Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach. Ulcers can also occur in part of the intestine just beyond the stomach – these are known as duodenal ulcers.
Both stomach and duodenal ulcers are sometimes referred to as peptic ulcers.
A peptic ulcer is an open sore in the upper digestive tract. There are two types of peptic ulcers, a gastric ulcer, which forms in the lining of the stomach, and a duodenal ulcer, which forms in the upper part of the small intestine.
Stomach ulcers are the most visible sign of peptic ulcer disease. They occur when the thick layer of mucus that protects your stomach from digestive juices is reduced, thus enabling the digestive acids to eat away at the lining tissues of the stomach.
Stomach ulcers are easily cured, but they can become severe without proper treatment.
Understanding your Gut and Digestion
Food passes down the gullet (oesophagus) into the stomach. The stomach makes acid which is not essential, but helps to digest food. After being mixed in the stomach, food passes into the first part of the small intestine (the duodenum). In the duodenum and the rest of the small intestine, food mixes with chemicals called enzymes. The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food which is taken up (absorbed) into the body.
What Causes Stomach Ulcers?
Stomach ulcers aren’t necessarily caused by one single factor. The decrease in the stomach’s mucus lining that leads to an ulcer is usually caused by one of the following:
an infection with the bacterium Helicobacter pylori (H. pylori)
long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
excess acid (hyperacidity) in the stomach, which may be related to genetics, lifestyle (stress, smoking), and certain foods
Zollinger-Ellison syndrome, a rare disease that makes the body produce excess stomach acid
Certain factors and behaviours can put you at higher risk for developing stomach ulcers:
frequent use of steroids (such as those for treating asthma)
hypercalcemia (overproduction of calcium)
family history of stomach ulcers
being over 50 years old
excessive consumption of alcohol
Radiation treatment to the area
Symptoms of Stomach Ulcers
A number of symptoms are associated with stomach ulcers. The severity of the symptoms depends on the severity of the ulcer.
The most common symptom is a burning sensation or pain in the area between your chest and belly button. Normally, the pain will be more intense when your stomach is empty and it can last for a few minutes or several hours.
Other common symptoms include:
dull pain in the stomach
not wanting to eat because of pain
a gnawing or burning pain in the middle or upper stomach between meals or at night
nausea or vomiting
burping or acid reflux
heartburn (burning sensation in the chest)
pain improves when you eat, drink, or take antacids
Talk to your doctor if you experience symptoms of a stomach ulcer. Even though discomfort may be mild, ulcers can worsen if they aren’t treated.
How is Stomach Ulcer Diagnosed?
Diagnosis and treatment will depend on your symptoms and the severity of your ulcer. To diagnose a stomach ulcer, your doctor will review your medical history along with your symptoms and any prescription or over-the-counter medications you’re taking.
To rule out H. pylori infection, a blood, stool, or breath test may be ordered. In a breath test, you’ll be instructed to drink a clear liquid and breathe into a bag, which is then sealed. If H. pylori is present, the breath sample will contain higher-than-normal levels of carbon dioxide.
Other tests and procedures used to diagnose stomach ulcers include:
barium enema: a thick white liquid (barium) that you drink helps the stomach and small intestine show up on X-rays
endoscopy (gastroscopy): In this test a doctor looks inside your stomach by passing a thin, flexible lighted tube through the mouth, down your gullet (oesophagus) and into the stomach to look for the presence of an ulcer. They can see any inflammation or ulcers.
endoscopic biopsy (small samples): a piece of stomach tissue is removed so it can be analyzed
Treating Stomach Ulcers
Treatment will vary depending on the cause of your ulcer. Most ulcers can be treated with a prescription from your doctor, but in rare cases, surgery may be required.
It’s important to promptly treat an ulcer. Talk to your doctor to discuss a treatment plan. If you have an actively bleeding ulcer, you’ll likely be hospitalized for intensive treatment with IV ulcer medications, and you may also require blood transfusion.
If your stomach ulcer is the result of H. pylori, you’ll need antibiotics. For mild to moderate stomach ulcers, your doctor will usually prescribe the following medications:
H2 blockers: to prevent your stomach from making too much acid
proton pump inhibitors: blocks the cells that produce acid
over-the-counter antacids: to help neutralize stomach acid
cytoprotective agents: to protect the lining of the stomach and small intestine, such as Pepto-Bismol
Symptoms of an ulcer may subside quickly with treatment. Even if your symptoms disappear, you should continue to take medicine prescribed by your doctor. This is especially important of H. pylori infections to ensure that all bacteria are destroyed. Doctors will also suggest that you avoid smoking, alcohol, and any medications or foods that can trigger symptoms.
Certain side effects associated with stomach ulcer treatment include:
These side effects are temporary. Talk to your doctor about changing your medication if you experience extreme discomfort as a result of these side effects.
In very rare cases, a complicated stomach ulcer will require surgery. These include ulcers that:
continue to return
tear the stomach or small intestine
keep food from flowing out of the stomach into the small intestine
Surgery may include:
removal of the entire ulcer
taking tissue from another part of the intestines and sewing it over the ulcer site
tying off a bleeding artery
cutting off nerve supply to the stomach to reduce the production of stomach acid
Over-the-counter medications that contain calcium carbonate (Tums, Rolaids), may help treat peptic ulcers but should not be used as the primary treatment. There is also some evidence that zinc can help heal ulcers.
Among botanicals recommended to treat peptic ulcers are turmeric, mastic, cabbage, deglycyrrhizinated licorice, and neem bark extract.
While over-the-counter and alternative medications may be helpful, evidence on effectiveness is lacking. Therefore they are not recommended as the primary treatment for peptic ulcers.
Complications Associated with Stomach Ulcer
Seek treatment as soon as you believe that you might have a stomach ulcer. The longer an ulcer remains untreated, the more likely you are to develop complications. You should seek medical treatment if you experience any of the following symptoms:
sudden, sharp pain that doesn’t stop
black or bloody stools
vomit that looks like coffee grounds
These could be signs that the ulcer has eroded through the stomach, or broken a blood vessel. Scar tissue development is another possible complication. The tissue can prevent food from moving from the stomach into the small intestine. All of these scenarios require intensive therapy, usually in a hospital setting.
Prevention of Stomach Ulcer
To prevent the spread of bacteria and reduce risk of bacterial infection, wash your hands with soap and water on a regular basis. Make sure all food is properly cleaned and cooked thoroughly.
To prevent ulcers caused by NSAIDs, stop using these medications (if possible) or limit their use. If you need to take NSAIDs, be sure to follow the recommended dosage and avoid alcohol while taking these medications.
Certain lifestyle changes can also help prevent ulcers from forming thereby contributing to a healthy stomach lining.
Lifestyle and home remedies
You may find relief from the pain of a stomach ulcer if you:
Choose a healthy diet. Choose a healthy diet full of fruits, especially with vitamins A and C, vegetables, and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer.
Consider foods containing probiotics. These include yogurt, aged cheeses, miso, and sauerkraut.
Consider eliminating milk. Sometimes drinking milk will make your ulcer pain better, but then later cause excess acid, which increases pain. Talk to your doctor about drinking milk.
Consider switching pain relievers. If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you.
Control stress. Stress may worsen the signs and symptoms of a peptic ulcer. Consider the sources of your stress and do what you can to address the causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal.
Don't smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid.
Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.
Try to get enough sleep. Sleep can help your immune system, and therefore counter stress. Also, avoid eating shortly before bedtime.
No particular diet is helpful for people with peptic ulcers.
At one time a bland diet and avoidance of spicy or greasy foods was recommended.
We now know diet has little effect on ulcers. In some people, however, certain foods seem to aggravate stomach ulcer symptoms. Avoid eating any foods that aggravate symptoms.
What's the Prognosis for a Person with a Peptic Ulcer?
Most people with peptic ulcers get better when treated with the appropriate medicine.
Treatment for H pylori bacteria is usually successful if medications are taken as prescribed.
Although ulcers can cause discomfort, they are rarely life threatening.
Ulcers can have several complications. These usually develop in people who do not receive appropriate treatment. Complications of ulcers may require emergency treatment including endoscopy or surgery. Complications may be severe and can even result in death if not treated promptly.