What is Gastric Ulcer (Stomach Ulcer)?
Gastric ulcers are quite common in the United States and often lead to the spending of millions of healthcare dollars. They form when there’s a damage or break more than 5 mm in the protective lining of the stomach, that reaches down to the muscular layer beneath the lining. It’s important to know that this condition is both preventable and curable, but the treatment can vary depending on what caused the ulcer.
The stomach has natural ways to guard its lining from the strong stomach acid. However, when these natural defenses change, it could lead to changes in the stomach lining. Over time, these changes can cause the lining to thin and eventually develop an ulcer. The stomach lining is protected by substances like prostaglandins, mucus, growth factors, and a good blood supply.
However, certain things could harm the stomach lining and increase the risk of developing ulcers. These include smoking, stomach acid, poor blood supply, medications like NSAIDs, lack of oxygen, alcohol, and infection with a bacteria called Helicobacter pylori.
What Causes Gastric Ulcer (Stomach Ulcer)?
The most common causes of stomach ulcers are bacterial infection from a germ called Helicobacter pylori and the loss of certain stomach-friendly substances, often due to over-the-counter anti-inflammatory medications. There are less common causes too, such as an excess of a hormone called gastrin (Zollinger-Ellison syndrome), viral infections like CMV, chemotherapy, radiation treatments, blockages in the stomach’s exit, diseases that affect the stomach lining like cancer, cigarette smoking, and Crohn’s disease.
The key similarity with all these causes is that they damage the protective lining of the stomach. When this happens, the stomach lining becomes vulnerable to harmful stomach acids, leading to ulcers.
Risk Factors and Frequency for Gastric Ulcer (Stomach Ulcer)
Gastric ulcers are a type of peptic ulcer disease, occurring in about 5 to 10% of people in their lifetime. This could be an understatement, as some folks with the condition may not show any symptoms. The likelihood of getting gastric ulcers increases as a person ages and if they continue to use NSAIDs (a type of medication) for a long time. Smokers have twice the risk of developing gastric ulcers compared to non-smokers. Both men and women can have gastric ulcers. Around half of the population of the US at the age of 60 tend to have Helicobacter pylori infection, which is associated with ulcers. Among people who use NSAIDS chronically, about 25% may end up having gastric ulcers.
Signs and Symptoms of Gastric Ulcer (Stomach Ulcer)
Gastric ulcers, often called stomach ulcers, usually present with pain in the upper part of the stomach that gets worse when you eat. This pain can feel sharp or similar to a burn and does not usually spread to other areas. Patients might feel mild nausea and get full quickly during meals. The main thing doctors notice during an examination is tenderness in the upper stomach. Symptoms might last for weeks or months before patients decide to seek medical help. In some cases, patients might show signs of upper digestive tract bleeding. It is crucial for them to mention if they have noticed dark, sticky stools, vomiting blood, vomiting something that looks like coffee grounds, or bright red blood from the rectum. Even though bright red rectal bleeding often indicates lower digestive tract bleeding, up to 15% of patients with this symptom actually have a fast upper digestive tract bleed.
During the medical consultation, the patient should be asked about certain risk factors. These include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), blood thinners, and a history of peptic ulcer disease.
Testing for Gastric Ulcer (Stomach Ulcer)
If you have a suspected stomach ulcer, doctors will first check your general health condition, particularly whether your body is losing too much blood as stomach ulcers often cause upper GI bleeding which might result in a drastic drop in blood pressure, otherwise known as hemorrhagic shock. They will order lab tests such as BMP (basic metabolic panel), CBC (complete blood count), PT/INR (which checks how well your blood clots), and lipase (an enzyme which aids digestion).
A chest X-ray could be requested too, as some other conditions can give you stomach ache. Sometimes, you may be checked for pancreatitis (inflammation of the pancreas) using an abdominal CT scan, too.
Doctors use a tool called endoscopy to get a better look inside your stomach. They grade stomach ulcers with a system called the Forrest classification. This helps doctors estimate the risk of an ulcer bleeding again and decide which ulcers need treatment through endoscopy. Treatments could include injecting medicine, applying heat to control bleeding, or placing a small clip to close the ulcer. The Forrest classification works like this:
- Ia – Arterial bleeding like a jet, rebleeding risk is 90%
- Ib – Oozing blood, rebleeding risk is 50%
- IIa – Visible blood vessel, rebleeding risk is 25 to 30%
- IIb – Blood clot sticking to the ulcer, rebleeding risk is 10 to 20%
- IIc – Dark spot in the ulcer, rebleeding risk is 7 to 10%
- III – Ulcer is clean, rebleeding risk is 3 to 5%
Treatment Options for Gastric Ulcer (Stomach Ulcer)
The treatment of stomach ulcers primarily aims to increase the stomach’s pH level to aid healing. This is usually done using drugs known as proton pump inhibitors, like pantoprazole. The next step might be performing an Upper Gastrointestinal Endoscopy (EGD). This procedure becomes more urgent if patients show alarm symptoms such as unexpected weight loss, bleeding, being over the age of 50, or experiencing nausea and vomiting.
When a stomach ulcer is found during an EGD, tissue samples from around the ulcer are taken to rule out inflammation of the stomach lining, infection with a bacteria called Helicobacter pylori, or cancer. Patients diagnosed with a stomach ulcer usually need to take proton pump inhibitors twice a day for eight weeks. After this period, another endoscopy is done to make sure the ulcer has healed.
If the patient is taking non-steroidal anti-inflammatory drugs (NSAIDs), stopping these immediately is crucial. If the tissue samples or lab tests reveal Helicobacter pylori infection, this needs to be treated with antibiotics, and tests to confirm the bacteria have been eradicated must be done.
If the stomach ulcer is bleeding or is considered severe based on the Forrest classification, measures to stop and prevent further bleeding are required. This could include injecting epinephrine (a drug to constrict blood vessels), cautery (burning the tissue to stop the bleeding), or placing metal or absorbable clips.
Surgery might be needed if endoscopic treatments don’t work or aren’t suitable. Situations calling for surgery can include a perforated or punctured stomach, uncontrollable bleeding, severe obstruction at the outlet of the stomach, or unhealed ulcers despite medical treatment.
What else can Gastric Ulcer (Stomach Ulcer) be?
When doctors are trying to figure out why a person may be experiencing dyspepsia (a fancy term for stomach pain or discomfort), there are other conditions they would need to check for. These could include:
- Gastritis (inflammation of the stomach lining)
- Chronic pancreatitis (long-term inflammation of the pancreas)
- Acute pancreatitis (sudden inflammation of the pancreas)
- Gastric cancer (cancer of the stomach)
- Biliary disease (issues with the bile ducts or gallbladder)
What to expect with Gastric Ulcer (Stomach Ulcer)
In general, people with stomach ulcers tend to improve if they continue with their treatment and stay away from medications that could make their condition worse.
Possible Complications When Diagnosed with Gastric Ulcer (Stomach Ulcer)
The most common issues linked with stomach ulcers include bleeding in the gastrointestinal tract, the ulcer breaking through the stomach wall, the ulcer moving into an adjacent organ, and obstruction of the gastric outlet leading to bloating and vomiting.
- Bleeding in the gastrointestinal tract
- Ulcer breaking through the stomach wall
- Ulcer moving into an adjacent organ
- Obstruction of the gastric outlet leading to bloating and vomiting
Preventing Gastric Ulcer (Stomach Ulcer)
People who have stomach ulcers should be aware of what caused their ulcer and should stick to their treatment plan. It’s recommended they stay away from NSAID medications (painkillers) if they can. If they have been diagnosed with a bacteria called Helicobacter pylori, they should undergo a course of antibiotics to get rid of it. Once the treatment is over, they should have a test to confirm the bacteria has been completely eliminated.
