Stomach Ulcer: Symptoms, Causes and Treatment

Ulcers are the painful sores which are formed due to breach in the continuity of the lining or covering of an organ. When they occur in stomach they are called stomach ulcers, also known as gastric ulcers. There can be similar type of ulcers present in the small intestine. Both these ulcers are called peptic ulcer and disease associated with them is known as peptic ulcer disease. They can be easily cured but if left untreated there are severe complications. It is estimated that every one out of ten people in the developed countries have an ulcer at some point of the life.

Signs and Symptoms of Stomach Ulcer

The severity of the symptoms is directly associated with the severity of the ulcers and patients presents with the wide varieties of complaints.

The most common symptoms are

• Burning pain in the middle of your abdomen
• Pain increases with empty stomach

Other common signs and symptoms

• Heartburn
• Dull pain in the stomach
• Nausea and vomiting
• Acid reflux or regurgitation

Causes of Stomach Ulcer

Stomach ulcer are generally due to decrease in the protective factors which protects the lining tissue of the stomach from the ill effects of the acid and the two most common reason are

Long term use of Nonsteroidal Anti-inflammatory Drugs(NSAIDs) like aspirin, naproxen, ibuprofen

Infection with a bacterium known as Helicobacter pylori

Risk factors for Stomach Ulcer

The risk of having stomach as well as other peptic ulcer increases if in addition to the causes you

Drink alcohol: alcohol is an irritant which irritates your lining of the stomach, increases the production of acid, worsen the current ulcer.

Smoking: smoking is a known risk factor if you are having Helicobacter pylori in the stomach

Stress: Persons having a lot of stress can have a specific type of ulcers known as stress ulcer

Spicy food

Complications of Stomach Ulcer

If the ulcer is left untreated then it can bleed or perforate and the patient presents with

• A sudden and sharp pain in your belly due to perforation
• Blood in vomiting: the blood color can vary from bright red to dull brown
• Infection: It occurs when the food material leaks from the stomach cavity into the body cavity through the perforation

This can be a medical emergency and you may need immediate help from a doctor

Diagnosis of Stomach Ulcer

Your doctor will use your medical history and order some test to establish a diagnosis

Medical history: Your doctor will ask you complete details about

• Your symptoms and signs
• Your current or past medications
• Your present or past illness
• Laboratory tests

Breath tests: This test is used to rule out the Helicobacter pylori infection, the patient is asked to breath in a bag after drinking a liquid. Increased concentration of carbon dioxide in the breath sample certain the presence of the bacteria.

Endoscopy: Endoscope is a hollow tube through which contains light and the camera. It is passed down through your throat to look for the inside features of the gut. If ulcer is found, biopsy or part of the ulcer can be taken for the laboratory examination.

Barium swallow or Upper GI series: Patient is given barium salt to drink. It is a radiopaque material means it can be easily visualized under x-ray. It gives an outline of the digestive tract and make the ulcer more visible.

Treatment of Stomach Ulcer

The management of the peptic ulcer is based on the removal of the underlying cause either bacteria or irritant medications and reducing the signs and symptoms

Medications

• To kill the bacteria: Antibiotics are prescribed by your doctor. The proper regimen must be followed and the antibiotics must not be stopped until the course is complete
• Proton pump inhibitors: These are the drugs which blocks the production of the acid and includes omeprazole, lansoprazole etc.
• Antihistamine: These are H2 blockers and reduces the production of the acid but they are not as much efficacious than proton pump inhibitor
• Ulcer protective effect: Substances like sucralfate forms a coating over the ulcer and prevents the contact with the acid.

Prognosis of Stomach Ulcer

Most patients are treated successfully with the eradication of H. pylori infection, discontinuing of NSAIDs. The recurrence rates of stomach ulcer have decreased due to eradication of H. pylori but the recurrence rate of non-bacterial stomach ulcer is increasing. The mortality rate for peptic ulcer disease has been lowered significantly to about 1 death per 100,000 cases.

Resources

• American Gastroenterological Association
• Peptic ulcer disease and H. pylori. National Institute of Diabetes and Digestive and Kidney Diseases. 
• Feldman M, et al. Peptic ulcer disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.