Talk with the Doc: Beware peptic ulcer disease, gastritis

Jim Surrell, MD

Peptic ulcer disease is medically defined as an ulcer that has formed in the stomach or more commonly, in the duodenum.

The duodenum is the very first part of the small intestine where our food and drink passes out of the lower part of the stomach into the small intestine. A peptic ulcer is defined as a sore on the lining of the stomach, the small intestine or the lower esophagus. A peptic ulcer in the stomach is called a gastric ulcer and a duodenal ulcer is an ulcer in the first part of the small intestine, just beyond where it leaves the stomach.

Know that our stomach makes very potent hydrochloric acid that acts on our food or drink to begin the process of digestion. The stomach contents then pass into the duodenum so the small intestine can absorb the nutrients we have taken in as our food and drink. It is generally agreed that nearly all stomach and duodenal ulcers are from our stomach cells producing excess stomach acid. This excess potent hydrochloric acid eventually causes inflammation and damage to the lining of the stomach and the duodenum, leading to the formation of these painful ulcers.

A dull or burning pain in the  stomach is the most common symptom of a peptic ulcer. A person will generally feel the pain anywhere between their belly button and breastbone. The pain most often happens when our stomach is empty, often between meals or during the night. The ulcer pain may come and go and it will often go away when we eat something that absorbs the stomach acid or if we take antacids or acid reducing medications. A less common symptom from these ulcers is bleeding. If ulcer bleeding does occur, it may present as blood in the stool, as black tarry stools, or even as vomiting blood. Of course, ulcer pain and ulcer bleeding always needs to be promptly medically evaluated.

If a person has these common symptoms of peptic ulcer disease, it is very important to be evaluated by your health care provider, and an upper gastrointestinal (UGI) endoscopy will often be recommended to accurately confirm the diagnosis of ulcers. Even with very mild symptoms, a person may have an ulcer. Without treatment, stomach and duodenal ulcers tend to get worse. Much less commonly, ulcers may be caused by a bacterial infection in the stomach from Helicobacter Pylori. When this bacterial infection is properly diagnosed, it will be treated with appropriate antibiotics.

There are numerous very effective medications that are used to treat peptic ulcer disease, and many are now available without a prescription. There are multiple ways to treat peptic ulcer disease and the three most common treatments are as follows. (1) Antacid tablets (such as Tums) or liquid antacids. (2) Acid reducing Proton Pump Inhibitors (PPI) medications such as Prilosec, Protonix, Nexium, and others. (3) Acid reducing Histamine 2 (H2) Blockers such as Zantac, Tagamet, Pepcid, and others.

Gastritis is medically defined as inflammation in the lining of the stomach that is also believed to be caused by excess stomach acid causing this inflammation. There are no ulcers present with gastritis, but gastritis may well lead to the formation of ulcers if not treated with an acid reducing program. Of interest, if a person has gastritis, and they eat something, the stomach pain may get worse because of the food causing more acid production. This increased acid then leads to more irritation of the inflamed lining of the stomach. Gastritis symptoms are also generally treated with acid reducing medications. .

If a person has any of the above symptoms of peptic ulcer disease or gastritis, they should promptly review this with their health care provider. With proper diagnosis and treatment, the symptoms of these common medical conditions can be very effectively treated.

EDITOR’S NOTE: Dr. Jim Surrell is the author of “The ABC’s For Success In All We Do” and the “SOS (Stop Only Sugar) Diet” books. Requests for health topics for this column are encouraged. Contact Dr. Surrell by email at