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Stomach Ulcer (Gastric Ulcer)

man with hands on stomach with pain

What is a stomach ulcer?

Stomach ulcers are small holes or erosions that occur in the lining of your stomach. They may also be called gastric ulcers.

Ulcers can also form in your duodenum which is the first part of your small intestine, immediately beyond your stomach. A peptic ulcer is a term used to describe either a stomach or duodenal ulcer.

What causes a stomach ulcer and who is more at risk?

Our stomach is lined with a mucus-producing inner layer known as the mucosa. This layer is delicate and its integrity depends on a careful balance of protective factors (such as the production of mucus) and destructive factors (such as acid production).

Disruption of this balance can result in a break in this protective layer, causing a stomach ulcer.

Disruptions may occur as a result of:

  • Excessive acid production
  • Excessive alcohol consumption (stimulates acid production)
  • Infection, particularly with a common stomach bacterium known as Helicobacter Pylori
  • Medications NSAIDs (eg, aspirin, ibuprofen, diclofenac, ketoprofen)
  • Other conditions, such as liver disease, Crohn’s disease, or Zollinger-Ellison syndrome
  • Physical stress, such as major surgery or burns

Although everyday stress (emotional stress) doesn’t appear to cause ulcers, it may make the pain worse.

The risk of getting an ulcer is also increased in people who smoke and coffee has been known to stimulate acid production in the stomach and make ulcers worse.

What are the symptoms of a stomach ulcer?

Symptoms vary from person to person, and some people may have no symptoms at all. Abdominal pain is common, and that associated with stomach ulcers tends to worsen after food.

Other common symptoms include:

  • Bloating or belching
  • Blood in the vomit or stools or dark tarry stools
  • Chest pain
  • Heartburn or indigestion
  • Nausea or vomiting
  • Tiredness
  • Weight loss

Symptoms such as vomiting, severe pain or blood in the stools are rare with stomach ulcers and should be reported to your doctor.

Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through is called a perforation and will cause severe pain and bleeding. It is a medical emergency.

How is a stomach ulcer diagnosed?

To help diagnose a stomach ulcer, your doctor will ask you what medications you take or have been taking, and if you have had a peptic ulcer or any other relevant condition in the past. Make sure you mention all the medications you are taking, especially NSAIDs such as aspirin, ibuprofen, diclofenac, or ketorolac.

Your doctor will also conduct a physical examination, to check for bloating or lumps within your abdomen, and to listen for bowel sounds. Make sure you mention any areas of pain or tenderness.

Blood may also be taken to test for infection or anemia and testing may also be conducted for Helicobacter pylori, a bacteria commonly associated with stomach ulcers. Testing usually involves either a breath test, stool sample, or biopsy. To get a clear picture of the inside of your stomach and small intestines, doctors may use an endoscope (a small thin tube with a camera on the end), a series of X-rays (called an upper GI series) and/or a CT scan.

How is a stomach ulcer treated?

Treatment for stomach ulcers usually involves a combination of medications which reduce acid secretion, protect the mucosa, and kill H. pylori bacteria (if present).

This allows ulcers to heal and reduces the chance of them will come back. All medications should be taken exactly as prescribed.

Examples of medications that may be considered to treat stomach ulcers include:

  • Antibiotics to kill H. pylori (usually two or three different antibiotics are taken in combination for one to two weeks)
  • H2 receptor blockers that reduce stomach acid production (like cimetidine or famotidine)
  • Proton pump inhibitors to block stomach acid production (such as esomeprazole, lansoprazole, omeprazole, or pantoprazole)
  • Protectants that coat the ulcer and protect it against acid and enzymes, enhancing healing (like sucralfate)
  • Bismuth (may help protect the lining and kill the bacteria)

Rarely, surgery may be needed.

If NSAIDs have caused your stomach ulcer, your doctor may advise you to stop taking them, reduce their dosage, or switch to an alternative medicine. Follow his/her advice. Talk to your doctor before taking antacids as these may reduce the absorption of some other medications.

How can i prevent a stomach ulcer from developing?

  • Don't smoke or chew tobacco.
  • Limit alcohol.
  • Avoid all NSAIDs, such as aspirin, diclofenac, ibuprofen, and naproxen. Try acetaminophen instead.
  • Eat a well-balanced, healthy diet. Avoid late-night snacks or overeating.
  • Reduce stress