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DEAR MAYO CLINIC: I have had a peptic ulcer for about nine months. I’ve tried over-the-counter medicine and even antibiotics, but it’s not getting better. What do you recommend?
ANSWER: Nine months is a long time to treat a peptic ulcer. These ulcers usually heal within several months. If you haven’t already done so, consult with a health care provider who specializes in disorders of the gastrointestinal tract. He or she can help you find the underlying cause of your ulcer and decide on the best treatment going forward.
Peptic ulcers are open sores on the inside lining of the stomach or the upper part of the small intestine. 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 start to experience symptoms related to a complication from an ulcer, such as bleeding or a hole in the lining of the stomach or bowel.
Before starting treatment, it is important to diagnose an ulcer definitively. Typically, peptic ulcers are diagnosed using a procedure known as endoscopy. For this test, your health care provider 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. During the exam, he or she looks for peptic ulcers and, if necessary, takes biopsies.
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 drug, or NSAID, use, which includes medications such as aspirin, ibuprofen and other related products, or an infection with a bacterium called Helicobacter pylori, or H. pylori. While there are other causes of peptic ulcers, they 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 provider find out if you have H. pylori. If you do, you must take antibiotic medications. To get rid of the infection completely, you must take the full course of antibiotics — usually for 10 to 14 days.
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 and selective serotonin reuptake inhibitors, can affect ulcer healing or make the complications of ulcers (such as bleeding) worse. If your doctor suspects medication may be to blame for your ulcer, he or she may recommend you switch to an alternative medication that is less likely to irritate your stomach and intestine 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 and location of the ulcer.
While other medication (such as histamine receptor blockers, antacids, and products that protect your stomach and intestine lining) can be used to alleviate some symptoms caused by peptic ulcers, alone they typically are not enough to eliminate a peptic ulcer. In almost all cases, they must be combined with a proton pump inhibitor for an ulcer to heal.
Make an appointment to have your condition evaluated by a gastroenterologist. If left untreated, peptic ulcers can lead to serious complications. In most cases, though, these ulcers can be managed. — Dr. Amy Oxentenko, Gastroenterology, Mayo Clinic, Rochester, Minnesota