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What is Peptic Ulcer Disease?


Bruce Springsteen announced on Wednesday night that he would be postponing September shows because he is being treated for symptoms of peptic ulcer disease.

Such symptoms are common, said Dr. William Chey, chief of the division of gastroenterology and hepatology at Michigan Medicine, and typically include nausea and burning, stabbing pain in the upper abdomen (just below the sternum.) People with peptic ulcers can also experience bloating, stomach pain after meals and a sensation of fullness that comes on quickly. In serious cases, they can have unexplained weight loss, vomit blood or material that resembles coffee grounds, or have black, tar-like stool.

But of those who experience peptic ulcer symptoms, only a small fraction are likely to actually have ulcers, Dr. Chey said.

โ€œThereโ€™s a big difference between the symptoms of peptic ulcer disease and having peptic ulcer disease,โ€ he added.

Peptic ulcers are defects in the lining of the stomach or small intestine that present like shallow sores, Dr. Scott Gabbard, a gastroenterologist at the Cleveland Clinic, said. It is more common in older people, but anyone can get the disease.

Around 5 to 10 percent of the general global population will develop peptic ulcers at some point in their lives, but many patients are asymptomatic. They may not know they have these ulcers until they experience bleeding, Dr. Harold J. Boutte, Jr., a gastroenterologist at Northwestern Medicine, said. But for those who do have symptoms, they can be painful, disruptive and, in some cases, debilitating.

A bacteria called Helicobacter pylori is a major cause of peptic ulcer disease cases. Many people infected with this bacteria do not get ulcers or show any sign that they are infected, Dr. Gabbard said.

Itโ€™s not totally clear what makes one person more likely than another to develop ulcers from H. pylori. The bacteria can spread orally and can transmit among members of the same household, Dr. Amy Oxentenko, a gastroenterologist at the Mayo Clinic, said.

Another common cause of peptic ulcers is medications known as nonsteroidal anti-inflammatory drugs, like those that bring down a fever or relieve joint pain โ€” think aspirin, naproxen and ibuprofen. The higher the dose you take, and the more regularly you take it, the more likely you are to develop an ulcer, said Dr. Mark Pochapin, director of the gastroenterology and hepatology division at NYU Langone Health. Occasional use likely wonโ€™t lead to ulcers, but daily use raises the risk.

Smoking tobacco and heavy drinking โ€” Dr. Gabbard estimated over 40 drinks a week โ€” also increase the risk of developing peptic ulcers.

There are a wide range of conditions that can potentially lead to similar discomfort. Many people with peptic ulcer symptoms have functional dyspepsia, an umbrella term for stomach pain with no clear cause. Gastric cancer also can cause peptic ulcer symptoms in very rare cases, probably accounting for less than 1 percent of people presenting with those symptoms, Dr. Chey said.

Other conditions that mimic the symptoms of peptic ulcer disease might include gastroesophageal reflux disease, known as GERD; gastritis, or the inflammation of the stomach lining; inflammation of the pancreas; and gallstones, Dr. Pochapin said.

In general, all patients who present with peptic ulcer disease symptoms will undergo testing for H. pylori. Those who have the bacteria will typically get treated with antibiotics.

Doctors often perform endoscopies to diagnose peptic ulcer disease. If a patient has peptic ulcers, doctors will also take a biopsy and typically prescribe proton pump inhibitors, a category of medications that limit how much acid the stomach makes, Dr. Pochapin said.

Most people treated for peptic ulcers will recover within one to two months, Dr. Gabbard said.

But treatment gets more complicated, and tends to take longer, when there isnโ€™t a clear cause behind these symptoms. Sometimes, physicians prescribe antidepressants to modulate the link between the brain and the gut, potentially relieving pain in some cases. Acid-blocking medications, like proton pump inhibitors, may also help when conditions like GERD cause the discomfort.

โ€œYou can sometimes medicate through some of these things to mitigate the symptoms,โ€ said Dr. Michael Goggins, a professor of pathology, medicine and oncology at the Johns Hopkins University School of Medicine.

Doctors act like detectives when a patient presents with these symptoms, Dr. Pochapin said, trying to identify the best course of action.

โ€œThatโ€™s where it really relies upon the art of medicine,โ€ Dr. Chey said.



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