Diagnosis And Treatment Of Peptic Ulcer Disease And H Pylori Infection
Am Fam Physician. 2015 Feb 15 91:236-242.
Patient information: See related handout on H. pylori and stomach ulcers, written by the authors of this article.
Dyspepsia is characterized by epigastric pain, discomfort, or a burning sensation.1 An important cause of dyspepsia is peptic ulcer disease , which includes gastric and duodenal ulcers. Although PUD is most commonly caused by Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs , other diagnoses should be considered .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Use the test-and-treat strategy for patients with dyspepsia who are younger than 55 years and have no alarm symptoms for gastric cancer. Use endoscopy for all other patients.
What If An Ulcer Doesnt Heal Or Comes Back After Treatment
- check for and treat any factors that could be causing the ulcer, such as an H. pylori infection.
- recommend you quit smoking, if you smoke. Smoking can slow ulcer healing.
- recommend or prescribe more medicines to help heal the ulcer.
What Is A Stomach Ulcer
A stomach ulcer, also called a gastric ulcer, is an open sore that develops in your stomach lining. You can also get one in your duodenum, the first part of the small intestine that your stomach feeds into. Duodenal ulcers and stomach ulcers are both types of peptic ulcers. Theyre named for pepsin, one of the digestive juices that are found in the stomach and that sometimes leak into the duodenum. These juices are a contributing factor in peptic ulcer disease.
Peptic ulcers occur when the protective mucous lining in your stomach and duodenum has been eroded, allowing gastric acids and digestive enzymes to eat away at your stomach and duodenal walls. This eventually results in open sores that are continually irritated by the acid. If left untreated, they can begin to cause serious complications, such as internal bleeding. Over time, they can even wear a hole all the way through. This is a medical emergency.
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What May Interact With This Medication
Do not take this medication with any of the following:
This medication may also interact with the following:
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
How Should I Use This Medication
Take this medication by mouth with a glass of water. Follow the directions on the prescription label. This medication works best if you take it on an empty stomach, 1 hour before meals. Take your doses at regular intervals. Do not take your medication more often than directed. Do not stop taking except on your care team’s advice.
Talk to your care team about the use of this medication in children. Special care may be needed.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
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Home Remedies For Peptic Ulcer
Pursuing conventional way of treating ulcer problems which leads to further complications in the digestive system we can take the route of homemade remedies mentioned below and lead a healthy life.
If Your Ulcer Was Caused By Helicobacter Pylori
Most stomach ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection. If this infection is not cleared, the ulcer is likely to return once you stop taking acid-suppressing medication. For more information, see the separate leaflet called Helicobacter Pylori.
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Alternative Therapy For Peptic Ulcer
The usage of medicinal plants in healing numerous diseases is as old as human beings, and well-known as phytotherapy. Moreover, in the past few years, there has been a rising interest in alternative therapies and the usage of herbal products, in particular, those produced from medicinal plants . Also, due to appearance of various side effects by usage of conventional drugs for numerous diseases, medicinal plants are considered the major reservoir of potentially new drugs. Plant extracts and their crude are the most significant sources of new drugs, and have been shown to cause promising results in the treatment of gastric ulcer as well . It is known that numerous pharmaceutical agents such as proton pump inhibitors, anticholinergics, antacids, antimicrobial agents, H2-receptor antagonists, sucralfate, and bismuth are not fully effective, and produce numerous adverse effects such as impotence, arrhythmia, hematopoietic alterations, hypersensitivity, and gynecomastia . Due to that, investigations of the new pharmacologically active agents through the screening of different plant extracts led to the discovery of effective and safe drugs with gastroprotective activity. Especially, plants with antioxidant capability as the main mechanism are used as the herbal reservoir for the treatment of ulcer disease .
Finally, the Ayurvedic knowledge and modern medicine could generate preferable antiulcer drugs derived from medicinal plants with less side effects .
What Are The Treatments For An Ulcer
You shouldnât treat an ulcer on your own without first seeing your doctor. Over-the-counter antacids and acid blockers may ease some or all of the pain, but the relief is always short-lived. With a doctor’s help, you can find an end to ulcer pain as well as a lifelong cure for it.
The chief goals of ulcer treatment are reducing the amount of acid in the stomach and strengthening the protective lining that comes in direct contact with stomach acids. If your ulcer is caused by bacterial infection, your doctor will also treat that.
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When To See A Doctor
If youre having ulcer symptomssuch as stomach pain, a gnawing feeling between meals or at night, a burning sensation beneath the breastbone, or black, tarlike stoolsask your doctor to test for the presence of the Helicobacter pylori bacterium. The infection can be detected with blood or breath tests. If you test positive, your doctor will probably put you on antibiotics for 1 to 2 weeks. In about 97% of cases, the ulcer never comes back. Its common for people with ulcers to have sewer breath long before they have other symptoms. If your breath has an unusually foul odor, it could be because youre infected with the H. pylori bacterium. Call your doctor.
Is Cheese Bad For Stomach Ulcers
Low-fat dairy Low-fat or fat-free milk, yogurt, and mildly flavored cheeses, such as cottage cheese, are all good options. Be careful, though. Lactose intolerance and milk protein intolerance are common reasons for GI discomfort in some people. And many experts recommend eliminating dairy to help treat peptic ulcers.
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Causes Of Ulcers Include:
- an infection with Helicobacter pylori bacteria
- long-term use of nonsteroidal anti-inflammatory medicines and ibuprofen
Stress and spicy food can also exacerbate the symptoms of an ulcer. Although they do not cause ulcers, they can make the situation worse by increasing the amount of stomach acid produced.
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Causes And Risk Factors
Stomach ulcers are most often caused due to:
- A bacterial infection caused by Helicobacter pylori.
- Long-term use of anti-inflammatory medications, like aspirin, ibuprofen, or naproxen.
- A medical condition called Zollinger-Ellison syndrome that increases the production of body acids.
The risk factors for stomach ulcers are:
- Age above 50 years
- A diet that consists of spicy foods
It is highly recommended to begin treatment as soon as you observe the onset of stomach ulcers. If left untreated, they may cause internal bleeding and become life-threatening. While mild to moderate ulcers may be healed with the remedies given here, severe cases need medical attention.
Stomach ulcers are like sores in the stomach that cause abdominal pain and discomfort. They are mostly caused due to poor lifestyle choices like smoking and drinking, spicy food, stress, infections, or certain medications. The most common signs of stomach ulcers include a dull pain that improves upon eating or taking antacids, acid reflux, bloating, nausea, loss of appetite from pain, heartburn, burping, and vomit resembling coffee grounds. You may be able to heal mild to moderate cases of stomach ulcers using the home remedies discussed here. However, urgent medical attention is needed for more severe cases as these ulcers can cause internal bleeding and become a life-threatening concern.
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Carrot And Cabbage Juice
Cabbage has many properties that can help with a stomach ulcer. It contains a good amount of vitamin C, which can help with your stomachs healing process. Cabbage also contains an amino acid that can help to increase blood flow to the stomach, which can also help stimulate healing. While carrot juice, on the other hand, contains vitamin U which has anti-peptic properties.
Chop half a cabbage and two carrots and place them into a blender or juicer and extract the juice. Drink a half cup of this juice before each meal and before bed. You may have to repeat this daily for a few weeks.
Try Cabbage To Treat Ulcers
Folk healers have traditionally advised people to drink cabbage juice during ulcer flare-ups. It might be worth a try because cabbage contains an amino acid called glutamine, which is thought to speed intestinal healing. Some alternative experts recommend juicing half a head of cabbage and drinking it once daily. Eating the same amount of raw cabbage will have similar effectsbut dont bother with cooked cabbage, because heat cancels the beneficial effects.
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How Is A Stomach Ulcer Diagnosed
To help diagnose a stomach ulcer, your doctor will ask you what medications you take or have been taking, and if you have had a peptic ulcer or any other relevant condition in the past. Make sure you mention all the medications you are taking, especially NSAIDs such as aspirin, ibuprofen, diclofenac, or ketorolac.
Your doctor will also conduct a physical examination, to check for bloating or lumps within your abdomen, and to listen for bowel sounds. Make sure you mention any areas of pain or tenderness.
Blood may also be taken to test for infection or anemia and testing may also be conducted for Helicobacter pylori, a bacteria commonly associated with stomach ulcers. Testing usually involves either a breath test, stool sample, or biopsy. To get a clear picture of the inside of your stomach and small intestines, doctors may use an endoscope , a series of X-rays and/or a CT scan.
Can You Treat An Ulcer Without An Endoscopy
There are several ways totreat stomach ulcers. These include taking over-the-counter medicines, using baking soda tablets, and so on. However, these treatments do not provide an effective cure.
Many people decide to treat their ulcers, both gastric and duodenal, on their own. These types of ulcers are easier to solve than other types of ulcers, but they can still be a problem. Thats why its essential to see your doctor before doing anything.
Some try to treat ulcers with acid-suppressing medications such as antacids or acid blockers. Unfortunately, many common over-the-counter medications are not only useless but may even make things worse.
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How Can I Look After Myself If I Have A Peptic Ulcer
As well as seeking help from a healthcare professional, there are things you can do to care for yourself:
- Eat a well-balanced diet and have regular meals.
- Eat smaller meals and eat your evening meal 34 hours before going to bed.
- Identify and avoid food and drinks that make the pain worse
- Antacids can offer short term relief and may help protect the lining of the stomach. You can buy antacids from your local pharmacy.
Home Remedies For Ulcer Pain
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How Do Doctors Diagnose A Stomach Ulcer
Your doctor will perform a physical exam and ask you about your medical history and any medications you may be taking. You may be asked to describe the stomach pain that you are feeling, for example, whether it is a dull pain or a sharp pain. If there is blood in your vomit or stool, this can also help them make an accurate diagnosis as these are common signs of stomach ulcers.
You might need tests like endoscopy, a procedure where they insert a long, thin, flexible tube with a camera on the end through your stomach to see what is going on, or an upper gastrointestinal series where you swallow barium, called a barium swallow, and they take an X-ray of the stomach and digestive tract. The doctor may also perform an endoscopic biopsy where they take a tissue sample from your stomach and analyze it. Blood, stool, and breath tests are also common to test for the H. pylori bacterium to ensure it is not an H. pylori infection.
How Soon After Treatment Will I Feel Better
If you take all medicines as prescribed and avoid irritating the ulcer with NSAIDs, alcohol or smoking, your ulcer should heal well within a few weeks. Surgical cases may take a few weeks more. Your healthcare provider will follow up with you at the end of your course of medication to make sure the ulcer has healed and any infection has cleared. They will probably take follow-up tests, including an upper endoscopy to look at the site of the ulcer and tests for H. pylori, if you had it, to make sure the infection is gone.
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When Should I Call My Healthcare Provider
See your healthcare provider right away if you have any of these symptoms:
- Vomiting blood or dark material that looks like coffee grounds
- Extreme weakness or dizziness
- Nausea or vomiting that doesnt get better, or gets worse
- A sudden, severe pain that may spread to your back
- Losing weight without even trying
Untreated peptic ulcers may cause other health problems. Sometimes they bleed. If they become too deep, they can break through your stomach.
Ulcers can also keep food from going through your stomach.
Causes Of Stomach Ulcers
H. pylori bacteria and a class of painkillers known as non-steroidal anti-inflammatory drugs are the two most common causes of stomach and small intestine ulcers.
Hyperacidity, or excess stomach acidity, and Zollinger-Ellison syndrome are two of the rarer causes of stomach ulcers. Many factors, including heredity, smoking, stress, and certain foods, can contribute to increased stomach acidity.
Extremely high levels of stomach acid are a symptom of Zollinger-Ellison syndrome, a rare disorder.
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What Tests Diagnose A Peptic Ulcer
To confirm a person has an ulcer a diagnostic imaging test will usually be ordered. The two most widely used tests are:
- Upper GI series : This is a type of X-ray. The patient is given a chalky liquid to drink that increases the contrast on the X-ray, making certain features easier to see. Because this liquid contains barium, this test is sometimes called a barium swallow.
- Endoscopy : An endoscope is a thin, flexible tube with a tiny camera at the end. The patient is given a mild sedative, and then the tube is passed through the mouth into the stomach. The doctor can see the lining of the stomach to diagnose a peptic ulcer. Tiny samples of the tissue will be taken , which are examined under a microscope.
If a diagnostic imaging test reveals an ulcer, the patient will most likely have a test to see if H pylori bacteria are present.
- It is important to be certain about this, because treatment of the H pylori is likely to heal the ulcer.
- Ulcers caused by H pylori are treated differently than ulcers caused by medications.
Three types of tests are available to detect H pylori.