How do you determine if you have an ulcer and what is the best medicine for it?

— Rip torn

Dear Rip torn,  

Ulcers can be a real pain in the gut! An ulcer is an open sore in the stomach or intestinal lining. The most common, the peptic ulcer, occurs in the stomach (gastric or stomach ulcer) and in the duodenum (duodenal ulcer). They’re often uncomfortable, causing stomach pain and, in some cases, bleeding. That being said, symptoms do vary, with some folks experiencing none. The two leading causes of peptic ulcers are bacterial infection and frequent use of certain pain relievers. The good news is that treatments such as lifestyle changes and medications can be helpful depending on the cause of the ulcer. Keep reading for more on the what, where, and ultimately, how to clear up an ulcer.  

So first, how does an ulcer develop? One common culprit is a Helicobacter pylori (H. pylori) bacterial infection that can cause damage to the stomach and duodenum lining. The bacteria can spread by contact with unclean food, water, utensils, and the bodily fluids of an infected person. Another common cause is use of certain painkillers such as aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAID), though there are a few others that can contribute to this risk as well. These medications work by blocking certain enzymes that promote pain. However, these same enzymes also produce another chemical that protects the lining of the stomach, making people who use painkillers frequently vulnerable to developing an ulcer. While they don’t cause ulcers, it’s worth mentioning that certain lifestyle factors, such as stress, alcohol consumption, eating spicy foods, and smoking can make symptoms worse or slow the healing process.  

To determine if you have an ulcer, it’s best to look out for symptoms (although about 75 percent of those who have peptic ulcers don’t have any). You might look out for burning pain in the abdomen, particularly early in the morning, late at night, or between meals (when the stomach is empty). Sometimes, a person will also experience belching, heartburn, bloating, nausea, and sensitivity to fatty foods. More severe symptoms include vomiting, changes in appetite, weight loss, fainting, and troubled breathing. With a bleeding ulcer, you may experience blood in vomit or in the stool, which can appear as red or black.  

If you have any of these symptoms and are concerned that they may be due to an ulcer, it’s wise to talk with your health care provider. In addition to a physical exam and health history, they may also test for H. pylori bacteria or perform an endoscopy. Another possible test, called an upper gastrointestinal series, requires the patient to swallow a barium solution which highlights the stomach, esophagus, and intestine, making these organs easier to see via x-rays.  

If someone is diagnosed with an ulcer, the treatment depends on the cause. Those who have an ulcer caused by H. pylori may be prescribed antibiotics. For other causes, medications (prescription and over-the-counter) may be recommended to reduce or neutralize stomach acid as well as promote healing. Still, there are a number of lifestyle behaviors that can help relieve symptoms, such as eating a balanced diet, adding probiotics, using pain relievers not associated with ulcers (such as acetaminophen), not smoking, practicing healthy stress-coping, limiting or eschewing alcohol use, and getting enough Zzzs. Many of these lifestyle behaviors also serve as prevention methods to keep ulcers at bay. Some of these include being careful with the type of pain relievers and frequency of use, as well practicing proper hygiene to reduce the risk of infections.  

Here’s hoping this satisfied some of your questions about this pesky stomach issue. For more information on ulcers, you can check out the National Institute of Diabetes and Digestive and Kidney Diseases

Last updated May 07, 2021
Originally published Jan 26, 1996

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