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• What is a peptic ulcer?

• How do you get a peptic ulcer?
• What are the symptoms of a peptic ulcer?
• How is a peptic ulcer diagnosed?
• What is an endoscopy?
• How is the presence of H. pylori detected?
• How serious are peptic ulcers?
• What is the treatment for peptic ulcers that are
associated with H...
• What about surgery for a peptic ulcer?
• Are some peptic ulcers not associated with H.
pylori infection?
What is a peptic ulcer?

A peptic ulcer is a sore area or hole on the lining of the

digestive system. If it is in the stomach, it is referred to as a
gastric ulcer. If it is in the duodenum (the part of the small
intestine just after the stomach), it is called a duodenal
ulcer. Duodenal ulcers are more common than gastric
ulcers and usually occur in people aged under 50. Gastric
ulcers are more common in people aged over 50.

How do you get a peptic ulcer?

The two major causes of peptic ulcers are infection with
bacteria called Helicobacter pylori (H. pylori) or the long-
term use of medicines such as nonsteroidal anti-
inflammatory drugs (NSAIDs) or aspirin.
• H. pylori is thought to weaken the protective mucous
coating of the stomach and duodenum, allowing
stomach acid to get through and cause damage. Both
the acid and the bacteria irritate the stomach lining
and cause an ulcer. More than 9 out of 10 people with
a duodenal ulcer and 7 out of 10 with a gastric ulcer
are infected with H. pylori. However, there are many
people who are infected with the bacteria who do not
develop peptic ulcers.
• Long-term use of NSAIDs or aspirin also increases
the risk of a peptic ulcer, usually a gastric ulcer. These
drugs reduce the protection of the stomach lining
against damage by acid. See NSAIDS and stomach
ulcers for more information.
Other factors may affect the course of peptic ulcer disease:
for example, spicy food, caffeine and alcohol may irritate
peptic ulcers, and smoking may increase the time it takes
for an ulcer to heal. Stress probably does not cause peptic
ulcers, but does worsen symptoms if an ulcer is present.
This is because your stomach produces more acid in
response to stressful situations.
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What are the symptoms of a peptic ulcer?

Some people do not have any symptoms and may not
realise that they have a peptic ulcer. Mild symptoms are
sometimes mistaken for indigestion or heartburn. If you do
have symptoms, the most common ones are as follows:
• Gastric ulcers may cause constant stomach pain or
cramps, which are made worse by eating, loss of
appetite and weight loss, belching, nausea and
• Duodenal ulcers may cause pain in the area between
the breast-bone and the navel, which normally occurs
2–3 hours after eating. People with duodenal ulcers
may be woken early in the morning by a sharp pain
above the navel. Drinking milk or eating may help to
relieve the symptoms.
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How is a peptic ulcer diagnosed?

Your doctor can normally tell whether you are suffering
from a peptic ulcer based on the symptoms you describe.
However, you may be asked to have an endoscopy to
determine whether you have a gastric ulcer or duodenal
ulcer and to ensure that you do not have a more serious
problem. Tests will also be done to see whether H. pylori is
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What is an endoscopy?
During an endoscopy, a narrow, flexible tube with a fibre-
optic light and camera at the end, is placed into the mouth,
then the throat and into the stomach and duodenum. This
allows the doctor to see whether there is a gastric ulcer or
duodenal ulcer. If an ulcer is found, a small sample, or
biopsy, can be taken and analysed under a microscope to
look for H. pylori and also to check for cancer.
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How is the presence of H. pylori detected?

The presence of H. pylori can be detected in a number of
• Urea breath test. This involves you drinking a special
substance that is normally broken down by H. pylori. If
H. pylori is present in your stomach, it changes the
substance into a chemical that can be detected when
you breathe out.
• Blood test. Your body makes antibodies against H.
pylori, which can be detected in your blood.
• Stool test. Your faeces can be tested for antibodies to
H. pylori.
• Tissue test. If a sample of tissue is taken from the
stomach during endoscopy, this can be tested for H.
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How serious are peptic ulcers?

Severe peptic ulcers may be very painful and may bleed.
You should contact your doctor immediately if:
• You vomit blood. If an ulcer bleeds, or if the blood is
partially digested, the vomit may look rather like
ground coffee.
• You see blood in your faeces when you go to the toilet
(they are black or tar-like in colour).
• You suffer sudden severe abdominal pains.
These symptoms indicate a serious problem. The ulcer
may have caused damage to a blood vessel, causing
bleeding, or may have made a hole through the stomach or
duodenal wall (perforation). Another complication of peptic
ulcers is a blockage of the digestive system (intestinal
obstruction), usually in the area where the stomach and
duodenum meet. As ulcers heal, they may leave scar
tissue, which can block the path of food out of the stomach,
resulting in vomiting.
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What is the treatment for peptic ulcers that

are associated with H. pylori?
If you have a peptic ulcer and are infected with H. pylori,
treatment consists of an antibiotic regimen to get rid of the
bacterium and a proton pump inhibitor (PPI) to reduce the
amount of acid in the stomach and enable the ulcer to heal.
The treatment is often called ‘triple therapy’ because it
involves three medicines: two antibiotics and the PPI. An
example of triple therapy consists of:
• Amoxycillin 1 g, clarithromycin 500 mg and PPI all
taken twice daily for 1 week.
For most people, one week of treatment is enough to get
rid of H. pylori and encourage the ulcer to heal. However, in
some cases, you may need to continue taking an acid-
reducing medicine for a further 2–4 weeks.

H2-receptor antagonists are an older type of acid-reducing

drug, but it is less common to use these in regimens to
treat peptic ulcers.

Medical treatment to completely clear H. pylori from the

body is needed to stop ulcers coming back. It is therefore
important that you take your ‘triple therapy’ exactly as
prescribed by your doctor and that you complete the entire
course of treatment, even if you start to feel much better
and your symptoms go away.
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What about surgery for a peptic ulcer?

With the introduction of effective medicines, the need for
surgery in patients with peptic ulcers has been reduced. If
you experience severe bleeding from an ulcer, or the ulcer
has perforated the intestinal wall, you may require surgery.
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Are some peptic ulcers not associated with H. pylori

with my best wishes
Ayman Mohamed Gamil