An ulcer forms when the innermost lining of the stomach erodes and prolonged erosion creates a sore or internal wound. In general, ulcers are referred to as “peptic ulcers,” however, there are specific names for ulcers affecting particular areas.

When an ulcer forms in your stomach, it is called a gastric ulcer. If an ulcer appears inside the duodenum - the first 10 centimeters of your small intestine – it is called a duodenal ulcer. A third type of ulcer can form on the esophagus, or food pipe and is called an esophageal ulcer.

How Ulcers Progress

An ulcer becomes increasingly threatening the longer it goes untreated. Erosion can perforate or pierce the stomach lining, forming a hole. Holes are rare, but they have been seen deep enough to perforate the whole stomach wall, leading to a leakage of stomach contents, including harsh acids. The acid can then leak into the abdomen, which puts someone at risk of an abdominal infection, also called peritonitis. 

Another risk forms when the ulcer erodes a blood vessel. When this happens, the blood vessel punctures causing internal bleeding. Bleeding can be trivial or severe, depending on how much blood escapes. Complications from prolonged bleeding include impaired circulation and a struggle to carry oxygen to the body's cells, which can result in anemia.

Once the bleeding stops, scar tissue typically builds up. The scar tissue seals the eroded blood vessel but blocks the gastrointestinal tract. The space inside the tract (called the lumen) becomes obstructed, making eating and digestion difficult and vomiting likely. A person might lose weight and the implications can be fatal.

By the time any of the above progressions have developed, a person is dealing with a medical emergency. There is another risk of an ulcer: stomach cancer.  

Ulcers form when stomach acid erodes the lining along the gastrointestinal tract.

A bacterium called Helicobacter pylori could be responsible for the erosion; H, pylori causes 80 to 90 percent of all peptic ulcers.

H. pylori is a widespread bacterium that usually causes no symptoms in carriers. This is because H. pylori is constantly moving, trying to get away from the harsh acid and peptic fluids inside the stomach. Only when the bacteria escape the space inside the stomach to the protective mucus lining, do they begin to cause gastrointestinal inflammation. Such inflammation can become discomforting, and in severe cases it can cause an ulcer.

However, the H. pylori alone will not cause an ulcer. To understand this, imagine the slimy protective mucus layer coating your gastrointestinal tract. The mucus layer is strengthened by a hormone called prostaglandin. Pain relievers and anti-inflammatory medicine can disrupt the production of prostaglandin making the stomach lining more vulnerable to acid.

Doctors have learned that H. pylori are also associated with stomach cancer; sometimes a patient will have an ulcer and cancer. Scientists have yet to figure out why cancer, ulcers, and H. pylori are linked.

Smoking and excess alcohol consumption can also weaken the stomach lining and cause an ulcer. In addition, extreme stress can cause the stomach to secrete more acid.  In certain cases, a medical condition called Zollinger-Ellison syndrome can stimulate acid production – called hypersecretion – and have the same effect as high stress levels.  Zollinger-Ellison syndrome is caused by a tumor in the pancreas that stimulates hypersecretion.

Risk Factors

People who are at high risk for developing an ulcer are those that smoke, consume excess alcohol, or have high stress levels. Patients who recently used artificial respiration, underwent surgery, or experienced a prolonged hospitalization are also prone to ulcers because of potential high stress levels and weakened immune systems. 

Ulcers are common among people who often take anti-inflammatory and pain medicine. If you take pain medicine often for a medical reason, such as chronic backache or joint pain, be careful. You might want to monitor how much medicine you take, as these can weaken your stomach lining.

Finally, people who have had ulcers in the past are at risk for another one in the future.

If your doctor suspects you have an ulcer, he will give you a milky drink with the chemical element barium. The barium causes an ulcer to show up on X-ray scans. 

Your doctor may also test for an ulcer by inserting a small camera into your gastrointestinal tract. The camera enters your mouth, esophagus, and then stomach on a flexible tube that contours to your body.

Testing for H. Pylori Infection

If your doctor thinks H. pylori are causing your ulcer, he will test for an infection by taking a blood sample to see if antibodies associated with H. pylori are present.

The doctor may also order a breath test. You will drink a solution of radioactive carbon and, if your stomach is infected with H. pylori, the radioactive carbon will be detected in your breath. 

Finally, the doctor might also take a stool sample to look for protein markers, called antigens.  An antigen is a toxic substance that causes an immune response in a patient. Their presence indicates a foreign substance, like H. pylori, is present.

It takes four to eight weeks for an uncomplicated ulcer to heal. Your doctor will prescribe a combination of medicines to target the stomach acid, such as acid suppressants and antacids (sodium bicarbonate and calcium carbonate), which neutralize stomach acid.

Cytoprotective medicine, which protects your cell membranes, can strengthen your gastrointestinal mucus layer to protect from acid. Cytoprotective drugs include sucralfate (which forms a coating on your mucus lining) and misoprostol (which protects against erosion). These drugs are especially important in patients who use pain medicine frequently.

Another drug called a proton pump inhibitor (PPI) can block the secretion of acid into your stomach.  These PPIs include omeprazole, pantoprazole, rabeprazole, and lansoprazole. Your doctor could also prescribe a type of drug called an H2 blocker. H2 blockers stimulate acid production while blocking production of histamine — a substance produced by your immune system as a response to an invasive substance. H2 blockers include ranitidine, famotidine, or cimetidine.

If you have an H. pylori bacterial infection, your doctor will likely prescribe a triple therapy, which includes H2 blockers, PPIs, and antibiotics to fight the bacterial infection. Antibiotics include clarithromycin, amoxicillin, or metronidazole. The regimen is safe and effective and should clear up your H pylori infection within 10 to 14 days.

Side effects of triple therapy can include an upset stomach, diarrhea, a metallic taste in the mouth, headache, a dark tongue, flushing, palpitations after consuming alcohol, and skin sensitivity to sunlight. Most patients do not consider the side effects serious enough to abandon treatment.

A stubborn ulcer that does not heal, even after 8 to 12 weeks of treatment, will need intensive therapy treatment.

To protect against developing an ulcer, quit smoking and limit alcohol intake. If you need to take an anti-inflammatory or pain killer for a medical condition, consult your doctor to learn of a healthy daily dose. Ask about alternative measures to control your pain.

It is important to relax and reduce your stress: try yoga or meditation.

You can prevent H. pylori infection by cooking food thoroughly and washing ingredients before consuming. Wash your hands before every meal and after every trip to the toilet, and remember to drink purified water. Ulcers are preventable if you take the necessary precautions.