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How Do I Know If I Have Them?

Noting your symptoms may lead your doctor to suspect that you have a peptic ulcer, but it will not likely help determine the type, because the symptoms of stomach and duodenal ulcers are so similar. To make a specific diagnosis, your doctor may administer several tests.

One such test is a barium swallow or upper GI series of X-rays, which allows your doctor to identify and locate the ulcer and determine its type and severity. The test requires you to drink a "barium milkshake," which has a liquid that will light up on an X-ray. You may be asked to eat only bland, easily digestible foods for two or three days before the test. After drinking the chalky liquid, you lie down on a tilting examining table, which evenly distributes the barium around your upper digestive tract and allows the X-ray to capture images at different angles.

If you do not respond to treatment or if you develop new symptoms, your doctor may perform a gastroscopy, or endoscopic examination, in which a flexible fiber-optic tube is inserted down your throat to give the doctor a direct view of the inside of your esophagus, stomach, and duodenum. This allows the doctor to determine the presence and cause of bleeding and test for any bacterial infection. During this examination, your doctor may also conduct a biopsy to check for cancer.

What Are the Treatments?

Medications are usually used to treat mild-to-moderate ulcers. If the cause is bacterial, antibiotics can cure the ulcer. For recurrent, severe cases that do not respond to medication, surgery may be necessary.

Although alternative therapies have been shown to aid in the relief of symptoms as well as in the healing of ulcers, they should be used only as supplements to conventional treatment.
You should not treat an ulcer on your own, without first seeing your doctor. Over-the-counter antacids and acid blockers may relieve some or all of the pain, but the relief is always short-lived. With a doctor's help, you can find relief from the ulcer pain as well as a lifelong cure from the disease.

The chief goals of treatment are reducing the amount of acid in the stomach, strengthening the protective linings that come in direct contact with gastric acids and - if your ulcer is caused by bacterial infection - treating the H. pylori infection with medication. Your doctor will likely prescribe a combination of antibiotics, such as amoxicillin or tetracycline with metronidazole, along with Pepto-Bismol, proton pump inhibitors and/or histamine H2 blockers.

If these treatments are unsuccessful, or if you have developed serious complications as a result of your ulcer, surgery may be necessary. If your ulcer is hemorrhaging, the surgeon will identify the source of the bleeding (usually a small artery at the base of the ulcer) and repair it. Perforated ulcers - holes in the entire stomach or duodenal wall - must be surgically closed. This is an emergency procedure.

In some cases, a surgical procedure that decreases stomach acid secretion is also warranted. Note, however, that peptic ulcer surgery is done only in emergency situations, because there are many potential complications associated with the procedure, including ulcer recurrence, hematological complications, and dumping syndrome (chronic abdominal pain, diarrhea, vomiting, and/or sweating that occurs an hour after eating).

Tips for Living with Ulcers:

• Be cautious when choosing over-the-counter pain relievers. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may not only irritate the ulcer but also prevent a bleeding ulcer from healing. Your best choice may be acetaminophen (Tylenol, for example), which does not cause or promote stomach ulcers.
• Don't overdose on iron supplements. Although people with bleeding ulcers can develop anemia and may need to take iron as a treatment, taking too much can irritate the stomach lining and thus the ulcer. Ask your doctor how much iron you need.
• Learn how to deal with stress. While there is no evidence that stress causes ulcers, it can exacerbate existing ones. Practicing relaxation techniques - including deep breathing, guided imagery, and moderate exercise - can help alleviate stress.