Peptic Ulcer Disease (PUD)

NSAIDs must be discontinued. If HP has been identified, a three antibiotic regimen lasting two weeks is often necessary to eradicate the bacteria. To demonstrate that HP has been eliminated, a repeat OGD and biopsy or a breath test may be done. A blood test and stool test is also available.

Powerful drugs that reduce acid secretion either belong to the class ‘proton pump inhibitors’ like omeprazole or esomeprazole or ‘H2 blockers’ like ranitidine or famotidine. Maintenance with these drugs is required for six to eight weeks. Over-the-counter alkaline salts called antacids (chewable or liquid) can provide quick relief of symptoms. They may contain magnesium trisilicate, calcium carbonate or sodium bicarbonate. On their own they cannot heal ulcers.

Complications of Peptic Ulcers

Bleeding can occur from ulcers causing black stool (the appearance of blood after undergoing digestion) or even vomiting of blood. Perforation, is where the ulcer deepens and penetrates a hole right through the muscular wall of the stomach or duodenum, with spillage of stomach contents into the abdominal cavity causing infection. This requires emergency surgery. Sometimes the ulcer can heal with a scar causing deformity of the stomach outflow called gastric outlet obstruction. This also requires surgery. Fortunately, with prompt and effective treatment, these consequences are quite rare today.

Can my upper abdominal pain be caused by other possibilities?

Not all upper abdominal pain is due to peptic ulcer, gastritis or duodenitis. Your doctor can help you evaluate.

Prevention

Avoidance of prolonged NSAIDs is important. Alcohol, smoking, stressful situations, delayed and irregular meals are often linked to gastritis and ulcers. By themselves these do not generally cause ulcers, but may affect promptness of recovery. Therefore, it is prudent to avoid these factors.