Peptic Ulcer Disease and H. pylori National Digestive Diseases Information Clearinghouse What is a peptic ulcer? Ulcer A peptic ulcer is a sore on the inner lining of the stomach or duodenum—the first part of the small intestine. Less commonly, a peptic ulcer may develop just above the stomach in the esophagus—the organ that connects the mouth to the stomach. Esophagus What causes peptic ulcer Stomach disease? Pancreas Causes of peptic ulcer disease include Duodenum • an infection with the bacteria Helicobacter pylori (H. pylori) Small intestine • long-term use of nonsteroidal anti- inflammatory drugs (NSAIDs), such as aspirin and ibuprofen A peptic ulcer is a sore on the inner lining of the • rarely, cancerous or noncancerous stomach or duodenum. tumors in the stomach, duodenum, or pancreas What are H. pylori? Who is more likely to develop an H. pylori-induced H. pylori are spiral-shaped bacteria that can cause peptic ulcer disease by damaging the peptic ulcer? mucous coating that protects the lining of A person who has contracted an H. pylori the stomach and duodenum. Once H. pylori infection is more likely to develop an have damaged the mucous coating, powerful H. pylori-induced peptic ulcer. Researchers stomach acid can get through to the sensitive are not certain how H. pylori infection lining. Together, the stomach acid and spreads, although they think that H. pylori irritate the lining of the stomach or contaminated food, water, or eating utensils duodenum and cause a peptic ulcer. may spread the infection. Researchers have found H. pylori in the saliva of some infected people, which suggests that infection could spread through direct contact with saliva or other bodily fluids.1 Most people contract Seek Immediate Care H. pylori infection during childhood, and it remains dormant for years. Adults rarely A person who has any of the following contract H. pylori. symptoms should call a health care provider right away: What are the signs and • difficulty breathing symptoms of peptic ulcer • dizziness or feeling faint disease? • red blood in the stool or black stools A dull or burning pain in the stomach • red blood in vomit or vomit that is the most common symptom of peptic looks like coffee grounds ulcer disease. A person can feel this pain • sharp, sudden, persistent, and severe anywhere between the navel and the stomach pain breastbone. The pain usually These symptoms could be signs of peptic • occurs when a person’s stomach is ulcer disease complications. empty—such as between meals or during the night • lessens briefly after eating food or taking antacids What are the complications • lasts for minutes to hours of peptic ulcer disease? • comes and goes for several days, weeks, Complications of peptic ulcer disease include or months • internal bleeding—when gastric acid or Other, less common symptoms include a peptic ulcer breaks a blood vessel • bloating • obstruction—when a peptic ulcer blocks the path of food trying to leave the • burping stomach • changes in appetite • perforation—when a peptic ulcer grows • nausea deeper and breaks completely through • vomiting the stomach or duodenal wall • weight loss • peritonitis—when infection or inflammation develops in the peritoneum, or lining of the abdominal cavity 1Momtaz H, Souod N, Dabri H, Sarshar M. Study of Helicobacter pylori genotype status in saliva, dental plaques, stool and gastric biopsy samples. World Journal of Gastroenterology. 2012;18(17):2105–2111. 2 Peptic Ulcer Disease and H. pylori How is peptic ulcer disease The breath test and stool test detect H. pylori more accurately than the blood diagnosed? test, so some health care providers prefer A health care provider diagnoses peptic ulcer to use one of these two tests. Testing is disease based on important because health care providers • a medical history treat H. pylori-induced peptic ulcer disease differently from peptic ulcer disease caused • a physical exam by NSAIDs. • lab tests Read more in Peptic Ulcer Disease and • upper gastrointestinal (GI) endoscopy NSAIDs at www.digestive.niddk.nih.gov. • upper GI series Blood test. A blood test involves drawing a • computerized tomography (CT) scan sample of a patient’s blood at a health care provider’s office or a commercial facility Medical History and sending the sample to a lab for analysis. Taking a medical history may help a health The blood test can show the presence of care provider determine the cause of a peptic H. pylori. ulcer. If a patient has peptic ulcer disease Urea breath test. For a breath test, the symptoms, the health care provider will ask patient swallows a special liquid that about the patient’s use of over-the-counter contains urea—a waste product the body and prescription NSAIDs. produces as it breaks down protein. If Physical Exam H. pylori are present, the bacteria will convert the urea into carbon dioxide. A A physical exam may help the health care nurse or technician will take samples of a provider diagnose the cause of peptic ulcer patient’s breath at a health care provider’s disease. During a physical exam, a health office or a commercial facility and send the care provider usually samples to a lab to measure the level of • checks for abdominal bloating carbon dioxide. • listens to sounds within the abdomen Stool test. A stool test is the analysis of a using a stethoscope sample of stool. The health care provider will give the patient a container to take • taps on the abdomen checking for home for catching and storing the stool. tenderness or pain The patient returns the sample to the health Lab Tests care provider or a commercial facility, and it is sent to a lab for analysis. Stool tests can A health care provider will look to see if show the presence of H. pylori. H. pylori are present using one of three simple tests: • blood test • urea breath test • stool test 3 Peptic Ulcer Disease and H. pylori Upper Gastrointestinal Upper Gastrointestinal Series Endoscopy Upper GI series is an x-ray exam that Upper GI endoscopy is a procedure that uses provides a look at the shape of the upper GI an endoscope—a small, flexible camera with tract to help diagnose peptic ulcer disease. a light—to see the upper GI tract. A health An x-ray technician performs this test at care provider performs the test at a hospital a hospital or an outpatient center, and a or an outpatient center. The health care radiologist—a health care provider who provider carefully feeds the endoscope down specializes in medical imaging—interprets the patient’s esophagus and into the stomach the images. This test does not require and duodenum. The small camera built into anesthesia. A patient should not eat or drink the endoscope transmits a video image to a before the procedure, as directed by his or monitor, allowing close examination of the her health care provider. Patients should GI lining. A health care provider may give a ask their health care provider about how to patient a liquid anesthetic to gargle or may prepare for an upper GI series. spray anesthetic on the back of the patient’s During the procedure, the patient will throat before inserting the endoscope. A stand or sit in front of an x-ray machine and health care provider will place an intravenous drink barium, a chalky liquid that coats the (IV) needle in a vein in the arm to administer esophagus, stomach, and small intestine so sedation. Sedatives help patients stay relaxed the radiologist and health care provider can and comfortable. The test may show signs see the shape of these organs more clearly on of inflammation or erosions in the stomach the x rays. lining. A patient may experience bloating and The health care provider can pass tiny tools nausea for a short time after the test. For through the endoscope to several days afterward, barium liquid in • take photos of the peptic ulcer. the GI tract causes white or light-colored stools. A health care provider will give the • obtain a biopsy of the lining of the patient specific instructions about eating and stomach or small intestine. A biopsy drinking after the test. is a procedure that involves taking a small piece of tissue for examination Read more in Upper GI Series at www. with a microscope by a pathologist—a digestive.niddk.nih.gov. health care provider who specializes in examining tissues to diagnose diseases. Computerized Tomography Scan The patient will not feel the biopsy. The Computerized tomography scans use test can show the presence of H. pylori. a combination of x rays and computer • inject medications that help the blood technology to create images. For a CT scan, clot. a nurse or technician may give the patient a solution to drink and an injection of a • stop any bleeding with an electrical special dye, called contrast medium. CT probe or special medications. scans require the patient to lie on a table that Read more in Upper GI Endoscopy at www. slides into a tunnel-shaped device that takes digestive.niddk.nih.gov. the x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need 4 Peptic Ulcer Disease and H. pylori anesthesia. CT scans can help diagnose a • esomeprazole (Nexium) perforated peptic ulcer. • dexlansoprazole (Dexilant) While PPIs cannot kill H. pylori, they do help How is an H. pylori-induced antibiotics fight the H. pylori infection. peptic ulcer treated? A health care provider will treat an H. pylori- Histamine Receptor Blockers induced peptic ulcer with Histamine receptor blockers are medications that work by blocking histamine, a substance • antibiotics that stimulates acid production.