That gnawing feeling in your gut
Have you ever felt like something was eating away at your stomach? Or have you experienced a burning sensation in your abdominal area? If you have, then you just might have an ulcer a small crater in your digestive tract created by your stomach's acidic gastric juices. These cause the pain and burning sensation you feel.
Ulcers are generally caused by a bacteria, Helicobacter pylori, that can live in your stomach. While antibiotics can eradicate these bacteria, the exact cause of infection is still unclear. However, risk factors include physical stress, smoking, improper diet, heavy alcohol consumption, and other lifestyle factors.
A gastric ulcer develops once the formation of small erosions along the stomach lining form. Erosion is caused by the acidity of the stomach fluids, which contain hydrochloric acid and the enzyme pepsin (hence the name peptic ulcer). Usually, a thick mucosal layer protects the lining of the gastrointestinal (GI) tract. This layer is continually rebuilt as the acid continually destroys it. Overproduction of acid tips the equilibrium in favor of those forces favoring breakdown, and as the mucosa begins to degrade, erosion occurs and an ulcer begins to form. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause or worsen this condition.
The mechanisms of erosion are still not fully understood, but somehow, Helicobacter pylori are able to survive stomach's acidic environment and reproduce in its mucosa. This infection causes tissue damage and leads to ulcer formation.
If you think you might have an ulcer, it's important to seek medical advice for diagnosis and treatment. If left untreated, an ulcer can further erode the mucosa until bleeding, obstruction, or perforation occurs. Follow-up is always recommended, as recurrence is likely if H. pylori is not completely eradicated. In some untreated cases, gastric ulcers have been shown to progress to malignancy, leading to a greater chance of developing stomach cancer.
A wide range of therapies exist to effectively treat symptoms and heal ulcers, so only in rare cases is surgery needed. So it's important to realize that treatment failure does not necessarily mean that your case is untreatable. The main reason treatments fail is noncompliance (i.e., not sticking to the medical treatment your doctor has suggested). Risk factors like alcohol, caffeine, aspirin and other NSAIDs, (such as ibuprofen) and especially cigarettes have been shown to aggravate existing ulcers, so it's important to follow your doctor's advice regarding diet and lifestyle modifications.
Characteristics of Gastric Ulcers
A gastric ulcer is one that forms within (or very near) the stomach. The ulcer is usually a crater anywhere from one to two inches in diameter. The surrounding area is typically inflamed.
How Common Are Gastric Ulcers?
Approximately 4 million Americans develop an ulcer or a recurrence due to a previous ulcer each year, with over 90,000 of those cases attributed to gastric ulcers. Anyone can develop an ulcer, but this is rarely the case in children and adolescents. Gastric ulcers usually appear after age 60 and are rare in people under age 40. Equal numbers of males and females are affected with gastric ulcers.
What You Can Expect
Current medications and dietary restrictions make for a good prognosis if you are diagnosed with a gastric ulcer. Gastric ulcers usually heal with treatment, but rarely they may become malignant. Thus, biopsies are sometimes necessary to determine if an ulcer is cancerous. If an ulcer is diagnosed before complications or perforation occur, medications can be prescribed to eradicate the Helicobacter pylori bacteria, heal the ulcer, provide symptom relief, and in most cases, prevent recurrence.
Goals of Treatment
Ulcers caused by Helicobacter pylori can be successfully treated and cured with antibiotic medication. Ulcers caused by certain drugs or substances can be cured by stopping their use and taking medications to protect the gastrointestinal tract lining. Your doctor can prescribe medication to provide symptom relief, promote ulcer healing, and prevent further complications. Surgery is rarely necessary.
Gastric ulcer treatment includes eliminating any H. pylori infection, controlling acute stomach acid to provide immediate pain relief and induce ulcer healing, controlling chronic stomach acid to prevent the ulcer from recurring, and preventing further complications. Antibiotics and antacids are typically prescribed, as are changes in lifestyle and diet, if necessary. Surgery, while rare, may be needed to repair a severe ulcer.
Drug therapy is aimed at eradicating H. pylori, reducing acid production, and in some cases, enhancing mucosal protection.
|Antibiotics To eliminate H. pylori bacteria|
|Histamine receptor antagonists (H2 blockers) To promote healing via slowing or stopping gastric acid production:|
|Proton pump inhibitors to stop acid production:|
|Mucosal protectants: directly protect the stomach and intestinal lining from damage:|
Surgery is usually a last resort. In rare cases, an ulcer might not respond to medication, gastric bleeding is serious enough to pose a danger, or there is danger of acute peritonitis. The latter cases (especially an ulcer that has perforated the lining or caused obstruction) are life-threatening conditions that require emergency surgery. Besides surgical repair of the ulcer, procedures have been developed that can reduce stomach acid production. If persistent obstruction occurs, surgery may be avoided via tube-suctioning the stomach contents for several days along with the IV administration of anti-ulcer medication.
Appropriate Healthcare Settings
Once you have been diagnosed, treatment is normally done on an outpatient basis under your doctor's supervision. You may need to be hospitalized if complications like bleeding, perforation, or obstruction develop. In this case, surgery may be necessary as a last resort.
Healthcare Professionals Who May Be Involved in Treatment
When being treated for a gastric ulcer, you might see any of the following doctors or healthcare professionals:
- General surgeons
- Family physicians
- Nurse practitioners
Activity & Diet Recommendations
For the most part, eat regularly and avoid alcohol, coffee, tea, and foods that might cause pain or indigestion. Talk to your doctor about discontinuing the use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, as they can irritate the digestive tract.
Pregnant women should not take the mucosal protective agent Cytotec (misoprostol), as it has been shown to cause miscarriages. Certain antibiotics, such as tetracycline and metranidazole, should also be avoided during pregnancy.
Considerations for Children and Adolescents
Children and adolescents are rarely diagnosed with ulcers.
Minimize a child's vocal activities. Discourage your child from shouting, crying, or singing, since these activities will only delay recovery.
Considerations for Older People
Certain anatomical abnormalities may cause reflux in a young child. These conditions may require surgery. Left untreated, chronic acid reflux may be drawn into the lungs and cause asthma.
Last updated 24 May 2012
- Peptic ulcer disease
The cause of gastric ulcers has not been fully established.
Ulcers seem to develop when the stomach acid eats into the gastrointestinal lining. Normally, the lining is protected by a thick mucosal layer. Gastric ulcers occur primarily when there is a defect in the layer of mucus that allows the digestive juices to penetrate it. Currently, scientists cannot fully explain the how this happens. A few known causes include:
- NSAIDs: Nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen have been shown to cause damage to the gastric lining and thus cause gastric ulcers. Studies show that NSAIDs are the primary cause in more than 30% of gastric ulcers.
- Helicobacter pylori: Discovered only within the last 20 years, this resilient bacteria can survive in the acidic stomach environment. There, it burrows through the mucous lining into the tissue, where it reproduces, ultimately weakening the tissue and making it more susceptible to ulceration. This accounts for the majority of ulcer cases.
- Genetic factors: Zollinger-Ellison syndrome is a genetic disease that prompts excessive amounts of stomach acid to form, causing recurrent ulcer formations.
Risk factors include:
- Excessive cigarette smoking
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen)
- Excess alcohol intake
- Use of corticosteroids
- Zollinger-Ellison syndrome
- Physical stress (not emotional)
- Certain chronic conditions (liver disease, rheumatoid arthritis) that increase GI tract vulnerability
Symptoms & Diagnosis
- Gnawing or burning pain in abdomen
- Indigestion (dyspepsia)
- Blood stools or vomit
- Recurrent vomiting (especially if obstruction occurs)
Conditions That May Be Mistaken for Gastric Ulcers
Conditions with symptoms similar to those of gastric ulcers include the following:
- Duodenal ulcer
- Gastroesophageal reflux disease (GERD)
- Gallbladder disease
- Stomach, duodenal, or pancreatic cancer
- Crohn's disease
- Variant angina pectoris
- Gastric carcinoma
How Gastric Ulcers Are Diagnosed
Two imaging techniques, EGD (esophagogastroduodenoscopy) and the upper GI series, are the most reliable procedures to use when diagnosing an ulcer. Other useful diagnostic procedures can include a discussion of your medical history, laboratory breath and stool studies, blood tests, or a biopsy of the GI-tract mucosa. See Imaging, below, for more information on these tests.
Laboratory diagnostic procedures include the following:
- Measurements of elevated blood gastrin levels (a hormone that stimulates stomach production of hydrochloric acid) to rule out Zollinger-Ellison syndrome
- Testing the stool for blood
- Measurement of blood pepsinogen (the precursor of pepsin) levels
- Measurement of urea level in breath
- Stool and serum tests for H. pylori antigens
- Your doctor may do an upper gastrointestinal (GI) series to look at the stomach. This test involves swallowing barium, a chalky solution that coats the lining of the GI tract, and then having X-rays taken. It helps to reveal inflammation or ulcers.
- Your doctor may also perform an EGD (esophagogastroduodenoscopy), which involves inserting an endoscope into your mouth and threading it down the esophagus into the small intestine. Performed while you are under mild sedation, this procedure allows a doctor to see, photograph, and biopsy the ulcer. It offers the most reliable method of diagnosis, and allows for the treatment of bleeding, if present.
Self care & Prevention
Preventing Gastric Ulcers
If you do not have gastric ulcers, the best way to avoid them are:
- Eradicate Helicobacter pylori bacteria through an antibiotic regimen
- Discontinue nonsteroidal anti-inflammatory drug (NSAID) usage
If you already have a gastric ulcer, the following lifestyle changes can help prevent you from getting more of them.
- If you smoke, stop. Smoking increases the concentration of stomach acids in the duodenum, which boosts the risk of ulcers and interferes with their treatment.
- Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) including aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). They can cause gastrointestinal bleeding and can cause and/or aggravate ulcers.
- Limit or eliminate caffeine, and alcohol. They increase the secretion of stomach acids.
- Eat more plant foods. In one study, Harvard researchers followed the diets of 48,000 middle-aged men for six years. Compared with those who did not develop ulcers during that time, those who did ate significantly fewer plant foods -- meaning they consumed less fiber. The most protective plant food was beans. Fruits and vegetables were also protective, but less so. Fiber slows the emptying of stomach contents into the duodenum, which reduces the concentration of stomach acids there.
- Avoid stress as much as possible.