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Peptic ulcers are sores in the lining of the stomach, lower esophagus, or small intestine caused by inflammation from the bacteria Helicobacter pylori (H. pylori) and stomach acid erosion.
WITHDRAWAL OF RANITIDINE
In April 2020, the
Food and Drug Administration (FDA)requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.
Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.
Peptic ulcers are a fairly common health problem. There are three types of peptic ulcers:
Different factors can cause the lining of the stomach, the esophagus, and the small intestine to break down. These include:
- H. pylori, a type of bacteria that can cause a stomach infection and inflammation
- frequent use of aspirin (Bayer), ibuprofen (Advil), and other anti-inflammatory drugs (risk associated with this behavior increases in women and people over the age of 60)
- drinking too much alcohol
- radiation therapy
- stomach cancer
The most common symptom of a peptic ulcer is burning abdominal pain that extends from the navel to the chest, which can range from mild to severe. In some cases, the pain may wake you up at night. Small peptic ulcers may not produce any symptoms in the early phases.
Other common signs of a peptic ulcer include:
- changes in appetite
- bloody or dark stools
- unexplained weight loss
- chest pain
Two types of tests are available to diagnose a peptic ulcer. They are called upper endoscopy and upper gastrointestinal (GI) series.
In this procedure, your doctor inserts a long tube with a camera down your throat and into your stomach and small intestine to examine the area for ulcers. This instrument also allows your doctor to remove tissue samples for examination.
Not all cases require an upper endoscopy. However, this procedure is recommended for people with a higher risk of stomach cancer. This includes people over the age of 45, as well as people who experience:
If you don’t have difficulty swallowing and have a low risk of stomach cancer, your doctor may recommend an upper GI test instead. For this procedure, you’ll drink a thick liquid called barium (barium swallow). Then a technician will take an X-ray of your stomach, esophagus, and small intestine. The liquid will make it possible for your doctor to view and treat the ulcer.
Because H. pylori is a cause of peptic ulcers, your doctor will also run a test to check for this infection in your stomach.
Treatment will depend on the underlying cause of your ulcer. If tests show that you have an H. pylori infection, your doctor will prescribe a combination of medication. You’ll have to take the medications for up to two weeks. The medications include antibiotics to help kill infections and proton pump inhibitors(PPIs) to help reduce stomach acid.
You may experience minor side effects like diarrhea or an upset stomach from antibiotic regimens. If these side effects cause significant discomfort or don’t get better over time, talk to your doctor.
If your doctor determines that you don’t have an H. pylori infection, they may recommend a prescription or over-the-counter PPI (such as Prilosec or Prevacid) for up to eight weeks to reduce stomach acid and help your ulcer heal.
Acid blockers like famotidine (Pepcid) can also reduce stomach acid and ulcer pain. These medications are available as a prescription and also over the counter in lower doses.
Your doctor may also prescribe sucralfate (Carafate) which will coat your stomach and reduce symptoms of peptic ulcers.
Untreated ulcers can become worse over time. They can lead to other more serious health complications such as:
- Perforation: A hole develops in the lining of the stomach or small intestine and causes an infection. A sign of a perforated ulcer is sudden, severe abdominal pain.
- Internal bleeding: Bleeding ulcers can result in significant blood loss and thus require hospitalization. Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools.
- Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. Signs of scar tissue include vomiting and weight loss.
All three complications are serious and may require surgery. Seek urgent medical attention if you experience the following symptoms:
With proper treatment, most peptic ulcers heal. However, you may not heal if you stop taking your medication early or continue to use tobacco, alcohol, and nonsteroidal pain relievers during treatment. Your doctor will schedule a follow-up appointment after your initial treatment to evaluate your recovery.
Some ulcers, called refractory ulcers, don’t heal with treatment. If your ulcer doesn’t heal with the initial treatment, this can indicate:
- an excessive production of stomach acid
- presence of bacteria other than H. pylori in the stomach
- another disease, such as stomach cancer or Crohn’s disease
Your doctor may offer a different method of treatment or run additional tests to rule out stomach cancer and other gastrointestinal diseases.
Certain lifestyle choices and habits can reduce your risk of developing peptic ulcers. These include:
- not drinking more than two alcoholic beverages a day
- not mixing alcohol with medication
- washing your hands frequently to avoid infections
- limiting your use of ibuprofen, aspirin, and naproxen (Aleve)
Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco use and eating a balanced diet rich in fruits, vegetables, and whole grains will help you prevent developing a peptic ulcer.