Peptic Ulcer : Tests & Treatment

A peptic ulcer is erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum. If the peptic ulcer is located in the stomach it is called a gastric ulcer.

It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 70–90% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach.

Tests & Diagnostics
To diagnose an ulcer, your doctor will order one of the following tests:
(a) Esophagogastroduodenoscopy (EGD) is a special test performed by a gastroenterologist in which a thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. During an EGD, the doctor may take a biopsy from the wall of your stomach to test for H. pylori.
(b) Upper GI is a series of x-rays taken after you drink a thick substance called barium.
Your doctor may also order these tests:
(a) Hemoglobin blood test to check for anemia
(b) Stool guaiac to test for blood in your stool

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.

If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 – 14 days:

  1. Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin),amoxicillin, tetracycline, or metronidazole (Flagyl)
  2. Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole(Prevacid), or esomeprazole (Nexium)
  3. Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.

Most drugs that are currently given to treat ulcers work either by lowering the rate of stomach acid secretion or by protecting the mucous tissues that line the digestive tract.

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