A pyloric ulcer is an open sore or lesion affecting the pylorus at the opening between the stomach and duodenum.

Most stomach ulcers are caused by infection with Heliobacter (H) pylori bacteria. It is the causative factor in 50% - 80% of peptic ulcers. The bacterium disrupts the mucosal surface making it more likely to erode in the presence of acid (especially hydrochloric acid and pepsin). The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are also associated with ulcer formation. Stomach ulcers can also be caused by cancer or by stress. Deterioration of the pylorus, permitting reflux of bile into the stomach in elderly persons may also cause a pyloric ulcer.

Manifestations of the condition are related to the site of the ulcer and the age of the patient. Older individuals present either few or no symptoms. Stomach ulcers may cause a dull, aching pain above the umbilicus that gets worse an hour or two after eating. Because of scarring and edema, pyloric ulcers tend to give symptoms of obstruction with bloating, nausea, and vomiting.

History and physical examination may be performed. Upper gastrointestinal (GI) tract x-rays, gastric secretory studies, serum antibody testing for H. pylori and upper GI endoscopy may be done to confirm the presence of the condition. In addition, a biopsy to rule out cancer, and stool specimens for occult blood may be done.

Treatment of the symptoms of pyloric ulcer may include medications, such as antacids to reduce gastric acidity; histamine receptor antagonists such as cimetidine (Tagamet) and ranitidine (Zantac) to reduce gastric secretion; anticholinergics such as propantheline (Pro-Banthine) to reduce gastrin production; and physical rest to promote healing. If GI bleeding occurs, emergency treatment may consist of the placement of a nasogastric tube for lavage with iced saline, blood transfusions, and blood pressure support. Special diets do not heal ulcers, and milk, which was formerly a part of treatment, has been found to increase acid secretion. Foods that cause distress should be eliminated, as well as the intake of alcohol. Smoking is inadvisable because it impairs ulcer healing. Poor response to medical management, and complications of perforation, hemorrhage or obstruction would require surgical intervention.

In severe cases, complications of ulcers may include hemorrhage, obstruction, or perforation in the stomach or intestine. These conditions would require prompt treatment.

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