Peptic ulcer

       Peptic ulcers -- open sores in the lining of the stomach, esophagus, or duodenum (the first part of the intestine -- are common. According to the American College of Gastroenterology, about 20 million Americans will develop an ulcer during their life. Contrary to popular belief, ulcers are not caused by spicy food or stress. Instead, a type of bacteria called Helicobacter pylori is usually to blame. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) can also cause ulcers.
Signs and Symptoms:

* Abdominal pain with a burning or gnawing sensation
* Pain 2 - 3 hours after eating
* Pain is often made worse by an empty stomach; nighttime pain is common
* Pain may be relieved by antacids or milk
* Heartburn
* Indigestion (dyspepsia)
* Belching
* Nausea
* Vomiting
* Poor appetite
* Weight loss
If you experience any of the following symptoms, it is considered an emergency and you should call your doctor immediately:
* Sudden increase in the abdominal pain or sharpness in the quality of the pain
* Vomiting blood or material that looks like coffee grounds
* Blood in your stool or black, tarry stools
Causes:
The lining of the stomach is usually protected from the damaging effects of stomach acid. When that protection fails, an ulcer forms. There are a few different ways this happens.
* Helicobacter pylori (H. pylori) -- H. pylori, a type of bacteria, is responsible for most ulcers. This organism weakens the protective coating of the stomach and first part of the intestine and allows damaging digestive juices to eat away at the sensitive lining below. As many as 20% of Americans over age 40 have H. pylori living in their digestive tract, but most do not develop ulcers.
* Nonsteroidal anti-inflammatory drugs (NSAIDs) – Long-term use of these pain relievers is the second most common cause of ulcers. These drugs block prostaglandins, substances in the stomach that help maintain blood flow and protect the area from injury. Some people are more susceptible to this side effect of NSAIDs than others. These drugs include ibuprofen (Advil, Motrin), naproxen (Aleve), and ketoprofen (OrudisKT), as well as prescription drugs. Some may be more likely to produce ulcers than others. If you must use long-term pain medications, talk to your doctor about which ones are safest.
Other causes of ulcers are conditions that can result in direct damage to the wall of the stomach or duodenum, such as heavy use of alcohol, radiation therapy, burns, and physical injury.

Medications

If you have H. pylori, you will probably be prescribed three medications. "Triple therapy," including a proton pump inhibitor to reduce acid production and two antibiotics, is commonly used to treat H. pylori-related gastritis and ulcers. Bismuth salicylate (Pepto-Bismol) may be used instead of the second antibiotic. This drug, available over the counter, coats and soothes the stomach, protecting it from the damaging effects of acid. Two-drug regimens are currently being developed.

Some of the same drugs are used for non-H. pylori gastritis as well as for symptoms (like indigestion) due to ulcers:

Antacids -- Available over the counter, they may relieve heartburn or indigestion but will not treat an ulcer. Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. It is recommended to take antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information. Antacids include:

* Aluminum hydroxide (Amphojel, AlternaGEL)
* Magnesium hydroxide (Phillips' Milk of Magnesia)
* Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta)
* Calcium carbonate (Rolaids, Titralac, Tums)
* Sodium bicarbonate (Alka-Seltzer)

H2 blockers -- reduce gastric acid secretion. They include:

* Cimetidine (Tagemet)
* Ranitidine (Zantac)
* Nizatidine (Axid)
* Famotidine (Pepcid)

Proton-pump inhibitors -- decrease gastric acid production. They include:

* Esomeprazole (Nexium)
* Lansoprazole (Prevacid)
* Omeprazole (Prilosec)
* Pantoprazole (Protonix)
* Rabeprazole (Aciphex)