Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

Warning signs of pressure ulcers are:

• Unusual changes in skin color or texture
• Swelling
• Pus-like draining
• An area of skin that feels cooler or warmer to the touch than other areas
• Tender areas

Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from red, unbroken skin to a deep injury involving muscle and bone.

Common sites of pressure sores

For people who use a wheelchair, pressure sores often occur on skin over the following sites:

• Tailbone or buttocks
• Shoulder blades and spine
• Backs of arms and legs where they rest against the chair

For people who are confined to a bed, common sites include the following:

• Back or sides of the head
• Shoulder blades
• Hip, lower back or tailbone
• Heels, ankles and skin behind the knees

When to see a doctor

If you notice warning signs of a bedsore, change your position to relieve the pressure on the area. If you don't see improvement in 24 to 48 hours, contact your doctor.

Seek immediate medical care if you show signs of infection, such as a Fever, drainage from a sore, a sore that smells bad, or increased redness, warmth or swelling around a sore.

Bedsores are caused by pressure against the skin that limits blood flow to the skin. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.

Three primary contributing factors for bedsores are:

• Pressure. Constant pressure on any part of your body can lessen the blood flow to tissues. Blood flow is essential to delivering oxygen and other nutrients to tissues. Without these essential nutrients, skin and nearby tissues are damaged and might eventually die.

  For people with limited mobility, this kind of pressure tends to happen in areas that aren't well-padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.

• Friction. Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
• Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.

Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid as well as playing a role in maintaining the natural, healthy condition of the stomach lining. These protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers but the increased risk of ulcers still exists.

People are at risk of developing pressure sores if they have difficulty moving and are unable to easily change position while seated or in bed. Risk factors include:

• Immobility. This might be due to poor health, spinal cord injury and other causes.
• Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
• Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
• Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.

Typically, drugs are used to treat mild-to-moderate ulcers.

• Antibiotics Antibiotics can treat an ulcer caused by the H. pylori bacteria. Typically, the doctor may prescribe triple or quadruple therapy, which includes numerous antibiotics as well as heartburn medication.

• Triple therapy includes the use of two antibiotics, such as amoxicillin and clarithromycin, as well as a proton pump inhibitor. If you are allergic to penicillin, your doctor can substitute metronidazole (Flagyl) for amoxicillin. If you've had previous encounters with these antibiotics, or if you reside in an area where clarithromycin or metronidazole resistance exists, quadruple therapy treatment with two antibiotics (such as metronidazole and tetracycline) plus bismuth and a proton-pump inhibitor works well. Regardless of the plan, you need to take all medications for 10-14 days.

• Inhibitors of proton pumping. Acid reducers are PPIs. Esomeprazole (Nexium) and omeprazole are two of these drugs (Prilosec).

• H2 obstructers These drugs are also referred to as histamine receptor blockers or H2-receptor antagonists. They inhibit histamine, a natural molecule that tells your stomach to produce acid. Cimetidine (Tagamet), famotidine (Pepcid), and nizatidine are examples of H2 blockers (Axid).

• Bismuth. This drug shields the ulcer from stomach acid by covering it. this drug assists in the removal of H. pylori infections. Doctors frequently prescribe it in conjunction with antibiotics.

• Antacids. They may temporarily relieve your symptoms, but they do not treat ulcers. Antibiotics may potentially be rendered ineffective if taken with an antacid. Before consuming an antacid for peptic ulcer disease, consult your doctor.

Conditions
Vomiting or vomiting blood,Dark blood in stools,Trouble breathing,Feeling faint,Nausea or vomiting,Unexplained weight loss,Appetite changes
Drugs
Amoxicillin,Clarithromycin,Metronidazole,Tinidazole,Tetracycline,Levofloxacin,Sucralfate,Misoprostol,Nizatidine,Cimetidine,Famotidine,Lansoprazole
Symptoms
Burning stomach pain,Feeling of fullness, bloating or belching,Intolerance to fatty foods,Heartburn,Nausea