What’s the Difference Between Gastric and Duodenal Ulcers?

One way of telling if you may have a gastric or duodenal ulcer is to figure out where and when your symptoms occur. For some, the time between meals aggravates an ulcer. For others, eating may be a trigger for the pain.

The exact location of the pain doesn’t always match up with the location of the ulcer, though. Sometimes the pain is referred. This means that a person may have pain in a location away from the actual ulcer.

Other symptoms can include:

• nausea
• vomiting
• bloating

According to digestive specialists, most ulcer symptoms are related to bleeding.

But nearly 75 percent of people who have gastric or duodenal ulcers don’t have any symptoms. In fact, these ulcers rarely cause severe symptoms.

If severe symptoms do occur, they can include:

• blood in your stool, or stool that appears black or tarry
• difficulty breathing
• feeling faint or losing consciousness
• vomiting blood
• shortness of breath with activity
• fatigue

Seek emergency medical attention if you feel stomach pain and any of the above symptoms.

Helicobacter pylori bacteria (H. pylori)

H. pylori is the most common cause of gastric and duodenal ulcers. This bacterium affects the mucus that protects your stomach and small intestine, allowing for stomach acid to damage the lining.

An estimated 30 to 40 percent of U.S. people are infected with H. pylori.

It’s unclear exactly how this bacterium spreads, but researchers believe it’s mostly through unclean food, water, and eating utensils. People who carry H. pylori can also spread it through direct contact with saliva.

Many people get this bacterial infection as a child, but it rarely develops into a peptic ulcer. In fact, most people don’t see symptoms until they’re older — if at all.

Medications

People who use or rely on nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, are more likely to develop peptic ulcers. In fact, after H. pylori, NSAID use is the other major cause of peptic ulcers.

NSAIDs can irritate and damage your stomach and intestinal lining. Acetaminophen (Tylenol) isn’t an NSAID, so it’s often recommended for people who can’t take NSAIDs due to ulcers or other digestive conditions.

Other conditions

A rare condition known as Zollinger-Ellison syndrome causes the development of both cancerous and noncancerous tumors. These tumors release hormones that cause extremely high levels of stomach acid that can lead to gastric and duodenal ulcers.

These tumors most often develop in the pancreas and duodenum, but can occur in other places throughout the body.

While doctors often recommend NSAIDs for health conditions such as arthritis or joint inflammation, NSAIDs can increase your risk for developing peptic ulcers.

Additional medications that may increase your risk for gastric, duodenal, and bleeding ulcers include:

• osteoporosis treatments such as alendronate (Fosamax) and risedronate (Actonel)
• anticoagulants, like warfarin (Coumadin) or clopidogrel (Plavix)
• selective serotonin reuptake inhibitors (SSRIs)
• certain chemotherapy medications

Other risk factors known to increase your risk for developing gastric and duodenal ulcers include:

• being 70 years old or older
• drinking alcohol
• having a history of peptic ulcers
• smoking
• severe injury or physical trauma

It’s a myth that spicy foods can increase your risk for ulcers or cause them. But certain foods can irritate the stomach further in certain individuals.

Your doctor will start by asking about your medical history and symptoms. Let your doctor know when and where you most often have symptoms.

Gastric and duodenal ulcers can cause pain in different parts of your abdomen. A variety of tests will usually be recommended since abdominal pain has many causes.

If your doctor thinks H. pylori may be the source of your symptoms, the following tests can confirm or rule out this possibility:

• A blood test. The presence of certain infection-fighting cells could mean you have an H. pylori infection.
• A stool antigen test. In this test, a stool sample is sent to a lab for testing. The test looks for certain proteins in the stool related to H. pylori.
• A urea breath test. A urea breath test involves swallowing a pill that contains a special formulation of urea. You breathe into a collection bag before and after swallowing the pill, and then your carbon dioxide levels are measured. When H. pylori is present, the urea in the pill is broken down into a certain type of carbon dioxide that can be detected.

Esophagogastroduodenoscopy (EGD)

An EGD test involves passing a lighted flexible instrument with a camera on its end, known as a scope, through your mouth and down into the esophagus, stomach, and small intestine.

Your doctor will be able to look for ulcers and other abnormal areas, as well as take a tissue sample (biopsy). They may even be able to treat certain conditions.

Upper gastrointestinal series

Your doctor may also order a test called a barium swallow or an upper GI series. This test involves drinking a solution with a small amount of liquid material that easily shows up on an X-ray.

Your doctor will then take several X-rays to see how the solution moves through your digestive system. This allows them to look for conditions that affect the esophagus, stomach, and small intestine.

Treatment for gastric and duodenal ulcers depends on the causes and how severe your symptoms are. For example, your doctor may prescribe histamine receptor blockers (H2 blockers) or proton pump inhibitors (PPIs) to reduce the amount of acid and protect your stomach lining.

For H. pylori infections, your doctor will prescribe antibiotics, PPIs, and other medications to fight the bacteria and promote healing. These medications include mucosal protective agents, which help protect your stomach’s mucus lining.

If NSAIDs caused the peptic ulcer, you’ll often be advised on how to reduce or eliminate your use.

If the ulcer is actively bleeding, your doctor can use special tools to stop the bleeding through an endoscope during the EGD procedure.

In cases that medication or endoscopic therapy doesn’t work, your doctor may recommend surgery. If the ulcer becomes deep enough to cause a hole through the wall of your stomach or duodenum, this is a medical emergency and surgery is most often required to fix the problem.

An untreated gastric or duodenal ulcer can develop into a serious problem, especially if you have certain existing medical conditions.

The most common complications of ulcers are:

You may not be able to completely remove your risk for developing an ulcer, but there are things you can do to lower your risk and prevent them:

• Lower your intake of NSAIDs, or switch to another medication if you’re taking NSAIDs regularly.
• When you do take NSAIDs, take them with meals or medications that protect your stomach lining.
• Refrain from smoking, as it can slow healing and increase your risk of digestive tract cancers.
• If you’re diagnosed with H. pylori, take all of the antibiotics you’re prescribed. Not taking the entire course can keep the bacteria in your system.
• Take steps to increase physical activity. Regular exercise can activate the immune system and help lower inflammation throughout cells.