A stomach ulcer (medical ulcer of the ventricle) is a deep wound on the stomach’s lining. It typically manifests as pain in the upper abdomen. Gastric ulcer mainly causes excess stomach acid. Colonization of the gastric mucosa by bacteria is often responsible for Helicobacter pylori. You can completely cure the gastric ulcer with medication. Find out which risk factors favor a stomach ulcer, which warning signs to look out for, and the treatment and prognosis.
- Brief overview
- Gastric ulcer: symptoms
- Gastric ulcer: complications
- Gastric ulcer: causes and risk factors
- Gastric ulcer: treatment and prevention
- Treatment of gastric ulcer: gastroscopy
- Treatment of gastric ulcer: surgical intervention
- Gastric ulcer: examination and diagnosis
- Medical examination
- Blood tests
- Tissue extraction
- 13C breath test
- Gastric ulcer: course and prognosis of the disease
- Gastric ulcer: prevention
What is a stomach ulcer? Deep wound on the abdominal mucosa; Men and women are equally affected.
Causes: Infection with Helicobacter pylori stomach germs, disturbed gastric emptying, disturbing production of stomach acid, certain medications, genetic predispositions, bad life habits (stress, alcohol, etc.)
Symptoms: upper abdominal pain, nausea, bloating, loss of appetite, possible stool, anemia
Possible complications: bleeding from the ulcer, perforation of the stomach with peritonitis
Examination: Doctor-patient discussion (anamnesis), physical examination, blood test, ultrasound, gastroscopy, breath test
Therapy: drug treatment; surgical intervention in case of complications
Prognosis: good with early treatment and a lifestyle adapted to the stomach.
Gastric ulcer: symptoms
Gastric ulcer is one of the most common gastrointestinal diseases. Only duodenal ulcers (medical ulcus duodenal) occur even more often.
Both gastric and duodenal ulcers usually cause pressing or burning pain in the upper abdomen (epigastrium = between the coastal arch and the navel). Symptoms often occur with food or drink. However, people with duodenal ulcers often have pain on an empty stomach and at night. In contrast, increased pain soon after eating is a typical stomach ulcer sign.
Furthermore, loss of appetite, bloating, nausea and vomiting, and weight loss may indicate a stomach ulcer. Some people also develop signs of anemia due to a bleeding stomach ulcer.
Gastric cancer can rarely cause symptoms similar to those of a stomach ulcer. Gastroscopy, in which a tissue sample is taken (biopsy) and examined histologically, can determine cancer.
Some types of stomach ulcers do not cause discomfort. They are often discovered only accidentally during the examination or become noticeable only when additional complications occur.
Gastric ulcer: complications
If the stomach ulcer bleeds profusely, the person may even vomit blood (hematemesis). This condition is life threatening and the patient should be taken care of urgently!
On the one hand, certain painkillers and anti-inflammatory drugs, such as acetylsalicylic acid (ASA), ibuprofen, or diclofenac, can cause stomach ulcers. On the other hand, if taken regularly, they can suppress the pain stimulus so that the affected person cannot notice the typical symptoms of a stomach ulcer. As a result, (severe) complications can develop unnoticed.
The most common complication of a stomach ulcer (and duodenal ulcer) is bleeding from an ulcer. A possible sign of this is a dark black chair (tarnat chair). Black color occurs when blood from an ulcer is broken down by stomach acid.
Sometimes the ulcer bleeds a little so that the stool will not change color. Constant blood loss is reflected in reduced hemoglobin levels in the blood.
Gastric ulcer rarely penetrates the abdominal wall into the abdominal cavity. Through this hole, digested food and acid can enter the abdominal cavity and cause peritonitis. Those affected then feel a sharp pain in the whole stomach (peritonism) and have a fever.
Penetration of a stomach ulcer on the outside of the stomach is an emergency that should be treated as soon as possible!
Gastric ulcer: causes and risk factors
- Psychological factors: “With a lot of stress, my stomach ulcer will work” – you often hear this statement. Stress at work or home seems to increase stomach ulcers’ risk. This is probably because the body produces an excessive amount of stomach acid when under mental stress, and at the same time, creates less protective mucus.
- Acute stress or shock situation as well depression they also favor the development of gastric ulcers. However, likely, they are not the only drivers. Instead, they have an effect that causes ulcers only in combination with other risk factors.
- Too much stomach acid: Gastric ulcer occurs when aggressive stomach acid and protective factors of the gastric mucosa (mucus and salts that neutralize acids) are out of balance. If the acid is too strong or the protective factors are too weak, the mucous membrane is damaged, and a stomach ulcer can develop. Such an imbalance first creates inflammation of the gastric mucosa (gastritis). If the inflammation lasts for a long time or keeps coming back, a stomach ulcer develops.
- Disturbed processes in the stomach: It is also suspected that disturbed stomach movements can cause stomach ulcers. If the stomach is emptied with a delay and at the same time more bile acid flows back into the stomach, it can accelerate the development of stomach ulcers. An increased tendency to develop ulcers is also observed in people who produce only a reduced amount of protein that repairs the gastric mucosa.
- Helicobacter pylori colonization: This bacterium, which is not bothered by aggressive stomach acid, is the main cause of stomach ulcers. The bacterium can be detected in 75 percent of all patients with gastric ulcers and up to 99 percent of all patients with duodenal ulcers. Stomach germs are not solely responsible for ulcers. The formation of ulcers can occur only in combination with other risk factors. These risk factors include taking certain medications, poor lifestyle, and poor eating habits (see the next points).
- Taking certain medications: People who regularly take painkillers and anti-inflammatory drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs or NSAIDs) are especially prone to developing stomach ulcers. These include active ingredients such as acetylsalicylic acid (ASA), ibuprofen, and diclofenac. The combination of cortisone (glucocorticoids) and nonsteroidal anti-inflammatory drugs is particularly problematic.
- Bad eating and living habits: Smoking, alcohol, and coffee increase the production of stomach acid and thus increase the risk of stomach ulcers. Certain foods (e.g., spicy foods) can also irritate the stomach lining. What the body tolerates varies greatly from person to person.
- Genetic predisposition: In some families, stomach ulcers are more common. This suggests that genetic factors are also involved in the formation of ulcers.
- Other causes: Gastric ulcers can rarely be caused by metabolic diseases such as overactive parathyroid glands (hyperparathyroidism) or tumors (gastrinoma; Zollinger-Ellison syndrome). The gastric ulcer can develop after major surgeries, accidents, or burns. Since various “stress reactions” occur in the body, such a stomach ulcer is also known as a stress ulcer. Also, people over the age of 65 and those with blood group 0 are more prone to stomach ulcers. Also, people who have had such an ulcer can easily form new ones.
Gastric ulcer: treatment and prevention
Treatment with Helicobacter antibiotics is called “Helicobacter pylori eradication therapy”. It works in more than 90 percent of people with a stomach or duodenal ulcer. In rare cases, however, gastric ulcer pathogens are resistant to one of the antibiotics.
The way doctors treat stomach ulcers largely depends on the cause. It is especially important whether the gastric bacterium Helicobacter pylori is detected in the patient’s stomach. If this is the case, the doctor primarily uses antibiotics to treat stomach ulcers to clear the infection. To do this, the person concerned takes two different antibiotics (clarithromycin and amoxicillin or metronidazole) every day for seven days. In addition, the doctor will prescribe a drug that reduces the acid (for example, the so-called “proton pump inhibitor”). As a “stomach protection”, they inhibit the production of stomach acid so that the damaged mucosa can recover.
If Helicobacter pylori cannot be detected, antibiotics are not used, but acid-reducing drugs, especially “proton pump inhibitors”. Therapy is symptomatic. This means it only alleviates the symptoms. Without the harmful effects of stomach acid, stomach ulcers will normally heal on their own. In addition, it must be ensured that the person concerned completely avoids substances and foods that irritate the stomach (alcohol, coffee, nicotine) until the stomach ulcer heals.
In addition to proton pump inhibitors, H2 antihistamines and antacids also have an acid-lowering effect. Here you can read more about the effect and use of these groups of active ingredients in the treatment of gastric ulcers:
Proton pump inhibitors (“stomach protection”)
Proton pump inhibitors block a certain enzyme in the gastric mucosa (H + / K + -ATPase = “proton pump”). This enzyme is essential for the production of stomach acid. By inhibiting the enzyme, stomach acid production is completely prevented in a period of about 24 hours. Since excess stomach acid is the main cause of stomach ulcers, proton pump inhibitors are an important part of therapy. They are usually taken in the morning because the enzyme to be blocked is produced mostly in the morning. Typical representatives of proton pump inhibitors are the active ingredients omeprazole and pantoprazole.
H2 antihistamines such as cimetidine or ranitidine occupy the points of attack of histamine, an important messenger substance for the formation and release of stomach acid. Since stomach acid is mainly formed at night, antihistamines should be taken at night. In some cases, an additional daily dose is required. As part of gastric ulcer treatment, the H2 antihistamine may also be combined with a proton pump inhibitor if necessary.
Treatment of gastric ulcer: gastroscopy
After gastric ulcer treatment, gastroscopy is performed within about six to eight weeks. Then it is checked whether the ulcer is really completely healed.
Gastroscopy can also be a reported complication: if the ulcer is bleeding, the doctor may inject a special protein glue (fibrin glue) into the wound as part of a gastroscopy to stop the bleeding.
Treatment of gastric ulcer: surgical intervention
Gastric ulcer is rarely operated on today. For example, if you have a very persistent ulcer, it may make sense to remove part of the stomach. As a rule, the vagus nerve is interrupted (vagotomy) in order to reduce the production of stomach acid.
Surgery will also be needed if there are complications of a stomach ulcer. For example, gastric perforation must always be treated surgically.
Gastric ulcer: examination and diagnosis
The right person to contact if you suspect an ulcer in the stomach or duodenum is a specialist in internal medicine and gastroenterology. However, those who suspect an ulcer can first see their family doctor. He can then arrange further examinations if necessary.
First of all, the doctor will talk to the patient in detail to collect his medical history. Possible questions are:
- Where exactly does the stomach hurt?
- Do eating and drinking make the pain worse or worse?
- Do you drink alcohol? When yes, how much?
- Do you smoke? When yes, how much?
- Do you drink coffee? When yes, how much?
- Do you have a lot of stress?
- Are you taking over-the-counter pain medications, such as acetylsalicylic acid (ASA), ibuprofen, or diclofenac?
- Are you taking other medications?
- Have you or a family member had a stomach or duodenal ulcer?
- Have you ever had a gastroscopy? If so, when?
- Do you have any pre-existing or underlying diseases?
After the conversation, the doctor will examine the patient briefly. He will press his stomach carefully. This will give him an insight into how severe the pain is. Also, the patient may twitch during palpation: This means that the abdominal muscles inadvertently tense due to pain. For the doctor, this signifies that he must immediately start further examinations and appropriate treatment.
If a stomach ulcer is suspected, the patient’s blood will also be tested. If there is a bleeding stomach ulcer, continuous blood loss can cause anemia. The hemoglobin (Hb) value is then typically low.
Different blood values can also indicate whether inflammation is taking place in the body (number of white blood cells, CRP, etc.). This result is possible with a stomach ulcer that has penetrated the abdominal wall.
An ultrasound examination of the abdomen can help you rule out other possible causes of abdominal pain. Pain can also come from other abdominal organs, such as the liver or gallbladder. To assess the condition of the stomach and duodenum more accurately, gastroscopy is necessary.
Gastroscopy is used to confirm the diagnosis of “stomach ulcer”. A flexible hose with a light source and small optics installed at the front end helps. This endoscope is carefully moved over the mouth and esophagus into the stomach and up to the duodenum. In this way, the doctor can directly examine any changes in the mucous membranes.
During gastroscopy, the doctor can take tissue samples (biopsies) from suspicious areas of the mucous membrane through an endoscope. They are examined microscopically in the laboratory. In that way, it can be determined whether the changes on the mucous membrane are actually a stomach ulcer and not stomach cancer. Also, colonization by gastric bacteria Helicobacter pylori can be detected based on tissue samples.
13C breath test
Another method for detecting Helicobacter pylori infection is a special breath test. The patient drinks a special solution marked 13C-urea. If the bacterium Helicobacter lives in the stomach, it breaks down urea. As a result, carbon dioxide labeled with 13C can be found in exhaled air.
Gastric ulcer: course and prognosis of the disease
If you consistently treat stomach ulcers early with medication and maintain a lifestyle adapted to the disease you have, the ulcer will usually heal easily and without complications. The disease-adapted lifestyle includes avoiding alcohol, nicotine, and caffeine as completely as possible, avoiding foods that irritate the stomach (because it is very spicy or spicy), and avoiding stress as much as possible.
If complications such as bleeding or perforation of the abdominal wall occur, healing usually takes much longer.
Gastric ulcer: prevention
You can do a lot on your own to prevent stomach ulcers. This is especially important if you have had a stomach ulcer.
Please pay attention to your diet, for example: Avoid scorching and spicy foods because they irritate the gastric mucosa. One should be careful with alcohol and coffee. In some people, the stomach is irritated by even small amounts of stimulants, so in that case, it is recommended to abstain completely. Other people can handle a glass of wine or a cup of coffee quite well.
To prevent stomach ulcers, stress should also be avoided whenever possible. Be sure to relax regularly in your daily life, for example, in walks, gardening, meditation, or yoga.
Some people must take medications regularly to damage the stomach and cause stomach ulcers. You should then talk to your doctor about the medicine, whether it is possible to reduce the dose or switch to better-tolerated preparation.