Stomach Ulcer (Gastric Ulcer): Symptoms, Diagnosed, and Treatment

A stomach ulcer, also called a gastric ulcer, is a raw area or open sore in the lining of the stomach.

How does it occur? 

The stomach's lining has a protective layer of cells that produce mucus. The mucus prevents the stomach from being injured by stomach acids and digestive juices. When this protective layer is damaged, an ulcer may occur.

Stomach ulcers may develop from:

• the presence of bacteria called Helicobacter pylori (H. pylori), the most common cause of stomach ulcers
• decreased resistance of the lining of the stomach to stomach acid
• increased production of stomach acid.

Stomach ulcers are more likely to occur in people who:

• regularly take nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, ibuprofen, and naproxen
• drink alcohol
• smoke tobacco
• have too much caffeine, for example, by drinking a lot of coffee, nonherbal tea, or colas
• often feel stressed.

What are the symptoms?
Symptoms include:

• gnawing or burning abdominal pain, especially in the middle of the upper abdomen
• heartburn
• nausea
• pain that may get better with eating or taking antacids
• pain that may get worse a couple hours after meals or sometimes may be worse before meals
• pain that awakens you during the night.

If an ulcer is bleeding, you may have:

• vomit containing bright red blood or digested blood that looks like brown coffee grounds
• black, tarry bowel movements.

It is possible, though unusual, to have an ulcer without any symptoms.

How is it diagnosed? 
Your health care provider will review your symptoms, ask about your medical history, and examine you. You may have one or more of these tests:

• upper GI x-ray (for this test you swallow liquid barium, which may allow your health care provider to see the ulcer on an x-ray)
• blood tests to look for H. pylori bacteria
• tests of a sample of your bowel movement to check for blood (which might come from a bleeding ulcer)
• blood test for anemia (which may be a sign of internal bleeding)
• an endoscopy, which may allow your provider to see the ulcer with a thin flexible tube and tiny camera inserted through your mouth down into your stomach
• a biopsy, which involves taking a piece of tissue during an endoscopy and sending it to the lab for testing (this is another way to test for H. pylori).

How is it treated? 
The goals of treatment are pain relief, healing of the ulcer, and prevention of complications. Treatment can also help prevent recurrence of the ulcer.

You may stay in the hospital for the first stage of treatment if your symptoms are severe or if you are having complications, such as bleeding.

Your health care provider may prescribe:

• antacids (the liquid form is more effective than the tablet form)
• medicine to reduce the amount of acid your stomach makes
• antibiotics to treat H. pylori
• sucralfate, a medicine that forms a protective barrier over the site of the ulcer to help it heal.

Antacids can have side effects after you have used them for a while. Follow your health care provider's instructions carefully, and report any problems promptly.

Because stress can contribute to the development of gastric ulcers, you may need to make changes in your lifestyle (see "How can I take care of myself?").

How long will the effects last? 
Stomach ulcers respond well to treatment but they can recur. You can help reduce the chance that an ulcer will recur by taking your medicine.

Possible complications of untreated ulcers are:

• hemorrhage (a lot of bleeding)
• perforation (a hole through the stomach wall produced by an ulcer)
• obstruction (ulcer scarring that prevents passage of food).

These complications may require surgery.

Two to three percent of stomach ulcers become stomach cancer. Make sure you report all continuing or recurrent symptoms to your health care provider.

How can I take care of myself?

• Follow the full treatment prescribed by your health care provider. Keep your follow-up appointments.
• Do not smoke or use other tobacco products.
• Do not drink alcoholic beverages.
• Do not drink strong nonherbal tea, caffeinated or decaffeinated coffee, or colas.
• Ask your provider if you should avoid drugs that irritate the stomach, such as aspirin, ibuprofen, and naproxen. If your provider says it is OK to take these drugs, try taking them with food to prevent stomach irritation. (Ask your provider if you can use acetaminophen instead.)
• You may want to make other lifestyle changes, such as:

• Eat healthy meals. Several small meals may be better than 2 or 3 large ones.
• Learn how to manage stress. Seek professional help for dealing with events that cause anxiety and stress.
• Get plenty of rest.
• Exercise as recommended by your health care provider.
• If you keep having symptoms or your symptoms get worse, tell your health care provider.

How can I help prevent stomach ulcers?

• Follow your health care provider's treatment plan and keep your follow-up appointments.
• Change your lifestyle in ways that will help prevent ulcers.

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