Peptic ulcers are open sores in either the stomach (called a gastric ulcer) or in the initial part of the small intestine (a duodenal ulcer). But, contrary to what many have believed, excessive stress and worry do not give people peptic ulcers. The two most common causes are:

• a local infection with the bacterium Helicobacter pylori (H. pylori).
• the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Motrin®), and many others.

Both H. pylori and the NSAIDs produce sores in the lining of the stomach or small intestine, and these wounds are then painfully irritated by the presence of the stomach's natural acid. The first step in managing any peptic ulcer is to determine which one of these two suspects is behind it.

Symptoms

The most common symptom felt by sufferers whenever the open wound of an ulcer gets bathed in stomach acid is a burning, aching, gnawing, or hunger-like pain below the breastbone. A gastric ulcer typically begins to hurt shortly after eating, whereas a duodenal ulcer usually begins hurting when the stomach is empty, 2 to 5 hours after a meal.

Relieving symptoms

Antacids like Tums® or Rolaids® will generally relieve the pain of duodenal ulcers but often will not alleviate the pain from a gastric ulcer. Also, continued long-term use of antacids will not only fail to cure an ulcer's root cause but can also lead to the creation of a new ulcer over time.

Curing an ulcer

Symptom relief, however, is just a stop-gap measure. In the case of duodenal ulcers, unless the underlying cause is found and treated, serious complications (bleeding, perforation, and, less often, scarring that can obstruct the movement of food from the stomach) can arise; these can require surgical intervention. Gastric ulcers require further evaluation because they may also be a manifestation of stomach cancer.

If tests reveal that an H. pylori infection is responsible, treatment of such infections with a combination of antibiotics usually leads to a cure. Ulcers caused by NSAIDs are generally healed with 4 to 8 weeks of treatment with either of two acid suppressors:

• H2 receptor antagonists (H2 blockers) prevent a substance called histamine from stimulating the production of acid by the stomach. Examples of H2 blockers are cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®).
• Proton pump inhibitors (PPI), whose main action is to stop the stomach's acid pump, cut off gastric-acid production sharply. The PPIs include drugs such as omeprazole (Prilosec®), esomeprazole (Nexium®), and lansoprazole (Prevacid®). Prilosec and all four of the H2 blockers are available without a prescription.

People with peptic ulcers should avoid foods that precipitate pain or other symptoms, but they needn't follow a bland diet or avoid spicy foods.