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Peptic Ulcer Disease

Bleeding Ulcers: Symptoms and Causes

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Bleeding ulcers can originate from many places in the gastrointestinal tract. Some symptoms are obvious such as vomiting blood or abdominal pain, others may not be so obvious such as lightheadedness, fatigue, and feeling weak

It started with feeling a little run down after working extra hard, perhaps there was some lightheadedness when he stood too quickly, and then came the fatigue. The baseball world blamed Ichiro Suzuki's malaise on playing too much in the World Baseball Classic. This time of year, baseball players are supposed to lounge in spring training and gradually get themselves into shape, not play like it's the World Series in October. But the baseball world was wrong. It was discovered in April 2009 that Ichiro was tired because he was anemic and because he was bleeding from an ulcer.

The scenario plays out routinely off the playing field too often. A person feels run down and blames it on all sorts of circumstances, but finally presents to their doctor to get some help. The clues come from the history of heartburn and indigestion, or maybe it was the extra aspirin or ibuprofen to help with the stress headaches at work.

What is a peptic ulcer?

A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the stomach cells. Peptic ulcer disease is common, affecting millions of Americans yearly. The medical cost of treating peptic ulcer and its complications runs in the billions of dollars annually. Recent medical advances have increased our understanding of ulcer formation. Improved and expanded treatment options are now available.

What are the causes of peptic ulcers?

For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, treatment emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called "Helicobacter pyloricus" (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

H. pylori bacteria is very common, infecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. While the mechanism of how H. pylori causes ulcers is not well understood, elimination of this bacteria by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence.

NSAIDs are medications for arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this class of medications. Prostaglandins are substances which are important in helping the gut linings resist corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer medication treatment failure.

Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer disease.

Peptic Ulcer Illustration - Peptic Ulcer Disease


Next: What are symptoms of an ulcer? »

Peptic Ulcer - Symptoms At Onset Of Disease

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