What are Stomach Ulcers?

Stomach ulcers are also known as gastric ulcers, and they are a type of peptic ulcer disease, a medical category that encompasses all kinds of ulcers whose symptoms affect the small intestines and the stomach. Around 10% of the world population is experiencing this disease during their lifetime, however as medical advances were made, it can be easily cured; however, it remains threatening if adequate treatment is not followed and it develops into its severe forms.

Stomach ulcers manifest in the stomach lining in the form of painful sores. At a glance, the inner workings of the stomach include the production and secretion of powerful acids that play a key role in digesting food and protecting the organism from bacteria and microbes. In the human body, around 2-3 liters of gastric fluids are discharged daily, their composition being 99% water and another key 1% made of organic and inorganic substances, enzymes, and mucus playing a part in decomposing all the foods we consume.

In order to protect the gastric tissue, a thick mucus is also produced and secreted, acting as a shield layer inside the stomach. If, for any reason, the layer starts thinning down, these strong gastric juices directly attack and deteriorate the stomach lining itself, entering a process known as auto-digestion and causing what is medically referred to as stomach ulcers.

Types of Ulcers

Ulcers extend to more regions of the human body, types including arterial ulcers, venous ulcers, mouth ulcers, or genital ulcers. However, this article focuses on peptic ulcers and their types.

Peptic ulcers are separated into three categories, based on their location in the body: gastric ulcers, developing in the stomach lining, and duodenal ulcers, developing the small intestine, also known as the duodenum and e esophageal ulcers, developing inside the esophagus, at its junction with the stomach. If a patient is experiencing gastric and duodenal ulcers at the same time, it is classified as a gastroduodenal ulcer.

The location of the pain can be a key element in diagnosing and differentiating between gastric and duodenal ulcers. This does not mean that the exact location of the pain will be a perfect match in localizing where the ulcer is.

Stomach Ulcers Signs & Symptoms

Like most medical conditions, there are a series of different symptoms associated with stomach ulcers, and their severity will depend on the severity of the ulcer formed. The most common sign is a burning pain in the abdominal area, usually located between the belly button and the breastbone. Typically, the pain is amplified when the stomach is empty in the periods between meals or during the night in your sleep and can last between minutes and hours, appearing, and disappearing for days, to periods as long as weeks or even months if it’s not being investigated or treated. Typically, burning abdominal pains settle in around 15-60 minutes after meals in gastric ulcers and 2-3 hours after meals in duodenal ulcers. Between 50 and 80% of patients diagnosed with duodenal types of ulcer also experience night-time pains, in their sleep.

Additionally, but less common symptoms range from bloating (swelling due to the stomach being full of air or gas), retching (sounding or feeling like you are about to vomit, without being able to), burping, feeling nauseous, and vomiting. Regarding nutrition, it can be manifested as poor appetite or feeling excessively full after a meal, and even unexpected weight loss. If any of these are repeatedly present, further investigations must be carried, even if the symptoms are mild.

If undiagnosed and left untreated, ulcers can cause complications – three main ways these complications manifest are bleeding, perforation, and stomach blockage.

Bleeding from stomach ulcers can range from light dripping to life-threatening bleeding. A slow, gradual trickle will go through the bowels and cause feces to show a very dark, even black color, medically known as melaena. Mild sudden bleeding can trigger vomiting, with a coffee-colored discharge caused by the gastric acids breaking down the blood. Heavy sudden bleeding will manifest by feeling extremely faint and vomiting blood, a symptom known as hematemesis.

Perforation is another complication that defines that the ulcers have penetrated completely through the thickens of the gastric wall, creating a hole and causing the contents of the stomach (food and gastric acids) to outflow from the stomach. Externally, it causes severe states of being unwell and extreme abdominal pain. This is a medical emergency, and the patent must receive urgent treatment.

Stomach blockage or scar tissue is usually present when the outlet of the stomach starts to narrow, creating an obstruction and making it difficult for the food to pass through. This complication will also cause recurrent severe vomiting. Due to medical advances and treatment, this complication now occurs very rarely.

Urgent medical attention must be required if any of the following symptoms are being experienced: sudden, sharp abdominal pain or the hard to touch appearance of the abdomen, signs of shock (fainting, confusion, or excessive sweating), blood in feces or vomit, and stomach pain that improves when lying down completely still but worsens with any type of movement. These are all signs of complications and must be treated urgently.

Stomach Ulcer Causes

Common causes that can lead to the thinning of the gastric protective layer inside the stomach and lead to painful open sores known as ulcers usually manifest by causing an imbalance if the amount of mucus is decreased and the amount of acid is increased.

Heliobacter pylori (H.pylori) is the principal bacterium that triggers stomach ulcers and causes stomach infections and inflammations. This bacterium can be found in the mucous shield layer that defends the stomach lining, and while mostly inoffensive, this bacterium can cause inflammation in the inner layer of the stomach and lead to the formation of ulcers. While it is still unclear how it’s transmitted, individuals can come into contact with this bacterium via unclean, contaminated water or unclean, contaminated food (including dirty cooking utensils), but it can also be transmitted through close person-to-person contact, via saliva or other bodily fluids, for example during kissing.

The H.pylori infection is commonly related to a series of risk factors, including living in crowded conditions with several other people, living without a reliable supply of uninfected water (running water reduces the risk of H.pylori), living in developing countries, where crowded and unsanitary conditions are more common or living with someone that is already infected with H.pylori.

Another cause of stomach ulcers is the regular use of certain pain relief medications, classed under the name of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and include ibuprofen and aspirin. While people of any age can take these drugs, it's those that take them daily or multiple times a week for prolonged periods of time that are at risk of developing forms of peptic ulcers. The possibility of developing ulcers through extended intake of NSAIDs is generally increased in females and individuals above the age of 70, patients that have had peptic ulcers before, taking more than two types of NSAIDs or taking additional medicines, such as corticosteroids. Alcohol intake and smoking can also contribute to an increased risk of ulcer formation in combination with long-term regular NSAIDs intake.

Tumors are a very rare cause that can lead to developing peptic ulcers and only manifest in individuals diagnosed with the Zollinger-Ellison syndrome (ZES). This condition only occurs in roughing every 1 in 1 million people, making it a rare digestive disorder. The syndrome causes one or multiple gastronomes, tumors in the pancreas, and/or the initial part of the small intestine. These tumors secrete gastrin, contributing to an excessive release of gastric acid in the stomach, which can lead to peptic ulcers.

For esophageal ulcers specifically, gastroesophageal reflux disease (GERD) can develop and lead to ulcers due to individuals experiencing frequent acid reflux (contents of the stomach travel backward into the esophagus), either due to weakness or damage in the esophageal sphincter, a muscle is designed to prevent food from moving upwards once in the stomach. Another category of individuals at risk of developing esophageal ulcers are those with compromised immune systems. For them, bacterial, viral, or fungal infections like HIV or Candida can be the triggering cause.

Stress Ulcers or Stomach Ulcers caused by Stress

Medically referred to as stress-related mucosal damage, stress ulcers can appear in individuals that are under extreme mental, psychological or physical stress. While research is still ongoing, many professionals in the medical field highlight the effect of physical stress rather than psychological or mental on ulcers. It must be noted that stress does not refer to day-to-day stress but rather intense and extreme situations of trauma or pressure.

While the causes are the same as those of peptic ulcers, what makes stress ulcers stand out is that in these instances, stress is an aggravating factor and contributes to symptom worsening. Some physical stress forms that can be aggravating causes of ulcer symptoms are severe long-term illness, trauma to the brain, serious burns, injury to the central nervous system, or some surgical procedures.

Again, while not considered the cause of stomach ulcer development, another association between ulcers and stress is the pressure added by the presence of the ulcer itself. In peptic ulcers, that is due to the symptom it causes, which naturally triggers worrying.

Stomach Ulcers and Food

Some food recommendations, known as an ulcer diet, are meant to aid in reducing pain and irritation associated with peptic ulcers. It must be highlighted that aliments and beverages do not cause or cure stomach ulcers, but some can be useful in helping to repair affected tissue, while others can further inflame and irritate the stomach.

When you have an ulcer, you should try to limit your diet to specific foods that can act against ulcer-causing bacteria, including fruits (apples, berries, cherries), vegetables (cauliflower, cabbage, bell peppers, carrots, broccoli, leafy greens), lean meat, fish and seafood, eggs, probiotic-rich foods and fermented dairy (yogurt miso, kombucha), olive oil, honey, garlic, decaffeinated green tea, and turmeric.

These foods can help in the ulcers caused by H.pylori infections because they are rich in antioxidants and can contribute to activating the immune system and fighting the infection. For example, broccoli contains a compound called sulforaphane that exhibits anti-H. Pylori activity and foods like berries and bell peppers are full of antioxidants.

On the other hand, products that must be avoided are those that make acid reflux worse and include alcohol, coffee, and caffeine, milk, fatty meat, fried food, heavily spicy food, citrus fruits and juices, tomatoes, and chocolate. Personalized recommended diets can be designed with the help of professionals. Aside from specific foods and drinks, overeating or eating 2-3 hours before going to sleep has proved to contribute to increased acid reflux symptoms.

In short, while food and drinks are not the cause or solution of gastric ulcers, they can be vital in repairing damaged tissues and fighting bacteria that caused the ulcers. By making the right dietary choices, individuals can reduce symptoms and help speed up healing.

Stomach Ulcers Diagnosis

Stomach ulcers can be diagnosed by medical professionals by physical exams and based on the individual's medical history. There are two main imaging testing procedures used to diagnose gastric ulcers.

• Upper Gastrointestinal Series or Barium Swallow is a test that examines the organs situated in the top part of the digestive system (esophagus, stomach, and duodenum) and is performed by swallowing barium – a metallic fluid that makes the organs visible on x-ray machines.
• Upper endoscopy or Esophagogastroduodenoscopy (EGD) is another imaging diagnosis exam that analyses the lining of the top part of the digestive system (esophagus, stomach, and duodenum). It is performed using an endoscope, a medical thing tube with a video camera on its end that goes through the patient's mouth all the way down to the duodenum and allows visibility inside these organs.

H.pylori infections can be diagnosed by performing a biopsy and removing a small tissue sample, or alternatively with the use of blood tests that check for antibodies (a sign the organism is fighting an infection), stool culture by collecting feces samples and analyzing them in the lab or by doing urea breath test. Urea breath tests measure the level of carbon dioxide found in the patient's breath when they exhale and are performed by swallowing the urea pill that contains carbon molecules. If H.pylori is present, the area will break down into carbon dioxide, and when analyzed, higher than normal levels of carbon dioxide will be present in the breath sample.

Stomach Ulcers Treatment

Depending on the gravity of the ulcers, the treatment can include dietary and lifestyle changes, prescribed medication, or in severe cases, surgery.

• Lifestyle modifications that can help include avoiding certain foods that aggravate the symptoms, drinking through a straw, not using any Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), or quitting smoking because it can prevent healing or even favor ulcers reappearing after treatment is ended. In NSAIDs caused ulcers, common medical advice is to reduce or eliminate the use of these drugs completely and find alternatives with GI specialized medical professionals.
• Medication commonly used for treatment usually included antibiotics, in a mixture used to eliminate the H.pylori bacteria and cure the ulcer, histamine receptor blockers (H2-blockers) that decrease the levels of gastric acid by blocking the histamine hormone that contributes to acid production, proton pump inhibitors (PPIs), also used to lower gastric levels, mucosal protective agents, prescribed to help restore the protective mucus lining after acid damage and antacid medication, that act to neutralize stomach acid, easing the pain and additional symptoms.

• Stomach ulcer endoscopy (EGD) procedures can be used with specialized tools in order to stop the active bleeding of the ulcer. Generally, EGD procedures are recommended in elderly patients or those that experience bleeding or recent weight loss and eating difficulties. The EGD will be repeated at the end of the treatment in order to confirm the healing.

For ulcers caused by the H.pylori bacterium, in most cases, drug treatment is enough to remove the bacteria, and the ulcers will not reappear,  however in rare cases, surgery could be required if the drugs do not help, or the severity of the ulcer is causing additional medical problems.

In modern-day medicine, surgery is a rare treatment method of stomach ulcers, considered a medical exception due to advances in other ways of curing the symptoms. When used, surgical methods are minimally invasive, usually resorting to laparoscopy (category of surgical procedures that allows the medical team to have access inside the abdominal area without a large incision. In rare, extreme cases, classical surgery methods are a last resort, used to remove affected areas of the stomach – but most patients do not reach this stage of ulcer severity. 

When to contact a medical professional?

It is extremely important to contact medical professionals if symptoms are recurring or do not go after treatment. Immediate medical help must be requested when extreme symptoms occur, including vomiting blood, bloody stools, or sharp abdominal pain that appears suddenly and does not ease or gets progressively worse. Symptoms of shock, like fainting, excessive sweating, or confusion, are also reasons to request urgent medical care.

How to Prevent Stomach Ulcers?

While not guaranteed, there are certain steps you can take to prevent stomach ulcers, liked talking to a medical professional about Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) alternative to relieve pain, especially if taking them for prolonged periods of time and discussing protective measures to implement while taking NSAIDs (such as probiotics). Lifestyle changes that can help prevent stomach ulcers are commonly drinking alcohol in moderation or not at all and quitting smoking or chewing tobacco.

3 Surprising Facts about Stomach Ulcers

1. Ulcers are not caused solely by stress or spicy foods

Until roughly 3 decades ago, in the 1980s, it was a common popular belief that ulcers are caused by stress that contributed to a raised buildup of acidic juices inside the stomach. Recent research disproves this theory, and while arguing that stress can indeed contribute and aggravate gastric ulcer symptoms, it is the Helicobacter pylori, shortly known as H. pylori bacterium, that is found in over 90% of cases. Its presence can be diagnosed using a breath test, a blood test, or a stool test and can be effectively treated using antibiotics.

2. Ulcers can be caused by the long-term use of some over-the-counter medications

It has been discovered that NSAID medications, medically known as Non-Steroidal Anti-Inflammatory Drugs, can become the cause of developing ulcers if used long-term. Examples of these drugs include aspirin, ibuprofen, and diclofenac. In order to protect the stomach and benefit from the curing effects these meds can offer, it is important to discuss with a specialist how to maintain the gastric protection layer, usually by taking probiotics.

3. Most people develop no symptoms

Approximately 75% of patients diagnosed with stomach ulcers do not experience any symptoms and find out about it during testing for other medical conditions, including acid reflux diagnosis, while others may start to develop symptoms when the ulcers become severe and must be treated immediately in order to avoid life-threatening consequences.

Conclusion

While most types and severities of stomach ulcers are now fully treatable, it is important to speak to a medical professional in time if you suspect you have any symptoms because if undiagnosed or left untreated, they can develop into severe complications like internal bleedings that can be life-threatening.