Stomach ulcers: What you need to know

Stomach ulcers are sores in the stomach lining, or in the small intestine. We happen when the defensive mucus covering the stomach is ineffective.

A strong acid is produced by the stomach to help digest food and protect against microbes. It also secretes a thick layer of mucus, to shield the body’s tissues from this poison.

If the mucus layer gets worn away and stops working efficiently, the acid will damage the tissue of the stomach, causing an ulcer.

An approximate one in every ten people in western countries will at some point in their lives have an ulcer in the stomach or small intestine.

Stomach ulcers are fairly easy to cure, but if left untreated, they can cause considerable problems.

Fast facts on stomach ulcers

Here are some key points about stomach ulcers. More detail and supporting information is in the main article.

  • Stomach ulcers are common in the West and easy to treat but can become serious.
  • The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs (NSAIDs).
  • The classic symptom of a stomach ulcer is indigestion.
  • Treatment for stomach ulcers normally focuses on removing the cause.

Symptoms

A lady having stomach pain
Pain is the main symptom of a stomach ulcer, either around the stomach or slightly higher up.

Indigestion is the classic symptom of a stomach ulcer, also called dyspepsia.

Indigestion causes pain in the stomach area, or nausea. You can mistake this symptom with heartburn, which can occur simultaneously.

Acid reflux or gastroesophageal reflux disease (GERD) can cause heartburn. This emerges from the stomach slightly higher and is felt in the lower part of the body.

It should be noted that not all ulcers of the stomach cause indigestion.

Symptoms of stomach ulcer tend to be more distinct than symptoms of heartburn but symptoms may still be vague.

An ulcer tends to cause burning or dull pain in the area around the stomach. Sometimes, this pain is described as “biting” or “nawing” pain. Some people can describe feeling hungry.

Other symptoms include:

  • weight loss
  • nausea and vomiting
  • not eating because of pain
  • burping
  • bloating
  • pain may be relieved by eating, drinking, or taking antacids

Many ulcers in the stomach go unnoticed and do not exhibit the usual indigestion pains. Such ulcers are less common and tend to be found after bleeding has started on the ulcer. Some ulcers may create a hole within the wall of the stomach. This is called perforation, and is a severe condition.

Signs of stomach ulcer sometimes change over time, and can be hard to spot.

Diet

Dietary changes can help prevent stomach ulcers from developing.

People at risk of stomach ulcers should include more of the following nutrients in their diet:

  • Fruits and vegetables: Eating a variety of fruits and vegetables is key to a healthy digestive tract lining. These foods are rich in antioxidants, inhibit acid secretion, and contain cytoprotective and anti-inflammatory properties. A 2017 study advises that these are all important factors for preventing and treating ulcers.
  • Fiber: Diets high in soluble dietary fiber reduce the risk of developing stomach ulcers.
  • Probiotics: Food that contains active bacterial content, such as probiotic yogurt, can help to reduce a Helicobacter pylori (H. pylori)infection. Probiotics have been shown to slightly improve symptoms of indigestion and the side effects of antibiotics.
  • Vitamin C: This powerful antioxidant may be effective in helping to eradicate H. pylori, especially when taken in small doses over an extended period. Fruits, legumes, and vegetables, such as oranges and tomatoes, contain high levels of vitamin C.
  • Zinc: This micronutrient is important for maintaining a healthy immune system and healing wounds. Oysters, spinach, and beef contain high levels of zinc.
  • Selenium: This may reduce the risk of infection complications and may also promote healing. Brazil nuts, yellowfin tuna, and halibut are recommended for their high selenium content.

Alcohol and caffeine avoidance can also help to reduce the risk, as both cause the body to produce more gastric acid. That can lead to ulcers in the stomach.

It is important to use nutritional choices to promote the most successful outcome of a treatment plan, as opposed to relying solely on the diet.

Causes

NSAIDs
A class of painkillers known as NSAIDs can increase the risk of stomach ulcers.

The two main causes of ulcers of the stomach and small intestine are:

  • H. pylori bacteria
  • a class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes of stomach ulcers include:

  • Excess stomach acidity, or hyperacidity: This can occur for a range of reasons, including genetics, smoking, stress, and some foods.
  • Zollinger-Ellison syndrome: This is a rare disease that causes an excess of stomach acid to be produced.

Risk factors

Certain behaviors and factors increase the chances of developing a stomach ulcer.

These include:

  • frequent steroid usage
  • smoking
  • overproducing calcium, or hypercalcemia
  • genetics
  • consuming alcohol frequently

Stomach ulcers are more common in people older than 50 years. Individuals at any age can develop an ulcer of the stomach but they are much less common in children. Children are at greater risk if their parents smoke.

NSAID drugs and stomach ulcers

A type of NSAIDs known as painkillers carries a risk of stomach ulcers. The two most recognized NSAIDs are aspirin and ibuprofen.

The risk of ulcers increases when the drugs are given at high doses, or for a long period of time everyday.

Stronger NSAIDs, such as those needing a prescription, are more dangerous for stomach ulcers than those purchased over- the-counter (OTC).

People should always check the labels and answer their concerns with a pharmacist or a doctor about using painkillers. They could suggest an alternative, including acetaminophen.

Types

Stomach ulcers are one type of peptic ulcers.

Two other forms of ulcers exist: esophageal and duodenal. In the esophagus, esophageal ulcers form, and duodenal ulcers occur in the uppermost part of the small intestine known as duodenum.

The ulcers share similar features, but their position in the body distinguishes them.

Treatment

If the doctor thinks there is a stomach ulcer, they may try to remove the cause by:

  • changing the type of painkiller if the cause is thought to be NSAIDs
  • trying the “test-and-treat” approach if the cause is thought to be H. pylori bacteria

Once the cause is removed, it is possible to treat the effects of stomach ulcers by shielding the ulcer from acid when healing. The medicines which a doctor may prescribe include:

  • proton pump inhibitors (PPI) that block acid-producing cells
  • H2-receptor antagonists, which prevent the stomach from producing excess acid
  • antacids or alginate. These are available to purchase over-the-counter.
  • drugs that protect the stomach lining, such as Pepto-Bismol

Symptoms usually subside rapidly after recovery. The treatment should continue, however, especially if the ulcer is due to an H. Pylori. Pylori. It’s also essential during treatment to avoid drinking alcohol, smoking tobacco, and any triggering foods.

Surgical treatments

Chirurgical intervention may be an option in some cases. For example, if the ulcer keeps coming back, it won’t heal, bleed, or stop food from leaving the stomach.

Surgery can include:

  • removing the ulcer
  • tying off bleeding blood vessels
  • sewing tissue from another site onto the ulcer
  • cutting the nerve that controls stomach acid production

Complications such as bleeding or perforation from stomach ulcers are rare. Each condition calls for urgent medical care.

Diagnosis

Physicians monitor the symptoms of a stomach ulcer by asking questions about how the pain feels, where and when it happens, and how intense and prolonged it is.

This process helps to narrow down whether or not there is an ulcer at the stomach. The doctor may also ask for a stool or breath test to determine if the ulcer in your stomach is from H. The genus Pylori.

If there are more serious symptoms such as bleeding the doctor may need more testing, including:

  • Endoscopy: A camera is inserted at the end of a long, thin, flexible tube to look at the gut lining. A biopsy may also be taken.
  • Barium enema: This is a thick liquid that allows X-rays to be taken of the gut.

Summary

Anyone who thinks they may have a stomach ulcer should contact their doctor. Any symptoms of the stomach that last for more than a couple of days or continue to occur need assessment and treatment.

Symptoms of anemia, such as being fatigued and breathless, may mean a slow-bleeding ulcer. More severe bleeding is an urgent medical problem and can be detected when blood is vomited or stools are black and sticky.

Perforation, or a stomach breach, is likewise an emergency. The stomach wall can become tainted without swift treatment. Sudden, worsening stomach pain can signify perforation, and any symptoms of being very unwell with infection require treatment as soon as possible.

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