Updated 2 March 2022 | Approved By Dr. Umberto Russo
What are Stomach Ulcers?Stomach ulcers (also known as gastric ulcers) are a type of peptic ulcer disease. Ulcers are slow healing sores that develop in the tissue lining of various body areas (e.g. mouth, blood vessels, etc.). People diagnosed with peptic ulcers will have an ulcer in their stomach, oesophagus or the duodenum (i.e. the first part of the small intestines). According to extrapolated global data, it is expected that between approximately 25000 to 50000 Australians will be diagnosed with peptic ulcer disease .
What does a Stomach Ulcer feel like?Stomach ulcer symptoms should be identified early to ensure that a GP is involved in managing this condition. Epigastric pain, which increases after a meal, is the most common stomach ulcer symptom . The epigastric region can be found in between the ribs and above the belly button. Patients will frequently describe their symptoms as a burning pain that doesn’t spread. Other symptoms may include :
- Reduced appetite
- Hematemesis or vomiting blood
- Black and tarry stools
- Bleeding from the rectum
What Causes Stomach Ulcers?Ulcers develop in the stomach due to various reasons. However, the two most common stomach ulcer causes are bacterial infections from Helicobacter pylori and non-steroidal anti-inflammatory medications (also known as NSAIDs). These causes lead to 80-90% of diagnosis . Other less common causes include :
- Viral infections
- Cancer treatment (i.e. chemotherapy, radiotherapy)
- Crohn’s disease
- Zollinger-Ellison Syndrome
Helicobacter PyloriHelicobacter pylori is a type of bacteria that are found in the stomach. Up to 50% of the population has been affected by this bacteria, which is more common in developing countries . This bacteria is spread person-to-person through saliva, poor hygiene, contaminated water and sexual activities. Helicobacter pylori infections can lead to inflammation and damage to the stomach lining. These changes lead to a higher risk of developing stomach ulcers .
Non-steroidal Anti-Inflammatory Drugs (NSAIDs)People who regularly use NSAIDs are at four times higher risk of developing stomach ulcers than those who do not . Mainly when used for long periods, these medications can cause the stomach lining to become leaky and more vulnerable to digestive acids.
Tests and Diagnosis
Urea breath testA breath test can be performed to check for the presence of Helicobacter pylori. Before the test, you are required to swallow a special drink containing urea. If the bacteria are present, the urea will be converted to carbon dioxide. A sample of how much carbon dioxide you breathe out will determine the presence of any Helicobacter pylori .
Blood testsBlood tests can detect antibodies that are produced from Helicobacter pylori. However, it cannot definitively diagnose the presence of stomach ulcers .
EndoscopyA gastroenterologist or specially trained healthcare worker will perform an endoscopy to examine the stomach. During this procedure, you may be provided with an anesthetic and/or sedation. An endoscope is a long-thin tubular medical instrument with a camera attached at the end. The images from the camera can be viewed on a monitor to determine the presence of stomach ulcers.
BiopsyA biopsy of tissue surrounding the stomach ulcer will be taken for laboratory testing. Samples of tissue can be collected during the endoscopy procedure, especially if an ulcer is found.
Stomach Ulcer Treatment
Stomach Ulcer MedicationGPs prescribe antibiotic therapies to destroy the Helicobacter Pylori bacteria found in the stomach . A combination of medication and therapy over several days or weeks may be required to treat the bacteria. Different medications may be prescribed depending on any underlying conditions, medications taken, and prevent bacterial resistance. Other medications that are usually used are antacid type medications which control your acid secretion into the stomach.
Changing Current MedicationsRegular use of certain medications, such as NSAIDs and aspirins, can be problematic to the stomach. Disruption to the stomach and intestines lining increases the risk of developing stomach ulcers . As a result, your GP may have to change or modify the current medications that you are currently using.
Lifestyle changesYour GP may discuss changes to your lifestyle habits to help your peptic ulcers recover. Examples include:
- Quit smoking . Cigarette smoking increases the risk of Helicobacter pylori infection and prevents ulcers from healing.
- Stomach ulcer diet considerations . Doctors recommend eating more vegetables and fruits. Consuming enough dietary fibre and vitamin A is protective against ulcers. Examples of foods to limit are caffeine, spice and alcohol, as they can irritate the gut.
- Stress management. The state of the gut is associated with mental health. Research has shown that people with high-stress levels have an increased risk of developing peptic ulcers . Talking about strategies, resources or seeking help from other healthcare practitioners (e.g. psychologists, counsellors, etc.) may be beneficial.
SurgerySome people with complications, such as failed medical treatments or uncontrolled bleeding, may require surgery . Those with perforated ulcers (i.e. where the digestive juices begin to leak from the stomach) will need emergency surgery.
RecoveryPeople with stomach or gastric ulcers will generally recover with appropriate medication and avoiding drugs, such as NSAIDs . After recovery, peptic ulcers can recur in 60% of patients . Developing healthy habits, such as limiting smoking and alcohol consumption, can help minimise these chances.
ComplicationsThe most common complication of stomach ulcers is bleeding stomach ulcers, which occur in 15% of people . If the stomach lining becomes weakened from the ulcers, digestive juices can leak, leading to additional damage and bleeding. Other less common complications include : Perforation or digestive juices leaking from the stomach to the rest of the body. Gastric outlet obstruction which causes narrowing of the intestines due to inflammation and scarring from the ulcers. Although this condition is rare, it can result in vomiting and bleeding from the mouth. Gastric cancer, however, is rare. Your doctor will refer you to the appropriate medical treatment if complications occur.
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- Sung, J. J. Y., Kuipers, E. J., & El‐Serag, H. B. (2009). Systematic review: the global incidence and prevalence of peptic ulcer disease. Alimentary pharmacology & therapeutics, 29(9), 938-946.
- Woolf A, Rose R. Gastric Ulcer. [Updated 2021 Jul 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537128/#
- Malik TF, Gnanapandithan K, Singh K. Peptic Ulcer Disease. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534792/
- Fashner, J., & Gitu, A. C. (2015). Diagnosis and treatment of peptic ulcer disease and H. pylori infection. American family physician, 91(4), 236-242.