Stomach ulcer

A stomach ulcer (gastric ulcer, ulcer ventriculi) is an open wound that forms in the inner wall of the stomach.

If the ulcer occurs in the first section of the small intestine, which is directly adjacent to the stomach, it is called a duodenal ulcer (duodenal ulcer, duodenal ulcer).

Both diseases are summarized under the term gastroduodenal peptic ulcer disease.


Anatomy of the stomach

The stomach is a digestive organ located on the left side of the abdomen, just below the ribs.
The ingested food passes through the esophagus and is pushed through a sphincter into the stomach, where it mixes with powerful digestive juices containing enzymes and hydrochloric acid.
The stomach is a muscle sac that mechanically and chemically crushes food.

When the contents of the stomach have acquired a mushy consistency, they are pushed through a sphincter into the first section of the small intestine (duodenum).
The inner lining of the stomach (gastric mucosa) has the shape of a comb. Peptic ulcer forms in the gastric mucosa.

How does digestion work?

Food enters the stomach through the esophagus. The stomach produces acidic substances that, although not essential, aid digestion. The food is mixed in the stomach and then reaches the duodenum, part of the small intestine.
In the duodenum and the rest of the small intestine, the digestion of food is carried out by various enzymes (chemical substances).
Enzymes are produced by the pancreas and the cells of the intestinal lining. The enzymes break down (digest) the food that is absorbed by the body.

Complications of peptic ulcer

The classic peptic ulcer can develop complications: bleeding and gastric perforation.

Bleeding is a serious complication and can be fatal in the elderly and patients with concomitant diseases.

Bleeding from stomach ulcers is more common in people taking blood thinners (anticoagulants), such as warfarin, aspirin, and clopidogrel (Plavix).
Those who take such remedies should consider taking anti-ulcer drugs to avoid this complication.

Gastric rupture
An ulcer can eat through the wall of the stomach, leaving a hole; Gastric acid and food can now enter the abdomen. This medical emergency is known as stomach rupturing.
As a rule, this occurs in the area of the gastric gatekeeper (pylorus).
Treatment provides for immediate surgery.

XJ Perforated ulcer stomach whole

Causes of a stomach ulcer

Normally, the inner wall of the stomach and small intestine is protected against the aggressive stomach acid. If this protective layer has damage and it can no longer perform its protective function, an ulcer (ulcer) or inflammation (gastritis) develops.

Most ulcers occur in the uppermost layer of mucosa. If there is a real hole in the wall of the stomach or duodenum, this is called a breakthrough (perforation). A breakthrough is a medical emergency.
The most common cause in adults and children is infection of the stomach by the bacterium Helicobacter pylori (H. pylori).
In most patients suffering from gastroduodenal peptic ulcer disease, these bacteria populate the gastrointestinal tract.
However, this bacterium is also found in many people without developing an ulcer.

Risk factors for gastric and duodenal ulcers:

  • excessive alcohol consumption;
  • regular intake of aspirin, ibuprofen, naproxen or other anti-inflammatory drugs (NSAIDs); sporadic intake of these funds is usually harmless;
  • cigarettes or chewing tobacco;
  • serious illnesses, such as those connected to a breathing apparatus;
  • Radiotherapy;
  • Stress.

Smoking not only increases the risk of stomach ulcers, but also associated complications, such as bleeding, stomach constriction, and stomach perforation. Smoking is one of the main reasons for treatment failure for stomach and duodenal ulcers.

Contrary to popular belief, coffee, cola, spicy foods and caffeine are not responsible for the development of stomach ulcers.

Symptoms of stomach and intestinal ulcers

Stomach ulcers do not necessarily cause symptoms, and depending on the position, very different symptoms can occur.
A stomach ulcer causes stomach pain, which typically occurs at the beginning of a meal, because then stomach acid is formed, which exerts an irritating effect.
If the ulcer is located in the lower part of the stomach, the pain disappears as soon as the stomach fills, but returns when it empties again.
In a duodenal ulcer, the pain is only noticeable when the gastric gatekeeper (pylorus), the muscles between the stomach and duodenum, closes – i.e. after the stomach has emptied, i.e. about 2 – 3 hours after eating.
Since the pain immediately subsides when eating, one can also speak of “hunger pain”, because the patient feels the urge to eat in order to feel better.
The symptoms sometimes occur at night.

In the acute phase, the symptoms are:

Signs of deterioration

  • Vomiting of blood
  • Digested blood in the stool (tar colors)
  • The person feels tired and loses weight

When do the symptoms appear?

  • they can disturb the night’s clock,
  • the pain becomes much stronger after eating,
  • they can last a few minutes or several hours,
  • particularly strong feelings of hunger arise,
  • Acid blockers can bring relief.
    • Stomach perforationPeptic ulcer can provoke severe complications and very severe abdominal pain. One complication is bleeding of the ulcer.


The symptoms of bleeding are:

  • black colored stool, called tarry stool (melana); it contains the excreted blood;
  • vomit, which looks like coffee or blood;
  • Weakness;
  • Headlessness;
  • severe abdominal pain;
  • Fever.

Diagnosis and examination procedure for peptic ulcer

gastroscopy can confirm the suspicion of a stomach ulcer. The doctor inserts a thin, flexible endoscope through the esophagus and examines the inside of the stomach; during this examination, inflammation and ulcers can be detected.

If there is a stomach ulcer, a test is carried out for the detection of the bacterium Helicobacter pylori.
If Helicobacter pylori is present, they are probably the cause of the stomach ulcer.
The proof can be provided by a stool examination, a breath test or by examining a tissue sample taken during gastroscopy.

Biopsy of the stomach or duodenum
As a rule, as part of endoscopy, a tissue sample is taken from the ulcer and its immediate surroundings.
Then this sample is examined microscopically in the laboratory.

How is a benign stomach ulcer treated?

Drug therapy

Acid blockers
As a rule, for a period of 4-8 weeks, it is recommended to take a stomach protector, which significantly reduces the amount of stomach acid produced. Proton pump inhibitors (PPIs) are most commonly used. PPIs are a group of drugs that act on the cells of the gastric mucosa and suppress the formation of gastric acid.

These drugs include: esomeprazole, lansoprazole, omeprazole (also in pregnancy), pantoprazole and rabeprazole with different trade names.
Sometimes another group of drugs is also used, the histamine receptor blockers. These drugs act on the acid-producing stomach cells in a different way, so that not too much stomach acid can be formed.
Active ingredients include: famotidine, nizatidine, ranitidine and cimetidine. Since the amount of stomach acid is significantly reduced, the stomach ulcer usually heals.

If the stomach ulcer was caused by Helicobacter pylori:
Most stomach ulcers are caused by infection with the pathogen Helicobacter pylori. Therefore, killing the bacterium is an important part of the treatment.
If the infection has not healed, the stomach ulcer is likely to return as soon as the intake of the acid blockers is interrupted.

Two antibiotics are needed to kill the bacterium Helicobacter pylori.
In addition, an acid blocker is prescribed, which reduces stomach acid, so that the antibiotics can act effectively. This combination therapy (formerly known as triple therapy) must be followed for a week. One course of treatment can kill H. pylori in up to 90% of cases.

If the eradication of H. pylori was successful, the probability of relapse is very low. Only in rare cases does a recurrence occur after a Helicobacter infection.

If the stomach ulcer was caused by anti-inflammatory drugs:
If possible, the stomach-damaging anti-inflammatories should be discontinued so that the stomach ulcer can heal. In addition, an acid blocker is usually used, which is to be taken for a few weeks; which prevents the production of stomach acid, which allows the ulcer to heal.

However, sometimes taking the anti-inflammatories is essential to relieve the symptoms of arthritis or other conditions or to prevent blood clots (aspirin).
In these cases, the solution may be to take the acid blocker every day long-term; in this way, the amount of gastric acid produced is reduced and the probability of new formation of an ulcer is considerably reduced.


Surgical treatment

Previously, surgical intervention was necessary to treat a stomach ulcer.
This was before it was known that mainly Helicobacter pylori were responsible for the occurrence of stomach ulcers, and before the modern acid blockers were developed.
Nowadays, surgery is actually only performed in emergencies when a complication occurs, such as heavy bleeding or stomach rupture.

After the therapy
A laparoscopy should be performed again a few weeks after the end of treatment. In this way, it can be checked that the stomach ulcer has healed; in addition, it can be ensured that it is not caused by stomach cancer.
If the pathogen Helicobacter pylori was the cause of the stomach ulcer, a test should also confirm that the bacteria were completely eliminated. The test should be performed no earlier than four weeks after therapy.
If the test is negative, the infection is cured. If the bacterium is still present, the doctor may repeat drug treatment, using other antibiotics.

What to eat? Nutrition for stomach ulcer

Some patients can eat whatever they want despite stomach ulcers, while others have symptoms flaring up as soon as they eat certain foods.
An eating diary can help find out which foods trigger the pain.
If you want, you can simply avoid everything that has a general irritating effect on the gastric mucosa; These include:

  • Coffee, tea, soda water and other carbonated and caffeinated beverages
  • alcoholic beverages or cocktails
  • Milk; significantly increases gastric acid production
  • fatty foods
  • fried food
  • spicy food
  • citrus fruits (oranges, lemons, etc.), but the consumption of other fruits is important,
  • tomato dishes; however, it is important to eat a lot of other vegetables.

Natural remedies for burning in the stomach include sodium bicarbonate (baking soda); dissolve a spoonful of it in water and take it after meals.
The effect is short-lived, some also use it to promote digestion.
To speed up healing, it is recommended to drink ginger tea and consume foods high in zinc, such as cereals (oats and barley) and legumes (peas).

Why does the stomach ulcer not heal?

With the appropriate treatment, a stomach ulcer can be cured within one to two weeks; If it cannot be cured, it is called resistant to therapy.
There can be several explanations for this:

  • The medication is not taken as directed.
  • Some types of Helicobacter pylori do not respond to antibiotics.
  • Smoking.
  • Regular use of painkillers that increase the risk of stomach ulcers.

Rarer causes include:

  • Extreme overproduction of stomach acid, such as Zollinger-Ellison syndrome.
  • Infection not caused by Helicobacter pylori.
  • Stomach cancer.
  • Other diseases that can cause sores, such as stomach or duodenal ulcers, such as Crohn’s disease.

Treatment of therapy-resistant ulcers usually requires avoiding all factors that can interfere with healing, as well as taking other antibiotics.

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