Stomach ulcer is a commonly used term for peptic ulcer. Ulcer refers to an open, slow-healing wound that penetrates several layers of tissue and measures at least 0.5cm in diameter. An ulcer can be found in the skin or surface of the digestive tract (epithelial tissue). Therefore, stomach ulcer can be described as a wound in the inner walls of the stomach and adjacent areas.
Peptic ulcers are divided into two classes, named after the exact location of the ulcer. Gastric ulcers are erosion on the stomach area itself. Duodenal ulcers are erosions that develop in the first part of the intestine that is connected to the stomach, the duodenum. Few people realize that ulcers often develop in the duodenum. This happens partly because the stomach has a lining that is more resistant to acids than the duodenunal lining, therefore making the later more prone to acid erosion. Ulcers can also be found in the esophagus (esophageal ulcer) and in the Meckel's Diverticulum (Meckel's Diverticulum ulcer).
The stomach area has secretory cells that continually produce protective mucus which covers and lubricates the stomach walls. The stomach enzymes and stomach acid are very corrosive substances. If something increases acid production, or reduces mucus in the stomach, the acid erodes and produces an ulcer in either the duodenum or gastrum. Multiple erosions can happen if stomach defenses are badly impaired. Duodenal ulcers are more common in people with 30 to 50 years of age and affect twice as many men than women. Gastric ulcers often affect elderly women (60 years above), but they can occur at any age or gender.
Most reported cases of stomach ulcers occur in the duodenum, only a small number of ulcers develop in the stomach. However, gastric ulcers are more likely to be associated by malignant tumors while duodenal ulcers are usually benign.
Globally, 1 in 10 people will get an ulcer during some time in their lives. In the United States, that translates to 1 million ulcer-related hospitalizations and 350,000 to 500,000 new cases per year, with 6,000 patients meeting death because of ulcer complications.
Stomach ulceration is perhaps one of the most studied disorders in medicine and this attention has yielded formidable knowledge about its causes and treatments. Most cases are caused by Helicobacter pylori infection. This hardy bacterium can survive in the harsh environment of the stomach by burying itself in mucus and escaping detection and eradication by the immune system. Helicobacter pylori causes gastritis by affecting production of gastrin, the enzyme that regulates acid production and secretion. Helicobacter pylori are very common in people worldwide, but many do not produce any symptoms at all.
Another common cause is through the use and abuse of non-steroid anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen and etodolac. They are common non-prescription drugs used as pain relievers and can damage stomach lining by inhibiting prostaglandin production. Prostaglandin is an agent important for resistance of the stomach lining to acid corrosion.
Smoking and alcohol can also abruptly increase stomach acid production and can increase risk of complications like massive bleeding and perforation. Chronic and excessive stress can also contribute to increased acid production.
Anyone with a stomach ulcer will usually exhibit some mild symptoms as a side effect, or they could experience severe symptoms that need immediate medical attention. Below are some of the symptoms you may have with a stomach ulcer:
- Sometimes asymptomatic, or have minimal indigestion
- Hunger with burning sensation two or three hours after meals, or in the middle of the night, that is relieved by consuming food (duodenal) or antacids (duodenal and gastric ulcers)
- Excessive bloating and gassiness in the stomach
- Nausea and vomiting
Some severe symptoms include:
- Dark-stained vomitus
- Vomiting dark and clotted blood
- Black tarry stools
- Pale skin due to anemia
- Weight loss
- Abdominal pain
- Loss of appetite
The diagnosis of stomach ulcers can be initially made based on an interview with a doctor alone, and if necessary, confirmed with the use of laboratory tests and imaging studies. Because of advances in study of ulcers, medical history alone is sometimes enough to support the diagnosis. But if the interview is inconclusive, tests are done to confirm diagnosis.
Barium swallow with an X-ray can outline the ulcer that readily shows in the film. It can also help alleviate abdominal pain because barium covers the ulcers. Testing for Helicobacter pylori includes an urea breath test and hydrogen breath test. Stool exam is done to detect traces of blood that indicate bleeding in the digestive tract. Endoscopy procedures can visualize the ulcer in the stomach and duodenum. If necessary, a biopsy from different areas of the stomach can be done too. The recovered tissues are examined for presence of malignancy. Blood tests may be performed, but often provide unreliable results, as they normally do not enable us to distinguish between past and current infection episodes.
The treatment is focused on reduction of gastric acids to allow healing of the ulcer. Antacid drugs like aluminum magnesium hydroxide, calcium alginate and other formulations coat the ulcer and prevent further acid contact. This is usually used to treat only younger patients.
Proton pump inhibitors and H2 antagonists work by directly reducing acid production. Dual antibiotics with proton pump inhibitors against Helicobacter pylori are also given; an example is amoxicillin-metronidazole-lansoprazole. In resistant cases amoxicillin-clarithromycin-metronidazole with proton pump inhibitors and bismuth compounds (to prevent vomit) are administered.
Surgery is recommended if there is massive bleeding, confirmed malignancy and danger of perforation. Bleeding is stopped by cauterizing or clipping bleeding vessels. If there is malignancy and perforation, part of or all of the stomach is removed and gastric bypass is performed.
Single ulcers heal through the use of medications alone, and sometimes even without treatment. If there were multiple ulcers, prognosis is still good unless there is perforation. Perforation Malignancy can often be treated by the removal of the stomach, especially if it is detected early.
Stomach ulcers can be prevented by consuming food before taking NSAIDs, and by avoiding smoking and the abuse of alcohol. Treatment with antibiotics after a positive test for the presence of Helicobacter pylori can prevent ulcers. Manage stress effectively.
The quality of life is quite normal if stomach ulcers are effectively managed by taking drugs at the proper time with regular check-ups. Avoid cigarette smoke, strong alcohol, soda drinks and milk products which can increase acid production.
If part of the stomach is removed, small frequent meals are better tolerated than three large meals. Planning the diet that gives just enough calories can prevent hunger and gaining weight. Individuals with a removed stomach can often live a normal life.
Research has established that coffee, spicy foods and having aggressive personality have much less impact in the increasing risk for ulcers than a Helicobacter pylori infection. The development of new drugs and vaccines to help management of a Helicobacter pylori infection is a currently active field of research.