Peptic Ulcer

Diagnosis

A proper diagnosis of peptic ulcers involves a combination of medical history, physical exam, and specialized tests. Your healthcare professional may use the following:

• Laboratory tests for H. pylori. Blood, stool, or breath tests can detect the presence of H. pylori. For the breath test, you consume a substance containing radioactive carbon. If H. pylori is present, your breath contains radioactive carbon dioxide. Antacids or antibiotics may affect results, so inform your healthcare professional.

• Endoscopy. A flexible tube with a tiny camera, called an endoscope, is passed through the throat into the esophagus, stomach, and small intestine. This allows the doctor to directly visualize ulcers. During endoscopy, a biopsy may be taken to examine tissue and test for H. pylori. Endoscopy is especially recommended for older adults, those with bleeding signs, unexplained weight loss, or difficulty eating. Follow-up endoscopy may be needed to confirm ulcer healing.

• Upper gastrointestinal series. Also known as a barium swallow, this X-ray series highlights the esophagus, stomach, and small intestine. Swallowing a barium-containing liquid makes ulcers easier to detect.

Treatment

Peptic ulcer treatment focuses on eliminating H. pylori if present, reducing stomach acid, and allowing the ulcer to heal.

Medicines may include:

• Antibiotics. Common options include amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline, and levofloxacin.

• Acid blockers. Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole reduce stomach acid. In hospital settings, PPIs may be given intravenously. Long-term use may increase fracture risk.

• H-2 blockers. Medicines like famotidine, cimetidine, and nizatidine help relieve pain and promote healing.

• Antacids. These provide fast symptom relief but do not heal ulcers. Side effects may include constipation or diarrhea.

• Cytoprotective agents. Prescription options such as sucralfate and misoprostol protect the stomach and small intestine lining.

Follow-up after treatment
Most peptic ulcers heal with appropriate therapy. Severe or persistent symptoms may require endoscopy to rule out other causes. For ulcers found during endoscopy, a follow-up endoscopy confirms healing.

Ulcers that fail to heal, called refractory ulcers, may result from:

• Not taking medications as prescribed
• Antibiotic-resistant H. pylori
• Frequent NSAID use

Less common causes include:

• Excess stomach acid (e.g., Zollinger-Ellison syndrome)
• Infections other than H. pylori
• Stomach cancer
• Conditions like Crohn disease

Treatment for refractory ulcers focuses on removing factors that prevent healing, trying alternative antibiotics, and lifestyle changes such as quitting smoking. Serious complications like bleeding or a perforation may require endoscopy or surgery, though surgery is much less common due to effective medications.