When we experience stomach pain or inflammation, we often think of gastritis. But sometimes the cause of that pain can be a stomach ulcer or a stomach ulcer (Stomach Ulcer / Gastric Ulcer). Just like a sore on our skin, this is an ulcer that forms on the inner wall of the stomach. This is a very common condition and can be treated and cured. However, if not treated properly, it can lead to serious conditions. So, what is a stomach ulcer? Why does it occur? What are the symptoms? What are the treatment and prevention methods? We will talk about all of this in this article.

What is this stomach ulcer? (Overview)

How do stomach ulcers develop?

Our stomach contains hydrochloric acid and enzymes that help digest food. These are very strong. So, to protect the stomach walls from these acids, there is a protective stomach lining made of thick mucus. But if for some reason this protective lining is damaged, that strong acid can eat away at the stomach wall. An 'open sore' that is formed by eating away at it is called a stomach ulcer.

How common is it?

This is actually a very common condition. It is also common in Sri Lanka. The main reason for this is that the two main causes of stomach ulcers are very common in our society. They are:

1. Widespread use of over-the-counter painkillers ( NSAIDs ) .
2. The prevalence of H. pylori infection .

Stomach Ulcers vs Peptic Ulcers

These two names can be confusing. "Peptic Ulcer Disease " is a common name for ulcers that occur in the stomach or the first part of the intestine ( duodenum ) due to stomach acid. So, ulcers that occur in the stomach (Gastric Ulcer / Stomach Ulcer) are a type of peptic ulcer. Ulcers that occur in the first part of the intestine are called "Duodenal Ulcers". The causes and treatments for both are very similar.

Symptoms and Causes

What are the symptoms of a stomach ulcer?

• Main symptom: Burning pain: The main symptom that most people feel is a burning or stinging pain in the upper abdomen (just below the middle of the chest, above the navel, and heavier on the left). This can feel like burning from acid, or like something is being eaten from the inside (a gnawing quality). This feeling is not just a feeling, but what is actually happening is that the acid and enzymes are eating away at the wound. This pain can be worse on an empty stomach, especially at night. Some people find that the pain is relieved by eating, but for others (especially with stomach ulcers), the pain may be worse when they eat.
• Indigestion and Fullness: Many people with stomach ulcers experience symptoms of indigestion. This is a burning sensation in the stomach along with a feeling of fullness. You may feel full as soon as you start eating, or you may feel full for a long time after eating.
• Other common symptoms: In addition to these, symptoms related to the conditions that caused the injury may include:
  • Acid reflux and heartburn
  • Nausea and vomiting
  • Bloating, belching, and gas pain
• Silent Ulcers and Symptoms of Complications: Surprisingly, some people have stomach ulcers but do not feel any pain or symptoms. These are called "silent ulcers." They may not realize they have an ulcer until a serious complication occurs, such as bleeding or perforation. Seek immediate medical attention if you have any of these symptoms:
  • Paleness of the skin (Pallor)
  • Dizziness, weakness or faintness - may be due to blood loss.
  • Black, tarry stools - due to digested blood.
  • Vomit that looks like coffee grounds - due to blood clots in the stomach.
  • Sudden, severe abdominal pain that doesn't go away - may be a sign of a perforation.

How serious are the complications?

If left untreated, stomach ulcers can cause serious problems:

• Bleeding Ulcers: The wound may bleed continuously, either slowly or suddenly. If it bleeds slowly, over time, the body's blood supply may decrease, leading to anemia. If it bleeds heavily, the body may go into shock and even die.
• Perforated Ulcers: A rare but serious emergency in which the ulcer completely breaks through the stomach wall and forms a hole. This hole can allow stomach acid and bacteria to leak into the abdominal cavity, causing a severe infection (peritonitis). This infection can also spread to the bloodstream, causing a life-threatening condition called sepsis.

What are the main causes of stomach ulcers?

The two main causes of stomach ulcers in Sri Lanka and around the world are:

• H. pylori (Helicobacter pylori) bacterial infection: This is a very common bacterial infection. It is estimated that about half of the world's population has this bacteria living in their stomachs. For most people, this bacteria does not cause any problems. However, in some people, this bacteria grows too much in the stomach and begins to eat away at the protective lining of the stomach. This causes chronic inflammation, which over time can lead to stomach ulcers.
• Use of NSAID painkillers: NSAID ( Nonsteroidal Anti-inflammatory Drugs) is a type of painkiller that we often buy from the pharmacy. For example, drugs like Ibuprofen, Naproxen, Diclofenac, and Aspirin belong to this group. (Paracetamol is not a drug in this group). When these NSAID drugs enter the stomach, they interact with the wall and cause minor damage (irritation), and they also prevent the production of some chemicals that protect and repair the stomach wall. Normally, our stomach wall can recover from such minor damage. But if we take these NSAID drugs more often than necessary, the stomach wall does not have enough time to repair itself. Gradually, the protective layer wears away and ulcers form.

Other rare causes

In addition to these two main causes, stomach ulcers can also be caused by the following, very rarely:

• Other infections: Very rarely, other bacterial, viral, or fungal infections can affect the stomach and cause ulcers.
• Zollinger-Ellison syndrome: This is a very rare condition in which the stomach produces too much gastric acid, causing damage to the stomach lining.
• Severe physiological stress: Hormonal and chemical changes that occur as the body tries to recover from a life-threatening illness (e.g., severe burns, major surgery) or accident can cause stomach acid to increase, leading to the development of what is known as a "stress ulcer." This is not the mental stress we experience in everyday life.

Does lifestyle affect it?

Many people think that eating spicy foods and stress cause stomach ulcers. The truth is, everyday lifestyle factors (such as what you eat and drink, general stress) do not directly cause stomach ulcers. However, if you already have a stomach ulcer, these things can make your symptoms worse . This is because they increase the acidity of your stomach, making the ulcer worse.

• Smoking
• Alcohol use
• Spicy foods
• Acidic foods like tomatoes and citrus fruits
• Caffeinated beverages like coffee and tea

Diagnosis and Tests

How do you recognize a stomach ulcer?

When you go to see a doctor, they will first ask about your symptoms, whether you regularly take NSAIDs, and whether you have had a previous H. pylori infection. If your symptoms suggest a stomach ulcer, they may need to examine the inside of your stomach to confirm.

What kind of tests do you do?

There are two main things the doctor needs to know:

1. Do you have H. pylori infection?
2. Do you have a stomach ulcer? What does it look like?

The best way to do both of these at the same time is through an endoscopy .

• Upper Endoscopy / EGD test: This involves inserting a long, thin, flexible tube (endoscope) with a camera and light at the end through your mouth and down your throat to examine the inside of your stomach and small intestine. You will be given sedation to help you feel comfortable. The doctor can use the camera to look at the stomach wall on a screen to see if there are any ulcers or bleeding. He or she can also use a small instrument to take a small piece of tissue (biopsy) from a suspicious area or ulcer to test for H. pylori bacteria. If there is bleeding from an ulcer, treatment can be given to stop the bleeding right away (for example, cauterizing the blood vessel) during this endoscopy.
• Other Tests: Although endoscopy is the best method, other methods may sometimes be used:
  • Upper GI X-ray series (Barium Swallow): In this, a liquid called barium is swallowed and X-ray images are taken. Because the barium coats the lining of the stomach, any lesions can be seen on the X-ray. However, this is not as accurate as endoscopy, and small lesions may be missed.
  • H. pylori tests: There are separate tests to check for the presence of the bacteria:
    • Urea Breath Test: You are given a special liquid to drink, and then your exhaled air is tested.
    • Blood Test: This tests for antibodies against H. pylori. However, it cannot tell for sure whether you are currently infected or have previously been infected.
    • Stool Antigen Test: A stool sample is tested for the presence of bacterial antigens.

Other conditions that can be mistaken for a stomach ulcer

If tests confirm that you do not have a stomach ulcer, the cause of your symptoms could be something else, such as:

• GERD (Gastroesophageal Reflux Disease): If acid from the stomach keeps coming back up into the throat (acid reflux), it can also cause symptoms such as heartburn, indigestion, and nausea.
• Functional Dyspepsia: This is a condition in which there are persistent symptoms of indigestion (stomach pain, heartburn, fullness) without an obvious physical cause. Although the symptoms are similar to those of a stomach ulcer, there is no visible ulcer in the stomach wall.
• Stomach Cancer: This is very rare, but can cause symptoms similar to a stomach ulcer (stomach pain, weight loss, loss of appetite). That's why it's important to get a biopsy during an endoscopy.

Management and Treatment

How to heal a stomach ulcer quickly?

Once the cause of the ulcer is eliminated, the stomach lining will gradually begin to heal. For example, if your ulcer is caused by an NSAID, if you stop taking the medication, the ulcer may heal without any other treatment. However, if you have an H. pylori infection, you will need to take antibiotics to kill the bacteria. In addition, a doctor may prescribe other medications that reduce stomach acid and protect the stomach lining until the ulcer heals. Taking these medications correctly can help the ulcer heal faster.

What treatments are available?

Most often, stomach ulcers are treated with a combination of medications. These medications include:

1. Reduces the amount of acid in the stomach.
2. It covers, protects, and helps the wound heal.
3. If there is an infection (H. pylori), it will be eliminated.

Rarely, a medical procedure may be needed to stop bleeding or close a hole.

• Medications:
  • Antibiotics : If you have an H. pylori or other bacterial infection, your doctor will likely prescribe two or three antibiotics at a time for 7-14 days to completely kill the bacteria. The most commonly used antibiotics are: Tetracycline, Metronidazole, Clarithromycin, and Amoxicillin. It is important to take the full course of medication prescribed by your doctor for the full duration of the course, or the infection may come back.
  • Cytoprotective agents: These medications work by forming a protective layer (coat) over the stomach wall, protecting it until the ulcer heals. They are often used to treat and prevent ulcers caused by NSAIDs. Examples: Sucralfate, Misoprostol, Bismuth subsalicylate.
  • H2 blockers (Histamine receptor blockers / H2 blockers): They block a chemical called histamine, which signals the body to produce acid in the stomach, and reduce acid production. Examples: Famotidine, Cimetidine, Nizatidine.
  • Proton Pump Inhibitors (PPIs): These are also powerful medications that reduce the production of acid in the stomach. They also protect the stomach lining and speed up the healing of ulcers. These are currently the most commonly used medications for stomach ulcers. Examples: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole, Rabeprazole.
• Medical Procedures: A complicated wound (bleeding, perforation) will need to be treated directly by the doctor . This can often be done at the same time as the endoscopy. A bleeding wound can be stopped by injecting medication or cauterizing it. If there is a perforation, it will need to be closed surgically.
• Surgery for persistent ulcers: Very rarely, some people's stomach ulcers may persist without treatment, or they may heal and come back. This can cause long-term pain and scarring of the stomach. Sometimes this scar tissue can block the outlet from the stomach to the intestines. In such cases, the following surgeries may be necessary:
  • Removing scar tissue or opening the blocked passage (Pyloroplasty).
  • Vagotomy is the cutting of the vagus nerve, which stimulates the production of stomach acid.

How to prevent? (Prevention)

How can stomach ulcers be prevented from forming or coming back?

Here are some things you can do to prevent a stomach ulcer from forming, or to stop it from coming back after it has healed:

• Eradication of H. pylori infection: Many people have H. pylori infection but don't know it. You can find out if you have it with a simple breath test or stool test. If you do, you can get rid of it with antibiotics before it causes any problems.
• Proper use of NSAIDs: If you regularly take NSAIDs from the pharmacy for body aches and headaches, be sure not to take more than the recommended dose. If you continue to take NSAIDs on the advice of a doctor for another condition (e.g. arthritis), if possible, reduce the dose, switch to a different medication, or talk to your doctor about taking another medication that protects the stomach (such as a PPI) at the same time.
• Reduce other harmful habits: If you have H. pylori infection or are taking NSAIDs, smoking and drinking alcohol increase your risk of developing stomach ulcers. So it's important to quit these habits.

How long will it take to recover? (Outlook / Prognosis)

How long does it take for a stomach ulcer to heal?

If you take your medications exactly as prescribed and avoid things that make the ulcer worse (NSAIDs, smoking, alcohol), the ulcer should usually heal completely within a few weeks . Your doctor may repeat an endoscopy or other test to make sure the ulcer is completely healed and the H. pylori infection is completely gone.

Chronic conditions

Most people only need short-term treatment. However, some people may have chronic conditions that cause stomach ulcers to develop. For example, someone with Zollinger-Ellison syndrome, mentioned earlier, has a condition where the stomach produces too much acid. These people may need to take medications (such as PPIs) for a long time.

What to do if you suspect a stomach ulcer? (Living With)

The importance of seeking medical advice

If you suspect you have a stomach ulcer, be sure to seek medical advice. Over-the-counter medications such as antacids or bismuth subsalicylate may temporarily relieve symptoms, but they will not heal the ulcer. In order for the ulcer to heal , the underlying cause (H. pylori or NSAIDs) must be treated.

Risks if left untreated

Even if you don't have severe symptoms, an untreated stomach ulcer can lead to serious complications, such as bleeding or perforation. There is also a risk of stomach cancer if H. pylori infection, the main cause of stomach ulcers, is left untreated for a long time.

When should you seek emergency treatment?

If you have these symptoms, go to a hospital immediately (ETU) :

• Unbearable, unbearable stomach pain.
• If you have black blood in your stool or vomit blood (like coffee grounds).
• Signs of excessive bleeding (pale skin, extreme dizziness, fainting).

Finally

Stomach ulcers are a common and treatable condition. The main causes are H. pylori infection and the use of NSAID painkillers. If you have symptoms such as stomach inflammation, pain, and indigestion, it is very important to seek medical advice rather than just assuming that it is gastritis. Then, the cause can be found out, the right treatment can be started, and serious complications can be prevented. Also, reducing smoking and alcohol consumption, and using NSAID medications only when necessary, in the lowest dose, for the shortest possible time, can help protect against stomach ulcers. Stay healthy!