What is a stomach ulcer?
A stomach ulcer, or peptic ulcer, is a sore in the lining of the stomach (ventricle) or the upper part of the small intestine (duodenum). A stomach ulcer occurs when the protective lining breaks down and stomach acid, which contains hydrochloric acid and digestive enzymes, damages the tissue. Most stomach ulcers are linked to infection with the bacterium Helicobacter pylori or to long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Symptoms of stomach ulcers
The most common symptoms of stomach ulcers are:
- Pain in the upper part of the stomach: Often burning or stinging and occurs in connection with meals or on an empty stomach.
- Nausea: Especially after eating.
- Bloating and gas: Feeling of a swollen stomach.
- Acid reflux or heartburn: Especially if the ulcer is in the stomach.
- Feeling full: Despite small amounts of food.
In more severe cases, stomach ulcers can cause bleeding, which can manifest as black stools or bloody vomiting, and then require emergency care.
Causes of stomach ulcers
Stomach ulcers are most often caused by a combination of factors that weaken the protective lining of the stomach:
- Helicobacter pylori: A bacterium that infects the stomach lining and causes inflammation.
- NSAIDs: Drugs such as ibuprofen, diclofenac, and naproxen can irritate the lining and increase the risk of ulcers.
- Smoking: Weakens the stomach lining and impairs wound healing.
- Alcohol: Can irritate and damage the stomach lining.
- Stress and diet: Do not directly affect the occurrence of stomach ulcers, but can worsen symptoms.
What happens in body?
When the lining is damaged, an open wound forms and is exposed to acid and digestive enzymes. This can lead to inflammation, pain and, in the worst case, bleeding. If the wound is deep enough, it can perforate the stomach wall, which is a life-threatening condition. Repeated ulcers can also cause scarring and strictures that prevent food from passing through.
Who gets stomach ulcers?
Stomach ulcers can affect people of all ages, but are most common in adults between the ages of 30 and 60. The risk is higher in people who use NSAIDs regularly, have an infection with Helicobacter pylori, smoke or have a hereditary predisposition to stomach ulcers.
Diagnosis of stomach ulcers
The diagnosis is made through a combination of symptom assessment and examinations:
- Gastroscopy: A camera examination of the stomach and duodenum that shows whether there is an ulcer, inflammation or bleeding. Tissue samples are often taken at the same time.
- Test for Helicobacter pylori (IgG) - There are several methods, such as a breath test (urease test), stool sample or blood test for antibody analysis.
- Blood tests: Anemia (anemia) can be detected in bleeding stomach ulcers. Common tests are:
Treatment of stomach ulcers
The treatment aims to reduce acid production, heal the ulcer and treat the underlying cause:
- Proton pump inhibitors (PPIs): Drugs such as omeprazole or esomeprazole reduce acid production and help the mucosa to heal.
- Treatment of Helicobacter pylori: A combination of antibiotics and PPIs for 1–2 weeks is required to eradicate the infection.
- Discontinuation of NSAIDs: If possible, these drugs should be avoided. In some cases, PPIs are given as a preventative measure if needed.
In very rare cases, in cases of complications that cannot be treated medically, surgery may be necessary.
Lifestyle advice for stomach ulcers
To relieve symptoms and reduce the risk of recurrence, the following advice may be helpful:
- Avoid smoking and alcohol: These irritate the stomach lining and delay healing.
- Eat regularly: Small, frequent meals reduce the load on the stomach.
- Avoid irritating foods: For example, spicy foods, coffee and carbonated drinks if they worsen symptoms.
- Stress management: Relaxation and balance in everyday life can help reduce symptoms.