A gastric ulcer (medicinal ventricular ulcer) is a deep wound in the gastric mucosa. It usually manifests itself through pain in the upper abdomen. Stomach ulcers are mainly caused by excess stomach acid.
Colonization of the gastric mucosa with Helicobacter pylori bacteria is often responsible. A stomach ulcer can usually be completely cured with medication.
Gastric ulcers are among the most common gastrointestinal disorders. The most common occurs is the duodenal ulcer.
Gastric and duodenal ulcers generally cause pressure pain or burning pain in the upper abdomen ( epigastrium = between the costal arch and the navel ).
Complaints often occur when you eat or drink. However, people with a duodenal ulcer often have pain on an empty stomach at night. An increase in pain shortly after eating is a typical sign of a gastric ulcer.
In addition, the loss of appetite, feeling of fullness, nausea, and vomiting, as well as weight loss, may indicate a stomach ulcer.
Some stomach ulcers do not cause any symptoms at all. They are often only accidentally discovered during an exam or only noticed in case of complications.
Rarely, stomach cancer can cause symptoms similar to those of a stomach ulcer. Clarification is carried out by gastroscopy, in which context a tissue sample ( biopsy ) is taken and a tissue examination ( histological ) is performed.
Peptic ulcer: complications
Certain pain relievers and anti-inflammatories like acetylsalicylic acid (ASA), ibuprofen, or diclofenac can cause stomach ulcers.
On the other hand, they can suppress the pain stimulus when taken regularly, so that those affected do not notice the typical symptoms of gastric ulcer. As a result, (serious) complications can go unnoticed.
The most common complication with stomach ulcers (and duodenal ulcers) is bleeding. One possible sign of this is finding stool a black hue. Blackening occurs when the blood from the ulcer is broken down by acidic gastric juice.
Sometimes the bleeding from the stomach ulcer is so light that the stool does not change color. Persistent blood loss is reflected in a reduced level of hemoglobin in the blood.
If a stomach ulcer bleeds heavily, the affected person may even vomit up the blood (hematemesis). This is life-threatening and should be treated by a doctor immediately!
Rarely, a stomach ulcer passes through the stomach wall into the abdominal cavity. Food and acid can enter the abdominal cavity through this hole. Those affected feel massive pain throughout the abdomen (peritonism) and have a fever.
Causes and risk factors
“With so much stress, a stomach ulcer occurs sooner or later,” such warnings are heard more frequently. In fact, the stress in the professional or private setting seems to increase the risk of a stomach ulcer.
This is probably due to the fact that the body produces excess stomach acid when stress is continuous, while at the same time producing less protective mucus.
Acute stress or shock situations, as well as depression, seem to favor gastric ulcers. However, they are not likely to be the sole trigger. Rather, they only cause ulcers in combination with other risk factors.
Too much stomach acid
A stomach ulcer develops when aggressive stomach acid and protective factors of the stomach lining (for example, mucus and acid-neutralizing salts ) are out of balance.
If the acid is too strong or the protective factors are too weak, the mucous membrane becomes damaged and a stomach ulcer can develop. Such an imbalance first ignites the gastric mucosa (gastritis).
If the inflammation persists for a long time or recurs, a stomach ulcer can develop over time.
Disrupted processes in the stomach
Even altered stomach movements are suspected to cause a stomach ulcer. If the stomach empties late and at the same time more bile acid flows back into the stomach, this can promote the development of a stomach ulcer.
An increased tendency to an ulcer is also seen in people who only produce small amounts of the protein that repairs the gastric mucosa.
Colonization with Helicobacter Pylori
This bacterium, which does not mind aggressive stomach acid, is the main trigger for a stomach ulcer. The bacteria can be detected in 75 percent of all patients with a gastric ulcer and up to 99 percent of all patients with a duodenal ulcer.
The gastric germ is not the only one responsible for an ulcer. Only in combination with other risk factors can ulcers form. These risk factors include taking certain medications and an unfavorable lifestyle and eating habits.
Take certain medications
People who are regularly susceptible to pain and non-steroidal anti-inflammatory drugs (NSAIDs) are particularly susceptible to stomach ulcers. These include active ingredients like acetylsalicylic acid (ASS), ibuprofen, and diclofenac.
The combination of cortisone (glucocorticoids) and non-steroidal anti-inflammatory drugs is particularly problematic.
Unfavorable eating and living habits
Smoking, alcohol, and coffee increase gastric acid production and, therefore, increase the risk of a stomach ulcer. Certain foods (for example, spicy foods) can also irritate the lining of the stomach. What is tolerated is very different for each person individually.
Gastric ulcers are common in some families. This speaks of the participation of genetic factors in the formation of ulcers.
Stomach ulcers very rarely can also be caused by metabolic diseases such as an overactive parathyroid gland (hyperparathyroidism) or a tumor (gastrinoma; Zollinger-Ellison syndrome).
Stomach ulcers can also develop after major operations, accidents, or burns. Since various “stress reactions” take place in the body in these situations, a stomach ulcer is also known as a stress ulcer.
People over 65 and people with blood group 0 are more susceptible to gastric ulcers. Also, people who have had such an ulcer can easily develop a new one.
Treatment and prevention
How doctors treat a stomach ulcer depends mainly on the cause. It is particularly important if the Helicobacter pylori gastric germ has been detected in the patient’s stomach.
If this is the case, the doctor mainly uses antibiotics to clear the infection. For this, the affected person takes two different antibiotics ( clarithromycin and amoxicillin or metronidazole ) every day for seven days. Also, your doctor will prescribe an acid-lowering medicine (for example, a so-called “proton pump inhibitor” or PPI ).
As “stomach protection” they inhibit the production of stomach acid so that the affected mucous membrane can recover.
Treatment of Helicobacter with antibiotics is known as “Helicobacter pylori eradication therapy.” It is successful in more than 90 percent of patients with gastric or duodenal ulcers. However, in rare cases, gastric ulcer pathogens are resistant to one of the antibiotics. So effective gastric ulcer therapy is more difficult.
If the bacterium Helicobacter pylori cannot be detected, antibiotics are not used, only acid-reducing drugs, especially “proton pump inhibitors”, are used. The therapy is symptomatic. That means it only alleviates complaints.
Without the harmful effects of stomach acid, the stomach ulcer usually heals on its own. In addition, however, it must be ensured that the person concerned completely avoids irritating substances and foods of the stomach (alcohol, coffee, nicotine) until the stomach ulcer has healed.
In addition to proton pump inhibitors, H2 antihistamines and antacids also reduce acidity.
After completing the gastric ulcer medicinal treatment, a gastroscopy is performed in approximately six to eight weeks. This checks whether the ulcer has really completely healed.
Also, a gastroscopy can be done to treat complications: If the ulcer is bleeding, the doctor can treat the wound using a special protein glue ( fibrin glue ) to stop the bleeding.
Gastric ulcers are rarely operated on today. Just in the case of a very stubborn ulcer, it may make sense to remove part of the stomach. As a rule, the vagus nerve is cut (vagotomy) to reduce gastric acid production.
Surgery may also be necessary if complications of gastric ulcers arise. For example, a gastric advance should always be treated surgically.
Exams and diagnosis
The person to contact in case of suspected gastric or duodenal ulcer is a specialist in internal medicine and gastroenterology. Affected people can go to their family doctor first. If necessary, you can initiate further investigations.
First, the doctor will have a detailed conversation with the patient to determine his medical history. Possible questions are:
- Where exactly do you have abdominal pain?
- Do eating and drinking worsen or weaken the pain?
- Do you drink alcohol? If so, how much?
- Do you smoke? If so, how much?
- Do you drink coffee? If so, how much?
- Do you have a lot of stress right now?
- Are you taking over-the-counter pain relievers like acetylsalicylic acid (AAS), ibuprofen, or diclofenac?
- Do you take any other medication?
- Have you or a family member ever had a stomach ulcer or duodenal ulcer?
- Have you ever had a gastroscopy? If so, when?
- Did you have any previous or basic illnesses?
After the interview, the doctor can briefly examine the patient. He will gently feel his stomach. This gives you an impression of how severe the pain is.
There may also be defensive tension on palpation – this means the abdominal muscles contract involuntarily due to pain. For the doctor, this is a sign that further examinations and appropriate treatment should be started immediately.
If you suspect a gastric ulcer, the patient’s blood should also be examined. If there is a bleeding stomach ulcer, continued blood loss may be reflected in anemia. The hemoglobin (Hb) value is typically reduced.
Different blood values can also indicate if there is inflammation in the body ( number of white blood cells, PCR, etc.). This happens with a stomach ulcer that has ruptured through the stomach wall.
An ultrasound of the abdomen can help rule out other possible causes of abdominal pain. Pain can also come from other abdominal organs like the liver or gallbladder. However, in order to assess the condition of the stomach and duodenum with greater precision, gastroscopy is necessary.
Gastroscopy serves to confirm the diagnosis of “gastric ulcer.” A flexible hose helps, with a light source and a small optic installed on the front. This endoscope is gently inserted into the mouth and esophagus into the stomach and into the duodenum. Therefore, the doctor can directly examine any changes in the mucous membrane.
During gastroscopy, the doctor may take tissue samples (biopsies) from suspicious mucous sites through the endoscope. They are examined microscopically in the laboratory.
In this way, it can be determined whether the changes in the mucous membrane are actually a gastric ulcer and not gastric cancer. In addition, colonization with the Helicobacter pylori gastric germ can be demonstrated based on tissue samples.
13c-urea breath test (UBT)
Another method of detecting Helicobacter pylori infection is a special breath test. The patient drinks a special solution with labeled 13c-urea. If the Helicobacter bacteria live in the stomach, it breaks up the urea. As a result, 13c-urea-labeled carbon dioxide can be found in the exhaled air.
Disease course and prognosis
If you constantly treat a stomach ulcer with medication at an early stage and maintain a stomach-friendly lifestyle, the ulcer usually heals easily and without complications.
A stomach-friendly lifestyle includes avoiding alcohol, nicotine, and caffeine as completely as possible, not eating foods that are irritating to the stomach (because they are very spicy), and avoiding stress.
If complications such as bleeding or an advance in the stomach wall occur, healing generally takes much longer.
You can do a lot yourself to prevent a stomach ulcer. This is especially important if you have ever had one.
For example, pay attention to your diet; avoid very hot and spicy foods, as they irritate the stomach lining. For the same reason, you should be careful with alcohol and coffee. In some people, the stomach is already irritated by small amounts of stimulants, in which case a full exemption is recommended.
Other people tolerate at least a glass of wine or a cup of coffee.
To prevent stomach ulcers, you should also avoid stress if possible. Provide regular relaxation phases in everyday life, for example in the form of walking, gardening, meditation, or yoga. Try whatever suits you best to rest.
Some people need to take medicine on a regular basis that can damage the stomach and cause an ulcer. Then you should talk to your treating doctor if it is possible to reduce the dose or switch to a better-tolerated preparation.