Peptic Ulcers

A peptic ulcer is an open sore in the lining of your stomach or duodenum, the upper part of the small intestine. When the peptic ulcer is in the stomach, it is called a gastric ulcer. When the peptic ulcer is in the duodenum, it is called a duodenal ulcer. Peptic ulcers occur when acids that aid in food digestion damage these areas. Research has shown that infection with Helicobacter pylori (H. pylori) bacterium is the most common cause of peptic ulcers. The long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen also contributes. Stress and spicy foods cannot cause peptic ulcers but can aggravate them. Learn more about the risks and causes of peptic ulcers.

At Brigham and Women’s Hospital (BWH), our board certified general and gastrointestinal surgeons offer innovative and effective treatment for patients who have peptic ulcers that do not heal with medication or have caused complications. We perform the latest and most effective minimally invasive surgery to diagnose and treat gastric and duodenal ulcers, including laparoscopic partial gastrectomy, vagotomy, antrectomy and pyloroplasty.

Diagnosis of Peptic Ulcers

Because the cause of the peptic ulcer determines the treatment, it is important that patients receive a comprehensive evaluation. General and gastrointestinal surgeons at Brigham and Women’s Hospital offer a range of procedures for diagnosing peptic ulcers and testing for the H. pylori bacterium:

• Upper GI (gastrointestinal) series (also called barium swallow)
• Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
• Blood, breath and stomach tissue tests detect the presence of H. pylori, a bacterium that causes chronic inflammation of the inner lining of the stomach.

It is important to seek treatment for peptic ulcers because complications, including bleeding, stomach or duodenum perforation, peritonitis and obstruction, can result.

Treatment for Peptic Ulcers

Peptic ulcers typically heal with medication and lifestyle changes. For people who do not respond to medication or have experienced complications such as hemorrhage, perforation or obstruction, surgery is the best option.

Surgical Treatment

Brigham and Women’s Hospital surgeons offer extensive expertise in all surgical approaches:

• Gastrectomy, subtotal or partial gastrectomy, removes part of the stomach.
• Vagotomy involves cutting the vagus nerve to reduce acid secretion.
• Antrectomy removes the lower part of the stomach which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes, an adjacent part of the stomach that secretes pepsin and acid may be removed. A vagotomy is usually done along with an antrectomy.
• Pyloroplasty may be performed with a vagotomy. In pyloroplasty, the opening into the duodenum and small intestine are enlarged, enabling contents to pass from the stomach.
• Laparoscopic surgery uses a long, thin tube with a camera lens attached to examine the organs inside the abdominal cavity to check for abnormalities, and to operate through small incisions.

Non-Surgical Treatment

Most people with peptic ulcers benefit from dietary and lifestyle changes and medication:

• Diet and lifestyle changes
  • No known diet has been proven to help reduce ulcers, but people should avoid foods that cause irritation.
  • Smoking has been shown to delay ulcer healing and has been linked to recurrence. Quitting smoking is advised.
  • Reduce alcohol consumption.
  • Limit use of anti-inflammatory medications.
• Medications
  • Antibiotics to kill H. pylori if it has been detected.
  • H2-blockers to reduce acid the stomach produces by blocking histamine.
  • Acid pump inhibitors help to block stomach acid production by stopping the stomach's acid pump.
  • Mucosal protective agents shield the stomach's mucous lining from the damage of acid, but do not inhibit the release of acid.
  • When treating H. pylori, these medications are often used in combination.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have a peptic ulcer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced general and gastrointestinal surgeon are important to the successful outcome for patients with peptic ulcers and stomach conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with gallstones or bile duct stones. After surgery you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating peptic ulcers and stomach conditions. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

General and Gastrointestinal Surgery Appointments and Locations

• Our General and Gastrointestinal Surgery Team
• Request General and Gastrointestinal Surgery Appointment
• General and Gastrointestinal Surgery Locations

Resources

Go to our health library to learn more about peptic ulcers.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.