and repair
- Endoscopic procedure: A flexible tube is inserted into the throat and advanced down into the stomach to repair the ulcer with the assistance of a camera and surgical tools
This video has been medically reviewed by Anju Goel, MD, MPH.
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When Should I Go To Er
Seek emergency care if you have:
- Severe pain that doesnt go away.
- Signs of blood in your poop or bloody vomit.
- Signs of severe blood loss, such as paleness and faintness.
A note from Cleveland Clinic
Stomach ulcers are common and treatable, but they should be taken seriously. Even when they dont cause symptoms, they arent a good sign. A stomach ulcer means that your natural stomach acid is overwhelming your protective stomach lining. Thats a situation that can only get worse if it isnt managed. Lifestyle changes may help, but youll still need to treat the underlying cause. Its probably either NSAID use or a common bacterial infection. Your healthcare provider can help prescribe the right medicines for your condition.
How Are Stomach And Duodenal Ulcers Diagnosed In A Child
Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
Your childs treatment will also depend on whats causing his or her ulcer. For instance, ulcers caused by H. pylori need different treatment from ulcers caused by using NSAIDs.
Your childs healthcare provider will ask about his or her health history. He or she will also give your child an exam. Your child may need more tests before his or her ulcer is diagnosed.
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Other Causes And Factors
Other causes are rare. For example, some viral infections can cause a stomach ulcer. Crohns disease may cause a stomach ulcer in addition to other problems of the gut.
Stomach cancer may at first look similar to an ulcer. Stomach cancer is uncommon but may need to be ruled out if you are found to have a stomach ulcer.
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How Are Peptic Ulcers Treated
Treatment will depend on the type of ulcer you have. Your healthcare provider will create a care plan for you based on what is causing your ulcer.
Treatment can include making lifestyle changes, taking medicines, or in some cases having surgery.
Lifestyle changes may include:
- Not eating certain foods. Avoid any foods that make your symptoms worse.
- Quitting smoking. Smoking can keep your ulcer from healing. It is also linked to ulcers coming back after treatment.
- Limiting alcohol and caffeine. They can make your symptoms worse.
- Not using NSAIDs . These include aspirin and ibuprofen.
Medicines to treat ulcers may include:
- Antibiotics. These bacteria-fighting medicines are used to kill the H. pylori bacteria. Often a mix of antibiotics and other medicines is used to cure the ulcer and get rid of the infection.
- H2-blockers . These reduce the amount of acid your stomach makes by blocking the hormone histamine. Histamine helps to make acid.
- Proton pump inhibitors or PPIs. These lower stomach acid levels and protect the lining of your stomach and duodenum.
- Mucosal protective agents. These medicines protect the stomach’s mucus lining from acid damage so that it can heal.
- Antacids. These quickly weaken or neutralize stomach acid to ease your symptoms.
In most cases, medicines can heal ulcers quickly. Once the H. pylori bacteria is removed, most ulcers do not come back.
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What Should I Do If I Think I Have A Stomach Ulcer
Always seek medical care for a stomach ulcer. While you may be able to manage symptoms temporarily with over-the-counter medications, these wont heal the ulcer. You need to identify and treat the underlying cause. An untreated ulcer can lead to serious complications, even if your symptoms are mild. The major cause of stomach ulcers, H. pylori infection, can also lead to other complications.
What If I Still Need To Take Nsaids
If you take NSAIDs for other conditions, such as arthritis, you should talk with your doctor about the benefits and risks of using NSAIDs. Your doctor can help you determine how to continue using an NSAID safely after your peptic ulcer symptoms go away. Your doctor may prescribe a medicine used to prevent NSAID-induced ulcers called Misoprosotol.
Tell your doctor about all the prescription and over-the-counter medicines you take. Your doctor can then decide if you may safely take NSAIDs or if you should switch to a different medicine. In either case, your doctor may prescribe a PPI or histamine receptor blocker to protect the lining of your stomach and duodenum.
If you need NSAIDs, you can reduce the chance of a peptic ulcer returning by
- taking the NSAID with a meal
- using the lowest effective dose possible
- avoiding alcohol
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Youre More Bloated Than Usual
If you notice your stomach feeling particularly bloated, it may be more serious than a little bit of gasit could be one of the signs of an ulcer. According to RM Healthy, bloating is often one of the earliest ulcer symptoms, with patients especially complaining of pain in their midsection. Of course, bloating can also be caused simply by eating something your body doesnt agree with or not drinking enough water, but when combined with these other symptoms, its worth checking out.
How Is A Peptic Ulcer Treated
Some peptic ulcers heal on their own. But if you donât treat them, the ulcers tend to come back.
They can erode the blood vessel wall in your stomach or small intestine. The ulcers also can eat a hole through the lining and get infected. Or they can cause swelling, which may block food from moving from your stomach into your small intestine.
If H. pylori is the culprit, your doctor may prescribe a mix of antibiotics to kill it. If aspirin and other NSAIDs are behind the ulcer, you may need to cut down on them, stop taking them altogether, or switch to another pain reliever.
Your doctor may also give you antacids to fight stomach acid, or prescribe medicine to lessen the acid your body makes. Prescription drugs called cytoprotective agents can help protect the lining of the stomach or small intestine so the ulcer can heal.
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Your Appetite Went Mia
For many patients with ulcers, the condition can actually result in a loss of appetite. This drop in food intake, combined with occasional vomiting, may lead to unexpected weight loss. Some ulcer patients report eating their normal amount of food, yet still lose weight, so the ulcer itself may cause a drop on the scale, too.
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Burning Pain In Your Abdomen
This may seem like a no-brainer but the most common sign that people experience when they have a stomach ulcer is a persistent burning pain in their abdomen. This sensation occurs when juices in the stomach used for digestion come into contact with the open sore. For the most part, the pain is felt from the breastbone to navel and is often worse at night than during the day. On the other hand, if you are someone who frequently skips meals, you may find that you experience this pain much throughout the daytime.
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What Can You Do To Prevent A Stomach Ulcer
Stomach ulcers are not caused by stress or eating spicy foods. So, how can you prevent them?
- Protect yourself from H. pylori infection: While experts dont know exactly how this bacteria spreads, you can reduce your risk of infection by practicing good hand hygiene and cooking foods properly.
- Discuss your use of NSAIDs with your healthcare professional: Try to avoid long-term use of NSAIDS. If possible, try switching to a lower dose or consider using a different pain medication that doesnt cause ulcers.
- If you must take NSAIDs, take antacids, PPIs, or other acid blockers: These drugs can help protect the lining of your stomach from acid damage caused by some NSAIDS. Ask your doctor what they recommend for you.
- Avoid drinking alcoholic beverages if you take NSAIDS: Alcohol can increase the risk of stomach damage, especially if you take certain pain medications.
What Does A Stomach Ulcer Feel Like
The classic symptoms of peptic ulcers are stomach pain and indigestion. Ulcer pain feels like burning or gnawing inside your stomach, which is between your breastbone and your belly button. It may improve temporarily when you eat or drink or when you take an antacid, medication to reduce stomach acid. It may feel worse between meals and at night when stomach acid builds up without food to digest. It may also make you feel like you dont want to eat.
How do I know if I have an ulcer or gastritis?
Gastritis and gastric ulcers share many symptoms and often go hand in hand. Gastritis can be a precursor to stomach ulcers, caused by the same conditions that will eventually cause ulcers, including H. pylori infection and mucous erosion. You may also have both.
Both gastritis and stomach ulcers can cause stomach pain, as well as symptoms of indigestion. Usually, the pain from an ulcer will feel more localized like its coming from one particular spot. But since some ulcers are silent, you might not feel it if you do have one.
If you have symptoms of either gastritis or stomach ulcer, you should seek medical care. Gastritis can lead to ulcers if it hasnt already. It can also indicate an infection or other condition that needs to be treated. Medical testing can quickly determine the causes of your stomach pain.
How can I tell if I have ulcer pain or heartburn?
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When To Contact A Doctor
Anyone who thinks they may have an ulcer in their stomach should consult a doctor. Any stomach symptoms that last for more than a few days or keep happening need evaluation and treatment.
Symptoms of anemia, such as tiredness and breathlessness, may signal a slow-bleeding ulcer. More serious bleeding is an urgent medical problem, as people may vomit up blood, or stools are black and sticky.
Perforation is also an emergency. Without quick treatment, the wall of the stomach can become infected. Sudden stomach pain that gets worse can indicate perforation, and any signs of being very unwell with infection need treatment as soon as possible.
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Treatment Of Peptic Ulcers
Its really important to get the right treatment if youre diagnosed with a peptic ulcer. If treated properly, duodenal ulcers will heal in around four weeks and stomach ulcers in eight.
Treating the underlying cause lowers the chance of your ulcer coming back. This usually means getting rid of the H. pylori or stopping taking NSAIDs.
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How Bad Are Soft Drinks
People with peptic ulcers should avoid consuming foods and drinks that cause discomfort, including caffeinated soda, according to the U.S. National Library of Medicine.
According to a January 2015 review in the journal BioMed Research International, soft drinks may include ingredients you might not want to consume even if you dont have an ulcer, such as caffeine sugar or other sweeteners artificial coloring preservatives and flavorings like phosphoric acid.
The U.S. Centers for Disease Control and Prevention warns that sugar-sweetened beverages in general are a major cause of the overabundance of sugar in the American diet. These drinks have been linked to tooth decay, obesity, type 2 diabetes, heart disease, liver disease, gout and arthritis.
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A safe drink to reduce stomach acid symptoms is one you can make at home, Rubman says. Add ½ teaspoon of baking soda to 4 or 5 ounces of water and sip slowly. Baking soda is sodium bicarbonate, which strengthens the mucosal barrier in the stomach.
Bottom line: Avoid soft drinks if you have an ulcer.
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