How can gut ulcers be detected and then treated

Crohn's disease may cause a stomach ulcer in addition to other problems of the gut. Stomach cancer may at first look similar to an ulcer.

Stomach cancer is uncommon but may need to be 'ruled out' if you are found to have a stomach ulcer. If your doctor thinks you may have a stomach ulcer, the initial tests will include some blood tests. These tests will help to check whether you have become anaemic because of any bleeding from the ulcer.

The blood test will also check to see that your liver and pancreas are working properly. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management ; NICE Clinical Guideline Sept - last updated October Drini M ; Peptic ulcer disease and non-steroidal anti-inflammatory drugs.

Aust Prescr. Epub Jun 1. Hey everyone! It all started with a simple UTI. After being on countless antibiotics i was cleared Of UTI but still had most the symptoms, especially frequency! Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.

Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. In this series. In this article How common are stomach ulcers? Stomach ulcer symptoms Stomach ulcer treatment What about surgery? What happens after treatment? Complications of stomach ulcers are relatively uncommon, but they can be very serious and potentially life threatening.

Read more about the complications of stomach ulcers. Page last reviewed: 17 September Next review due: 17 September Signs and symptoms The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the tummy abdomen.

When to seek medical advice You should visit your GP if you think you may have a stomach ulcer. Seek urgent medical advice if you experience any of the following symptoms: vomiting blood — the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds passing dark, sticky, tar-like stools a sudden, sharp pain in your tummy that gets steadily worse These could be a sign of a serious complication, such as internal bleeding.

What causes stomach ulcers? This is usually a result of: an infection with Helicobacter pylori H. Eradication heals most duodenal ulcers and greatly diminishes the risk of recurrent bleeding. Test of cure for all patients after therapy is neither cost-effective nor practical. Indications for eradication testing with the urea breath test or stool antigen test include H.

A seven- to day triple drug regimen consisting of a PPI, amoxicillin 1 g, and clarithromycin mg Biaxin twice daily has long been the first-line therapy to eradicate H. Sequential therapy consists of a five-day course of a PPI and amoxicillin 1 g taken twice daily, followed by a five-day course of a PPI, clarithromycin mg, and metronidazole mg Flagyl or tinidazole mg Tindamax taken twice daily.

A recent meta-analysis of available global data revealed that sequential therapy is superior to seven-day triple therapy, but it is not superior to day triple therapy, bismuth-based quadruple therapy, or non—bismuth-based quadruple therapy. Compliance and tolerance rates of sequential therapy are similar to those of triple therapy but cost is lower, especially when the cost of failure of first-line therapy is considered.

However, most studies were performed in Italy, and the ACG guideline states that sequential therapy requires validation in the United States. This approach involves the addition of metronidazole mg or tinidazole mg twice daily to the standard triple regimen. It is less complex than sequential therapy with similar eradication rates. This is the traditional quadruple regimen and includes a bismuth salt subsalicylate mg or subcitrate potassium mg , metronidazole mg, and tetracycline to mg, all taken four times daily, in addition to a PPI taken twice per day.

A three-in-one combination capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline has been developed to help reduce the pill burden, but patients still have to take three capsules four times per day in addition to a PPI.

The regimen is usually given for 10 to 14 days. This is a day regimen of a PPI and amoxicillin 1 g twice daily, and levofloxacin mg Levaquin once daily. Risk factors for gastrointestinal toxicity from NSAID use include older age; chronic use of high-dose NSAIDs; use of aspirin, anticoagulants, or corticosteroids; and a history of ulcer. A Cochrane review on the effectiveness of these therapies compared with placebo suggests that high-risk patients should take a COX-2 inhibitor with a PPI for the greatest gastrointestinal safety.

Concerns have been raised about increased cardiovascular risk with the use of COX-2 inhibitors. The ACG 22 and the Canadian Association of Gastroenterology 24 have each developed evidence-based guidelines for the prevention of NSAID-related ulcers in patients at risk of cardiovascular disease, including those with previous cardiovascular events.

The recommendations are summarized in Table 4. Cardiovascular concern is greater than gastrointestinal concern: naproxen plus PPI. Information from references 22 and Older persons are at a higher risk of PUD, in part because of high-risk medication use, including antiplatelet drugs, warfarin Coumadin , selective serotonin reuptake inhibitors, and bisphosphonates.

After eradication of H. Although gastrointestinal symptoms are common in children, PUD is rare The best supported recommendations are presented in Table 5. Physicians should wait at least 2 weeks after the patient stops taking a proton pump inhibitor or 4 weeks after the patient stops taking an antibiotic to perform biopsy-based or noninvasive testing e. Diagnostic testing for H. In patients with peptic ulcer disease and H.

Tests based on the detection of antibodies immunoglobulin G or A against H. The urea breath test carbon 13 is a reliable noninvasive test to determine whether H. Grade of evidence: high further research is unlikely to change the groups' confidence in the estimate of effect. Information from reference The complications of PUD from any etiology include bleeding, perforation, and gastric outlet obstruction. In one study, the incidence of peptic ulcer hospitalizations was 5.

The duodenum can become narrowed from continued inflammation and scarring from ulcers, which may lead to gastric outlet obstruction. Gastric outlet obstruction is rare, and physicians should consider an underlying malignancy in these patients. Gastric cancer is the second leading cause of cancer-related mortality. It also causes chronic inflammation with an exaggerated immune response, which results in carcinogenesis. Data Sources : Essential Evidence Plus was searched using the key words duodenal ulcer, Helicobacter , Helicobacter infections, peptic ulcer, and stomach ulcer.

The Trip database was also searched using the key words Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Search date: November 27, Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors. Guidelines for the management of dyspepsia. Am J Gastroenterol. American College of Gastroenterology guideline on the management of Helicobacter pylori infection.

Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev. Effects of Helicobacter pylori and nonsteroidal anti-inflammatory drugs on peptic ulcer disease. Clin Gastroenterol Hepatol. This pain is often in the upper abdomen. Sometimes food makes the pain better, and sometimes it makes it worse. Other symptoms include nausea, vomiting, or feeling bloated or full.

Bleeding from an ulcer can be slow and go unnoticed or can cause life-threatening hemorrhage. Ulcers that bleed slowly might not produce the symptoms until the person becomes anemic. Symptoms of anemia include fatigue, shortness of breath with exercise and pale skin color. People with bleeding ulcers may also vomit. Symptoms of rapid bleeding represent a medical emergency.

If this occurs, immediate medical attention is needed. People with these symptoms should dial or go to the nearest emergency room. The two most important causes of ulcers are infection with Helicobacter pylori and a group of medications known as NSAIDs. Helicobacter pylori also called H. The understanding that H. In fact, Dr. Barry Marshall and Dr. Robin Warren were awarded the Nobel Prize in Medicine for this discovery. People infected with H. When a person is diagnosed with an ulcer, testing for H.

There are a number of tests to diagnose H. People with ulcers. Treatment usually consists of taking either three or four drugs. The drug therapy will use acid suppression therapy with a proton pump inhibitor PPI along with antibiotic therapy and perhaps a bismuth containing agent such as Pepto-Bismol. There are many drugs in this group.

NSAID use is very common because many are available over the counter without a prescriptionand therefore they are a very common cause of peptic ulcers. NSAIDs cause ulcers by interrupting the natural ability of the stomach and the duodenum to protect themselves from stomach acid. NSAIDs also can interfere with blood clotting, which has obvious importance when ulcers bleed.

These people should discuss the various options for preventing ulcers with their physician.