An Ulcer is a sore that eats into the body; “peptic” refers to the stomach or duodenum (beginning of the small intestine, see Diagram — Gastrointestinal System). Gastritis is more like a superficial abrasion or scrape, which can be extensive. Both can cause pain and bleeding (sometime massive hemorrhage); Ulcers can cause weight loss (malnutrition), and can rarely perforate the stomach or small intestine. Ulcers and Gastritis may be caused by irritation (alcohol, aspirin, NSAID medications), although many are due to a common germ Helicobacter pylori (H. pylori).
Pain is felt in the upper abdomen. It’s often described as “gnawing,” may radiate to the back, may ease after eating. The main thing that makes us think of Ulcer or Gastritis, instead of milder conditions, is if the pain occurs daily, and lasts on & off throughout the day.
Diagnosis is made by seeing the disease by endoscopy, performed by a Gastroenterologist. We could also order a special fluoroscopy x-ray with barium, but that’s not done much anymore. Oftentimes we just give treatment, and if the patient gets better, they don’t need any tests. In that case, they should have some sort of test for H. pylori, to treat it if positive (with antibiotics).
If we think there may be complications, we certainly refer for endoscopy. If the abdomen is rock hard when we examine it (possible perforation), or if the patient is vomiting blood or coffee-ground material (clotted blood), we send the patient to the ER by ambulance. If the patient describes bowel movements that look pitch-black, it could be clotted blood from slower bleeding, so we’d want a same-day blood test to see how much they might have lost. Iron tablets and “pink” medicine like Pepto-Bismol® can also turn stools black.
If a person gets better on medication, we treat for 2 months & discontinue it. If pain returns, they can take it again, but definitely need endoscopy to rule out cancer. Patients over 45-50 always need endoscopy, since cancer is much more common then.