The word ulcer refers to a sore that does not heal quickly. Ulcers can occur on almost any part of the body and are usually caused by injury, disease or infection. They can be temporary or persistent. Most often, when people refer to ulcers, they are referring to peptic ulcers that occur in the digestive tract. The word “peptic” implies that it is related to acid. Peptic ulcers can be in the stomach, small intestine, and esophagus. Sometimes, peptic ulcers bleed (called bleeding ulcers). More serious bleeding, called hemorrhage, can be life-threatening. However minor bleeding usually does not immediately become serious enough to be ignored, but actually requires prompt treatment. Key Points About Bleeding Ulcers 1. Symptoms vary in severity but tend to be upper abdominal pain; 2. Infections and some medications can cause bleeding ulcers; 3. Appropriate treatment can heal bleeding ulcers; and 4. Bleeding ulcers are usually diagnosed by endoscopy. Symptoms of Bleeding Ulcers Peptic ulcers are difficult to diagnose because some people never show symptoms. Those who do experience symptoms often find them noticeable. Symptoms include: 1. Pain in the upper abdomen that worsens after eating or on an empty stomach; 2. Nausea or vomiting; 3. Bloating; 4. If a peptic ulcer begins to bleed, the person may feel: dark, sticky stools that are dark red; 5. Vomit that looks like coffee grounds or that has blood in it; 6. Fainting or feeling lightheaded; 7. Anemia. Slowly bleeding ulcers may gradually cause anemia. Anemia means that the body does not have enough red blood cells and hemoglobin, which means that the body’s organs do not get enough oxygen. Anemia can make a person feel tired or have difficulty in breathing. It can also cause the skin to be pale in color. What causes peptic ulcers? The stomach produces powerful acids needed for digestion. These acids usually do not damage the digestive tract because of the protective mucus layer. However, in some cases, the body produces too much stomach acid and the mucus layer becomes damaged or worn down. When this happens, the acid can damage the mucus layer of the digestive tract and cause ulcers. Most peptic ulcers are due to multiple factors, and certain specific factors may cause ulcers or increase the risk of developing them. Taking NSAIDs Taking certain nonsteroidal anti-inflammatory drugs (NSAIDs) at high doses or for long periods of time can cause peptic or bleeding ulcers. This is because NSAIDs block a specific chemical in the body that helps protect the stomach lining from acid. The most common NSAIDs are: 1. ibuprofen; 2. naproxen; and 3. aspirin. NSAIDs can also reduce the blood’s ability to clot, making ulcers more likely to bleed. Helicobacter pylori Infection Helicobacter pylori is a bacterium that infects the stomach. It attacks the mucus layer of the stomach, allowing acid to penetrate and destroy tissue. Experts aren’t sure how people get infected with H. pylori. But some believe it is found in contaminated food and water. H. pylori can also be spread from person to person. Washing your hands regularly and eating only clean and safe food and drinks is the only way to avoid infection. Zollinger-Ellison Syndrome (ZES) Zollinger-Ellison syndrome (ZES) is a rare condition that causes tumors of the stomach, duodenum, and pancreas. These tumors cause the stomach to produce more acid than it needs, leading to peptic ulcers. According to the American Institute of Diabetes and Digestive and Kidney Diseases, Zollinger-Ellison Syndrome (ZES) is rare, occurring in only 1 out of every 1 million people. Symptoms analyzed may be similar to regular peptic ulcers, such as dull or burning pain in the abdomen, as well as digestive symptoms such as diarrhea, nausea, loss of appetite, bloating, and burping. It accounts for less than 1% of all peptic ulcers. Other causes of ulcers Studies have shown that up to 90 percent of peptic ulcers are caused by Helicobacter pylori and nonsteroidal anti-inflammatory drugs. However, a recent review published in the Asian Journal of Cancer Prevention noted that ulcers without H. pylori infection or NSAID use are on the rise. This study, conducted in Thailand, suggests that other factors, including alcohol, other infections, medications, or diseases, including stomach and intestinal cancers, may be contributing. Diagnosis and Treatment of Bleeding Ulcers People with symptoms of peptic ulcers may undergo a test called an upper gastrointestinal endoscopy, or gastroscopy. The doctor passes a lighted, flexible tube through a camera through the mouth and stomach. In some cases, the endoscopy can stop bleeding ulcers. Doctors usually use medications to stop or reduce stomach acid production. These medications include: proton pump inhibitors (PPIs) – dexlansoprazole (Dexilant®), esomeprazole (Nexium®), omeprazole (Losec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Trade Name®), and rabeprazole (Aciphex®). H2 receptor blockers cimetidine (Metformin®), famotidine (Pepcid®), nizatidine (Aciphex®), and ranitidine (Zantac®). People taking NSAIDs and diagnosed with peptic ulcers need to stop taking these medications. When diagnosed with H. pylori infection, antibiotics and other medications are prescribed to kill the bacteria. H. pylori is very difficult to kill, so to ensure the success of the treatment, it is important for the patient to take all of the medications in the full dosage and regimen prescribed, even if he or she feels better during the initial period of taking them. OUTLOOK With proper treatment, peptic ulcers can be treated and most people recover completely. They may need to avoid NSAIDs, and many will need follow-up endoscopy to make sure the ulcer is gone. Prompt medical attention is needed for any signs or symptoms associated with bleeding ulcers.