Ulcer - stomach

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Alternative names
Gastric ulcer; Peptic disease; Stomach ulcer

Definition
A gastric ulcer is a break in the normal tissue lining the stomach. See also duodenal ulcer, which is a break in the normal tissue lining the duodenum (the first part of the small bowel).

Causes, incidence, and risk factors

Benign gastric ulcers are caused by an imbalance between the secretion of acid and an enzyme called pepsin and the defenses of the stomach’s mucosal lining. This leads to inflammation that may be aggravated by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs) such as ibruprofen.

Risk factors for benign gastric ulcers include the following:

• Use of aspirin and NSAIDs
  
• Helicobacter pylori infection
  
• Chronic gastritis
  
• Smoking
  
• Increasing age
  
• Mechanical ventilation (being put on a respirator)

Stress does not cause or worsen gastric ulcers.

Symptoms

• Abdominal pain
  o May wake you at night
  o May be relieved by antacids or milk
  o May occur 2 to 3 hours after a meal
  o May be worse if you don’t eat
  
• Nausea
  
• Abdominal indigestion
  
• Vomiting, especially vomiting blood
  
• Blood in stools or black, tarry stools
  
• Unintentional weight loss
  
• Fatigue

Note: There may be no symptoms.

Signs and tests

• EGD (esophagogastroduodenoscopy) and biopsy showing a benign gastric ulcer
  
• Upper GI series showing a gastric ulcer

Treatment

For people with Helicobacter pylori infection, the main goal is eradication of the organism that causes the problem. Multiple regimens are effective and usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics.

For people without H. pylori infection, ulcer-healing medications such as antacids, H2 receptor antagonists, or proton pump inhibitors are usually effective. Long-term treatment may be required.

In the event of bleeding from the ulcer, endoscopic therapy can control bleeding in most cases.

Surgical intervention may be recommended for people who do not respond to medical therapy or to endoscopic therapy for bleeding. A vagotomy (cutting the vagus nerve, which controls the stomach’s production of gastric acid) or a partial gastrectomy (removal of part of the stomach) may be necessary.

Self-help measures include:

• Avoiding smoking
  
• Avoiding tea, coffee, and soft drinks containing caffeine
  
• Avoiding alcohol
  
• Avoiding aspirin and NSAIDs
  
• Eating several small meals a day at regular intervals

Expectations (prognosis)

Most ulcers heal with medication in 6 to 8 weeks. Recurrence is common, but is less likely if H. pylori infection is treated and acid-blocking medications are continued.

Complications

• Bleeding from the ulcer
  
• Perforation (hole) in the stomach
  
• Obstruction of the passage of stomach contents

Complications are often corrected by medication, through an endoscope, or (in rare instances) with surgery.

Calling your health care provider

Call your health care provider if symptoms of gastric ulcer develop.

Prevention

Use caution in taking aspirin and NSAIDs if prone to gastric ulcers.

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