Gastric Ulcer - Also called: Stomach Ulcer

What is it?
A gastric ulcer, also called a stomach ulcer, is a raw, eroded area in the lining of the stomach.

Who gets it?
About two percent of the adult population in the United States has active ulcers, and about ten percent will develop ulcers at some point in their lives. Of the approximately 500,000 new cases of ulcers in the United States each year, about sixteen percent are gastric ulcers. Gastric ulcers are most common in males between the ages of 55 and 70.

Gastric ulcers occur in people who take anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen; drink alcohol; smoke tobacco; have a high caffeine intake and often feel stressed.

What causes it?
A gastric ulcer develops when stomach acids and digestive juices injure the stomach’s lining of protective mucus. Gastric ulcers most commonly are caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen. Aspirin is the NSAID most likely to cause ulcers. The widespread use of NSAIDs may be why the incidence of gastric ulcers in the United States is rising.

Gastric ulcers may also develop from the presence of bacteria called Helicobacter pylori (H. pylori), decreased resistance of the lining of the stomach to gastric acids, increased production of gastric acids and infection, certain types of medication, and disorders that cause over secretion of stomach juices. Ulcer can also be caused by the use of tobacco, alcohol and caffeine.

What are the symptoms?
The symptoms of gastric ulcers include indigestion and heartburn in the middle of the upper abdomen, nausea and loss of appetite, weight loss and repeated episodes of gastrointestinal bleeding. About 30% of patients with gastric ulcers are awakened by pain at night. Many patients have periods of chronic ulcer pain alternating with symptom-free periods that last for several weeks or months. The pain may be relieved by eating or taking antacids, and may get worse a couple of hours after meals or before meals.

If the gastric ulcer is bleeding, the patient may vomit bright red blood or digested blood that looks like brown coffee grounds and have black, tarry bowel movements.

How is it diagnosed?
To diagnose a gastric ulcer, the doctor may first examine the patient and look at the medical history. The doctor may suspect gastric ulcers based on risk factors such as male sex, age over 45, location of pain, anemia, history of using NSAIDs, history of heavy smoking and alcohol use, and family history of ulcers or stomach cancer.

The doctor may perform an endoscopy and imaging studies to determine if the patient has a gastric ulcer. An endoscopy is considered the best procedure for diagnosing gastric ulcers and for taking samples of stomach tissue for biopsies. An endoscope is a slender tube-shaped instrument that allows the doctor to view the tissues lining the stomach and duodenum.

The doctor may also test for H. pylori because almost all ulcer patients who are not taking NSAIDs are infected. Noninvasive tests include blood tests for immune response and a breath test. The doctor may also take a blood test to see if the patient is anemic due to a bleeding ulcer.

What is the treatment?
To treat a gastric ulcer the doctor may prescribe drugs that will lower the rate of stomach acid secretion or protect the mucous tissues that line the stomach. Surgical treatment of ulcers is usually recommended if the doctor suspects complications and malignancies. Possible complications of untreated ulcers include hemorrhaging, a perforation of the stomach wall, and an obstruction (ulcer scarring that prevents passage of food).

The doctor may also recommend treatment to eliminate H. pylori in order to prevent ulcer recurrences. Without such treatment there is an eighty percent chance the ulcer will reoccur within one year. The usual regimen used to eliminate the bacterium is a combination of tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol).

Self-care tips
Patients with gastric ulcers can make several lifestyle changes to prevent their recurrence, including avoiding unnecessary use of aspirin and NSAIDs, giving up smoking, and cutting down on alcohol, tea, coffee, and sodas containing caffeine. Other preventative measures include eating balanced, nutritious meals, learning how to manage stress, getting plenty of rest and exercising as recommended.