An ulcer is a sore that has opened up in damaged body tissue. While most stomach ulcers cause only discomfort or nausea, untreated ulcers can progress to serious and even life-threatening complications.
Symptoms of Stomach Ulcer
- Belly pain: This is generally in the upper abdomen. For , this pain is classically worse with eating, particularly things like spicy foods or alcohol.
- Heartburn: This describes a specific kind of pain caused by irritation from stomach acid, named because it’s usually in a territory near the heart (but in no way involving the heart). Heartburn is usually caused by gastroesophageal reflux (GERD) but can also occur in .
- Nausea: This is a common symptom, classically worse with eating.
More serious symptoms
- Vomiting blood (hematemesis): Vomit may be red or have a “coffee-ground appearance.”
- Black or bloody stools (melena)
- Fatigue, dizziness or fainting: This can result if there is significant blood loss (known as anemia).
- Unintentional weight loss
- Sudden, severe pain: This may be a sign that an ulcer has perforated, or opened up, allowing stomach contents to leak into the belly.
Causes of Stomach Ulcer
The lining of your stomach is under constant assault. It lives in a bath of hydrochloric acid. It has to tolerate everything we eat and drink, and protect from the enzymes your body uses to break those things down. When something interferes with these protective mechanisms, a range of problems can occur from mild indigestion to deadly bleeding ulcers.
In general, stomach ulcers occur when the stomach's protective mechanisms are overpowered. This can happen because the protections have been weakened because the attack has worsened, or some combination of the two. Things that disrupt this balance include the following.
These include steroids like prednisone or methylprednisolone (Medrol) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. We usually think of inflammation as a response to some specific injury like a wound or infection, but the same systems play an important role in maintaining our body against the everyday wear-and-tear of life. When NSAIDs reduce inflammation, they also reduce some of those protective mechanisms keeping the stomach healthy. In small doses, the effect isn't noticeable, but with large doses and regular use, problems like stomach ulcers can develop.
Infection with H. pylori
is a recently discovered bacteria that is a major cause of stomach ulcers and several other conditions. For many years it was believed that no bacteria could survive in the acidic environment of our stomachs. Dr. Barry Marshall infected himself with to convince the scientific community of its role in stomach disease . For his efforts, Dr. Marshall was awarded the Nobel Prize.
This is not a major cause of stomach ulcers but has been found to increase the risk of developing ulcers and slow healing. Similar concerns have been raised about alcohol consumption, though there is no definitive evidence linking alcohol with stomach ulcer formation.
The following are less common causes of stomach ulcers but are still possible.
- Chemotherapy agents
- Cancer: Certain cancers can cause stomach ulcers, including a rare tumor known as a gastrinoma which causes a massive increase in stomach acid production (termed Zollinger-Ellison syndrome).
- Severe illness: Almost any severe illness can impair the stomach’s protective and healing mechanisms. This is particularly true of severe burns (Curling’s ulcers) and head injuries (Cushing’s ulcers).
Treatment Options, Relief, and Prevention for Stomach Ulcer
Definitive treatment of peptic ulcer disease requires addressing the underlying cause. If anti-inflammatory medications such as NSAIDs are contributing to the ulcers, your physician will likely advise you to stop taking them or to reduce the dose .
Acid suppression and antibiotics
For ulcers caused by H. pylori infection, treatment consists of both acid suppression and targeted antibiotics . H. pylori can be a difficult bacteria to fully eliminate, and it can cause serious complications if insufficiently treated. Therefore a combination of two antibiotics is often used along with a PPI, a regimen known as triple therapy.
Reducing stomach acid plays an important role in treating stomach ulcers of any cause. This can be done in several ways including the following.
- Antacids: Aluminum hydroxide (Tums) work by directly neutralizing stomach acid. This makes them very fast-acting but generally not a good long-term solution and less effective than options which reduce acid production. However, they can be very useful as a “therapeutic trial” since belly pain that is not at least somewhat relieved by antacids probably isn’t caused by stomach acid.
- H2 antagonists: This includes medications like famotidine (Pepcid) and ranitidine (Zantac). These block one pathway of stomach acid production but not others. This makes them a good balance, as they reduce symptoms while maintaining many of the good things about having relatively normal stomach acid production.
- Proton pump inhibitors (PPIs): These include things like omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix) or lansoprazole (Prevacid). These medications block multiple pathways of stomach acid production at once, causing significant reductions in stomach acidity. This makes them very effective at reducing symptoms caused by excess stomach acidity, but also means they cause significant changes from the digestive system’s natural balance. They have been associated with side effects. Several are now available over-the-counter, but given the known risks it’s worth talking with your physician before starting a PPI regimen.
Prevention of stomach ulcers consists mainly of avoiding excessive anti-inflammatory use and treating H. pylori infection when present. Limiting the use of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve). However, limiting NSAID use can be difficult for those with chronic pain conditions. If you find yourself taking anti-inflammatories multiple times a week or in doses approaching the recommended limits, it’s worth talking with your physician about other options for pain control.
Preventing is more difficult. Unfortunately, it’s still not known exactly how H. pylori infection is transmitted. Current theories suggest it may be passed from person to person, either directly in body fluids or through contaminated food or water. Therefore, the best steps to avoid H. pylori infection would include washing hands thoroughly and maintaining sanitary living conditions. It’s also advisable to only consume food that is properly prepared and water that is known to be from a safe drinking sourc.
When to Seek Further Consultation for Stomach Ulcer
Most stomach ulcers are mild and can be addressed as part of a routine doctor’s visit. Symptoms that may indicate a more serious problem include unexplained weight loss, black or bloody stool, bloody vomit, persistent vomiting or prolonged inability to tolerate anything by mouth. While these are not proof of serious illness, they are concerning enough to schedule an appointment sooner rather than later.
A sudden increase in symptoms such as pain, fainting, severe weakness, and vomiting or defecating large volumes of blood may all be signs of a perforated stomach ulcer which has eroded into a blood vessel or is leaking contents into the belly. If you or someone you know is experiencing these symptoms, please seek medical help immediately.
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