The most common sign of an ulcer is a burning pain that is either made better by eating or aggravated between one and three hours after a meal, when food can no longer neutralize the acid produced by the stomach. Other ulcer symptoms include vomiting, gastrointestinal bleeding, and severe abdominal pain or bloating, brought on by a penetrating ulcer that has perforated and needs emergency surgical repair. Horrible gas and excessive bloating are more likely to be associated with gallstone-related disease, dyspepsia, or irritable bowel syndrome. I advise you to see your doctor and discuss your symptoms so you can be properly diagnosed. Q2. I have Crohn’s disease. A few months ago during a flare, my stomach and right side were hurting. The CT scan didn’t pick it up, but an endoscope picked up that I had two large perforated ulcers in my stomach. The biopsy of the ulcers was not taken on the diseased tissue but on normal tissue to the side of the diseased tissue. I have been on Prevacid (lansoprazole) and Carafate (sucralfate), and the stomach pains and ulcer-like symptoms have not retreated after four months. I am thinking that it is the Crohn’s in the stomach now and not just in the small intestine. I am on Imuran (azathioprine) and Humira (adalimumab), but it doesn’t help my stomach, just my lower gut. Shouldn’t the GI doc be thinking that it is not just regular ulcers but Crohn’s in the stomach at this point, since that is what I think? I do not drink alcohol or coffee or smoke and am eating a bland diet. How else is Crohn’s of the stomach treated? Upper gastrointestinal Crohn’s disease is rare and only seen in less than 5 percent of Crohn’s disease patients. While ulcers in the stomach may be due to Crohn’s disease, more commonly they are due to non-steroidal anti-inflammatory drug (NSAID) use (such as aspirin, ibuprofen or naprosyn) or to infection with bacteria called Helicobacter pylori. The biopsies taken of the normal tissue next to the ulcers were done to rule out H. pylori. If H. pylori has been ruled out and you are not taking NSAIDs, then it is reasonable to assume that Crohn’s disease is the cause of the ulcers. Upper gastrointestinal Crohn’s disease is best treated with proton-pump inhibitors, like the Prevacid that you are taking, and anti-inflammatory medications, like the Humira and Imuran you are taking. Q3. What are the signs of a stomach ulcer? — Fern, New Jersey Peptic ulcer remains a common problem in the United States — 10 million Americans are estimated to be affected. There are two main causes of ulcers: the bacterium Helicobacter pylori, and too many non-steroidal anti-inflammatory drugs (NSAIDs). H. pylori, which infects the stomach, mostly causes ulcers in the duodenum, the first portion of the small intestine after the stomach. H. pylori-associated ulcers usually cause burning or sharp abdominal pain one to two hours after meals, on awakening in the morning, and at night. These symptoms are often relieved by food or antacids. NSAIDs, such as aspirin, naproxen, and ibuprofen, usually cause ulcers in the stomach and often do not result in ulcer-like pain. While NSAID-induced ulcers may not cause traditional symptoms, they reveal themselves through gastrointestinal complications like bleeding (which leads to darkening of the stool), vomiting of fresh blood or older blood that resembles coffee grounds, or, rarely, passing fresh blood in the stool. These signs may indicate a perforation of the stomach or duodenum, which is a surgical emergency. If you notice such symptoms, call your doctor immediately. Q4. What kinds of foods are safe to eat with an ulcer (caused by H. pylori) and gallstones? — Gail, New Jersey For patients with peptic ulcer disease, all foods are safe to eat, although eating small meals more frequently helps to decrease symptoms and improve ulcer healing by neutralizing acid. However, once the ulcer is healed and Helicobacter pylori is eradicated, there are no specific dietary restrictions. In contrast, fatty foods are poorly tolerated by patients with gallstones and can cause abdominal pain and bloating known as biliary colic. All patients with gallstones should avoid fried foods and foods with high fat content as much as possible. Q5. Can you share your thoughts on the relationship between stress and ulcers? — Nidya, Connecticut For centuries, stress was thought to be the major factor in forming ulcers (“You’re giving me an ulcer!”). By the early twentieth century, we thought that acid was important in ulcer formation, although stress was thought to increase acid production and cause ulcers that way. In the mid-1980s, the medical world recognized that a bacterium, Helicobacter pylori (along with aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen), caused the vast majority of ulcers of the stomach and duodenum. That discovery downplayed the importance of stress or acid. Severe stress, however, such as that experienced by patients with substantial burns or critical illness in intensive care units, creates a very high risk for the development of specific stress ulcers of the stomach, known as Cushing’s and Curling’s ulcers, respectively. These forms of acute stress are thought to cause ulcers by reducing blood flow, also called ischemia, to the stomach. Regarding the more common type of peptic ulcers, cigarette smoking has clearly been shown to be a cofactor in the formation of ulcers in patients infected with H. pylori. The evidence is much less clear that “everyday stress” and stress-prone personality traits are cofactors in causing peptic ulcer disease. Q6. I have been constipated lately, and my bowels aren’t regular. I have very bad breath and I am gaining weight. What could be going on? Because you have developed abdominal bloating, bad breath, and a change in your bowel habits, you should be referred to a gastroenterologist as soon as possible. While many disorders could be causing your symptoms, including peptic ulcer disease, dyspepsia, and irritable bowel syndrome, the change in bowel habits and weight gain may signify difficulty in moving food through your gastrointestinal tract. Your bad breath may be a reflection of bowel contents that are not moving — meaning that the odors could be coming up from your bowel and being released from your mouth. Starting with your colon, your gastrointestinal tract should be examined by colonoscopy, upper endoscopy, or barium X-rays to make sure that you do not have a structural lesion that is causing these symptoms. Learn more in the Everyday Health Ulcer Center.
