Stomach (or gastric) ulcers are sores on the lining of the stomach. However, stomach ulcers may also occur in the duodenum, the first part of the small intestine that connects to the stomach. Both gastric and duodenal ulcers are considered peptic ulcers and require treatment.
The gastric mucosa is regenerative, but smoking, infection, or overdose of certain drugs can affect its regeneration and repair mechanisms or cause it to become ruptured or damaged, allowing ulcers to develop. The main causes of stomach ulcers include:
Heliobacter pylori (H. pylori) bacteria: H. pylori is a common type of bacteria, and is the only contagious bacteria that can multiply within the stomach. Some studies have shown that H. pylori infections may be present in more than half of the worldwide population. The bacteria can damage the lining of the stomach and cause inflammation and ulcers, or even increase risk of gastric cancer or gastric lymphoma. Many cases of gastric cancer in young people are associated with H. pylori.
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs): use of ibuprofen or aspirin over long periods of time or in large doses may damage the regenerative function of the gastric mucosa and cause gastric ulcers or even kidney failure.
Gastric/pancreatic cancer: gastric cancer may lead to development of gastric ulcers. Meanwhile, pancreatic Neuroendocrine tumor can releases hormones that facilitate the secretion of acid in the stomach, which can also lead to gastric ulcers.
The most common symptom is burning pain in the stomach, though not all patients experience pain. Some patients seek medical assistance due to bleeding from the stomach and duodenum, which causes stool to become black or tarry, while others may experience stomach pain when they have an empty stomach, or symptoms such as indigestion, appetite changes, heartburn, nausea, etc.
If left untreated, gastric ulcers can cause severe complications, such as:
- Internal bleeding: as symptoms persist, patients may pass black, tarry stool or bright red stool as a result of severe gastrointestinal bleeding, and experience acute pain. Internal bleeding may lead to anemia or severe blood loss.
- Hole in the stomach wall: the stomach or duodenal ulcer may continue to erode, leading to perforation. This led to abdominal cavity infection (peritonitis) or even sepsis, which may result in death. This is a surgical emergency that requires urgent surgical treatment.
- Gastric outlet obstruction: ulcers in the pylorus (the part of the stomach that connects to the duodenum) or scar tissue from a healed ulcer can block the passage of food into the small intestine, causing gastric outlet obstruction. This condition is relatively rare.
- Gastric cancer: recurring gastric ulcers, may indicate the presence of gastric cancer.
Treatment for gastric ulcers varies depending on the cause. If the ulcer is a result of smoking or excessive use of certain medications, the patient will need to quit smoking or stop taking the medications. Generally, treatment involves taking medication, with most patients recovering within a few months.
- Medication: proton pump inhibitors (PPIs) or other medications help to reduce stomach acid and prevent ulcers from worsening during the natural healing process. The course of treatment generally spans eight to 12 weeks. Patients usually do not need to undergo another gastroscopy after taking medication for duodenal ulcers. Patients with gastric ulcers, however, are recommended to undergo gastroscopy three months after completing their course of treatment to check whether the ulcer has healed. An unhealed ulcer may point to gastric cancer, and a repeat biopsy will be performed.
- Antibiotics: if the ulcer is caused by H. pylori, patients may take a course of eradication therapy, followed by a breath test to determine whether the bacteria has been completely eliminated.