Ulcers are sores on the lining of your stomach or small intestine. Sores also could be on your esophagus (throat). Most ulcers are located in the small intestine. These ulcers are called duodenal ulcers. Stomach ulcers are called gastric ulcers. Ulcers in the throat are called esophageal ulcers.
What Are Stomach Ulcers?
Stomach ulcers are sores in the lining of the stomach or small intestine. They occur when the protective mucus that lines the stomach becomes ineffective.
The stomach produces a strong acid to help digest food and protect against microbes. To protect the tissues of the body from this acid, it also secretes a thick layer of mucus.
Stomach ulcers, which are also known as gastric ulcers, are painful sores in the stomach lining. Stomach ulcers are a type of peptic ulcer disease. Peptic ulcers are any ulcers that affect both the stomach and small intestines.
Stomach ulcers occur when the thick layer of mucus that protects your stomach from digestive juices is reduced. This allows the digestive acids to eat away at the tissues that line the stomach, causing an ulcer.
A stomach or gastric ulcer is a break in the tissue lining the stomach. The term ‘peptic ulcer’ refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum.
It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion.
In some people, the H pylori bacteria cause an infection in the lining of the stomach, which may lead to gastric ulcers. Damage to the stomach lining from stomach acid increases the likelihood that H pylori infection will result in a gastric ulcer. Other risk factors for stomach ulcer include alcohol use, tobacco use, and prolonged use of medications such nonsteroidal anti-inflammatory drugs (NSAIDs). Severe illness has also been associated with developing a gastric ulcer.
The signs and symptoms of stomach ulcer can be constant or sporadic, and the disease course varies among individuals. If H pylori is the cause, the symptoms will remain as long as the infection is untreated. Some people with stomach ulcers have no symptoms at all, while others may have burning pain, severe nausea, and vomiting.
In the case of H pylori-related stomach ulcers, the infection can be treated successfully with antibiotics. For stomach ulcer not related to H pylori, antacids or other medications are an effective treatment. You can reduce your risk of H pylori bacteria infection by following commonsense hygiene practices, such as washing your hands with soap and water prior to preparing food and after handling dirty diapers or using the bathroom.
Treatment for stomach ulcers includes the use of antibiotics to kill the infection, and acid-suppressing drugs.
Symptoms of Stomach Ulcers
The classic symptom of a stomach ulcer is indigestion, also called dyspepsia.
Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.
Heartburn can be caused by acid reflux or gastroesophageal reflux disease (GERD). It occurs slightly higher up from the stomach and is felt in the lower part of the chest.
It is worth noting that not all stomach ulcers cause indigestion.
Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague.
A number of symptoms are associated with stomach ulcers. The severity of the symptoms depends on the severity of the ulcer.
The most common symptom is a burning sensation or pain in the middle of your abdomen between your chest and belly button. Typically, the pain will be more intense when your stomach is empty, and it can last for a few minutes to several hours.
Some stomach ulcers don’t produce any symptoms. If present, they can include:
- dull pain in the stomach
- weight loss
- not wanting to eat because of pain
- nausea or vomiting
- feeling easily full
- burping or acid reflux
- heartburn, which is a burning sensation in the chest)
- pain that may improve when you eat, drink, or take antacids
- anemia, whose symptoms can include tiredness, shortness of breath, or paler skin
- dark, tarry stools
- vomit that’s bloody or looks like coffee grounds
Causes of Stomach Ulcers
When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.
- The food is partially digested in the stomach and then moves on to the duodenum to continue the process.
- Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall.
In the past it was thought that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.
- Now it is understood that people with ulcers have an imbalance between acid and pepsin coupled with the digestive tract’s inability to protect itself from these harsh substances.
- Research done in the 1980s showed that some ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori.
- Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.
Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slow the healing of existing ulcers.
Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex])
Stress: physical (severe injuries or burns, major surgery)
Radiation therapy:-used for diseases such as cancer
People who take aspirin or other anti-inflammatory medications are at an increased risk even if they do not have H pylori infection.
- Elderly people with conditions such as arthritis are especially vulnerable.
- People who have had prior ulcers or intestinal bleeding are at a higher-than-normal risk.
- If a person takes these medications regularly, alternatives should be discussed with a health-care professional. This is especially true if the affected individual has an upset stomach or heartburn after taking these medications.
H pylori bacteria is spread through the stools (feces) of an infected person.
- The stool contaminates food or water (usually through poor personal hygiene).
- The bacteria in the stool make their way into the digestive tracts of people who consume this food or water.
- This is called fecal-oral transmission and is a common way for infections to spread.
The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum.
- Many people who are exposed to the bacteria never develop ulcers.
- People who are newly infected usually develop symptoms within a few weeks.
- Researchers are trying to discover what is different about the people who develop ulcers.
Infection with H pylori occurs in all ages, races, and socioeconomic classes.
- It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
- It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
- African Americans and Hispanic Americans are more likely to have the bacteria than Caucasians and Asian Americans.
It is important to distinguish between ulcers caused by H pylori and those caused by medications because the treatment is completely different.
Ulcers can be linked with other medical conditions.
- People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers.
- A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.
How Are Stomach Ulcers Diagnosed?
Diagnosis and treatment will depend on your symptoms and the severity of your ulcer. To diagnose a stomach ulcer, your doctor will review your medical history along with your symptoms and any prescription or over-the-counter medications you’re taking.
To rule out H. pylori infection, a blood, stool, or breath test may be ordered. With a breath test, you’ll be instructed to drink a clear liquid and breathe into a bag, which is then sealed. If H. pylori is present, the breath sample will contain higher-than-normal levels of carbon dioxide.
Other tests and procedures used to diagnose stomach ulcers include:
- Barium swallow: You drink a thick white liquid (barium) that coats your upper gastrointestinal tract and helps your doctor see your stomach and small intestine on X-rays.
- Endoscopy (EGD): A thin, lighted tube is inserted through your mouth and into the stomach and the first part of the small intestine. This test is used to look for ulcers, bleeding, and any tissue that looks abnormal.
- Endoscopic biopsy: A piece of stomach tissue is removed so it can be analyzed in a lab.
Treatment For Stomach Ulcers
Special diets are now known to have very little impact on the prevention or treatment of stomach ulcers. Treatment options can include:
- medication – including antibiotics, to destroy the H. pylori colony, and drugs to help speed the healing process. Different drugs need to be used in combination; some of the side effects can include diarrhoea and rashes. Resistance to some of these antibiotics is becoming more common
- subsequent breath tests – used to make sure the H. pylori infection has been treated successfully
- changes to existing medication – the doses of arthritis medication, aspirin or other anti-inflammatory medication can be altered slightly to reduce their contributing effects on the stomach ulcer.
- reducing acid – tablets are available to reduce the acid content in the gastric juices
- lifestyle modifications – including quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process.
If your stomach ulcer is the result of H. pylori, you’ll need antibiotics and drugs called proton pump inhibitors (PPIs). PPIs block the stomach cells that produce acid.
In addition to these treatments, your doctor may also recommend:
- H2 receptor blockers (drugs that also block acid production)
- stopping use of all NSAIDs
- follow-up endoscopy
- probiotics (useful bacteria that may have a role in killing off H. pylori)
- bismuth supplement
Symptoms of an ulcer may subside quickly with treatment. But even if your symptoms disappear, you should continue to take any medication prescribed by your doctor. This is especially important with H. pylori infections, to make sure that all bacteria are eliminated.
Side effects of medications used to treat stomach ulcers can include:
- abdominal pain
These side effects are typically temporary. If any of these side effects cause extreme discomfort, talk to your doctor about changing your medication.
In very rare cases, a complicated stomach ulcer will require surgery. This may be the case for ulcers that:
- continue to return
- don’t heal
- tear through the stomach
- keep food from flowing out of the stomach into the small intestine
Surgery may include:
- removal of the entire ulcer
- taking tissue from another part of the intestines and patching it over the ulcer site
- tying off a bleeding artery
- cutting off the nerve supply to the stomach to reduce the production of stomach acid
In the past, it was thought that diet could cause ulcers. We know now this isn’t true. We also know that while the foods you eat won’t cause or cure a stomach ulcer, eating a healthful diet can benefit your intestinal tract and overall health.
In general, it’s a good idea to eat a diet with lots of fruits, vegetables, and fiber.
That said, it’s possible that some foods play a role in eliminating H. pylori. Foods that may help fight off H. pylori or boost the body’s own healthy bacteria include:
- broccoli, cauliflower, cabbage, and radishes
- leafy greens, such as spinach and kale
- probiotic-rich foods, such as sauerkraut, miso, kombucha, yogurt (especially with lactobacillus and Sacharomyces)
- blueberries, raspberries, strawberries, and blackberries
- olive oil
People at risk of stomach ulcers should include more of the following nutrientsTrusted Source 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.
Avoiding alcohol and caffeine can also help reduce the risk, as they both cause the body to produce more gastric acid. This can lead to stomach ulcers.