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DEAR MAYO CLINIC: Last year, I was diagnosed with heartburn due to a peptic ulcer. My doctor suggested that I see a specialist. Who should I see, and what type of treatment is available?
ANSWER: Many people will note that they have "heartburn," and it is important to know that such a symptom could be related to one of several issues in the digestive tract, including peptic ulcer disease. This is where visiting with a health care professional who specializes in disorders of the gastrointestinal tract — a gastroenterologist — can help.
Once diagnosed and treated, ulcers usually heal within several months. But a gastroenterologist can help you find the underlying cause of your ulcer and decide on the best treatment going forward.
A peptic ulcer is an open sore on the inside lining of the stomach or the upper part of the small intestine. Peptic ulcers are not rare, and their frequency can depend on age, gender, other medical issues, medications and geography.
It's possible to have a peptic ulcer and not have any symptoms, although they may cause stomach pain. In some people, a peptic ulcer isn't identified until they experience symptoms related to a complication from an ulcer, such as bleeding or a hole in the lining of the stomach or bowel.
Before treatment, it is important to diagnose an ulcer definitively. Typically, peptic ulcers are diagnosed using a procedure known as endoscopy. For this test, your physician passes a small tube with a lens at the tip, called an endoscope, down your throat and into your esophagus, stomach and upper portion of the small intestine. This exam looks for peptic ulcers, and biopsies are taken if necessary.
Once a peptic ulcer has been identified, the underlying cause must be assessed. Two of the most common causes of these ulcers are nonsteroidal anti-inflammatory drugs, or NSAIDs, which include medications such as aspirin, ibuprofen and other related products, or an infection with a bacterium called Helicobacter pylori, or H. pylori. Other causes for peptic ulcers are rare.
H. pylori is a bacterium that can live in the mucous layer covering the lining of the stomach. It doesn't always lead to health problems, but it can sometimes trigger inflammation of the stomach's inner layer, producing an ulcer.
Certain tests, such as stool or breath tests, or biopsies taken when the ulcer is diagnosed, can help your health care professional determine if you have H. pylori. If you do, you must take antibiotic medications. To cure the infection completely, you must take the full course of antibiotics — usually for 10 to 14 days. In this situation, it is also important to be tested after the treatment is complete to ensure the bacterium has been eliminated.
NSAIDs can irritate or inflame the lining of your stomach and small intestine, leading to a peptic ulcer. Taking other medications along with NSAIDs, including steroids, anticoagulants or anti-platelet agents, can affect ulcer healing or worsen ulcer complications, such as bleeding. If medication may be to blame for your ulcer, your health care professional may recommend that you switch to a medication that is less likely to irritate your stomach and intestinal lining.
In addition to addressing the underlying cause of the peptic ulcer, you'll also need medication to help the ulcer heal. That usually involves taking a proton pump inhibitor. These medications help promote healing by reducing the amount of acid your stomach makes. Most people who have a peptic ulcer need to take a proton pump inhibitor for at least six to eight weeks, depending on the size, location and presumed cause of the ulcer.
While other medications, such as histamine receptor blockers, antacids and products that protect your stomach and intestinal lining, can be used to alleviate some symptoms caused by peptic ulcers, they typically are not enough by themselves to eliminate a peptic ulcer.
Make an appointment for a gastroenterologist to evaluate your condition. If left untreated, peptic ulcers can lead to serious complications. In most cases, though, these ulcers can easily be managed. — Dr. Amy Oxentenko, Gastroenterology, Mayo Clinic, Scottsdale, Arizona, and Mayo Clinic, Rochester, Minnesota
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