What Is A Stomach Ulcer

What Triggers Stomach Ulcer Symptoms

Stomach ulcers are irritated by stomach acid. Some people notice this irritation more after they eat, and some people notice it more on an empty stomach. There are also certain irritants that seem to make ulcer symptoms worse and make them more difficult to heal. Smoking and alcohol are the biggest ones.

When To Call A Healthcare Provider

While stomach ulcers can be painful and uncomfortable, they’re rarely life-threatening. But if you notice changes in appetite, unexplained weight loss, vomiting blood, dark black or bloody stools, or trouble breathing, call a healthcare provider or seek immediate medical attention. These serious symptoms could be signs of perforation , internal bleeding, or a blockage, which all require emergency care.

History Of Ulcer Causes

Ulcers have a unique and interesting history when it comes to their suspected causes. For decades, stomach ulcers were considered to be psychosomatic, meaning a high-stress lifestyle was to blame. At the time doctors started identifying high rates of ulcers in hard-working businessmen who smoked a lot of cigarettes and were likely sleep-deprived, and then animal studies further confirmed stress-triggered ulcers. Rats producing high amounts of stomach acid experienced a decrease in stomach ulcer symptoms when researchers fed them antacids, so a connection was then drawn between ulcers, chronic stress and an increase in stomach acid, which changed ulcer treatment approaches forever.

A bacterium called Helicobacter pylori was then discovered that seemed to be present in nearly everyone suffering from ulcers. It was also found to run in families and was connected to other digestive disorders, including stomach cancer. In patients given medications/antibiotics to kill H. pylori, ulcers were often resolved at least for a period of time.

However, today its more common to treat ulcers using less risky acid-reducing drugs in combination with lifestyle and dietary changes, rather than prescribing antibiotics to kill H. pylori, which can come with complications and lead to antibiotic resistance. Antibiotics used to combat H. pylori can work short term to lower the bacteria, but dont seem to keep it from returning without other interventions.

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Peptic Ulcers Are Often Symptomless

About 30 percent of 60 year olds with confirmed peptic ulcer disease have no abdominal pain.24 This means 1 in 3 old people without the slightest hint of the major symptom of peptic ulcers actually have them.

As if it was not already challenging to diagnose what cannot be seen, sometimes individuals suffering from peptic ulcers do not experience any symptoms.

Older people and children are, unfortunately, at a higher risk of belonging to this no-symptoms niche. This increases the likelihood of a delayed diagnosis and grave complications like perforation and internal bleeding.

Another group of individuals who may struggle with identifying peptic ulcers are those who are heavily dependent on NSAIDs. Even though abdominal pain is the most prominent indicator of peptic ulcers, such is not always the case. To our dismay, 1 in 3 people with peptic ulcers dont have any abdominal pain, particularly those popping NSAIDs.252627 This resonates with research findings that NSAIDs mask the symptoms of peptic ulcers.28 It is, thus, advisable to exercise caution if you need to regularly take these painkillers to treat other conditions.

Having no symptoms or weak symptoms, hence, does not rule out the possibility of peptic ulcers.

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Diagnosis Of A Stomach Ulcer

Diagnosing a stomach ulcer is done using a range of methods, including:

• Endoscopy a thin flexible tube is threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer.
• Barium meal a chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable.
• Biopsy a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found.
• C14 breath test this checks for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women.

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How Can I Prevent Ulcers

You may be able to prevent ulcers from forming if you:

• Talk to your doctor about alternatives to NSAID medications to relieve pain.
• Discuss protective measures with your doctor, if you cant stop taking an NSAID.
• Opt for the lowest effective dose of NSAID and take it with a meal.
• Drink alcohol in moderation, if at all.

What Causes Stomach And Duodenal Ulcers In A Child

Experts used to think that stress, diet, and stomach acid caused ulcers. Today, research shows that most ulcers form because of an infection with Helicobacter pylori bacteria. Other things play a role, but this germ is often the main cause of most ulcers.

The following things may play a role in stomach or duodenal ulcers:

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How Is An Ulcer Diagnosed

Your doctor will ask you about your symptoms. They may do an endoscopy. This procedure involves inserting a thin, flexible tube attached to a camera down your throat and into your stomach. Your doctor will test your blood, breath or stool for H. pylori. They also can test a sample of your stomach lining. Your doctor also will ask you if you regularly take aspirin or anti-inflammatory medicines.

What Causes A Stomach Ulcer

A stomach infection associated with Helicobacter pylori bacteria is the most common cause of stomach ulcers. The bacteria affect stomach acid and act on the stomachs lining, making it more vulnerable to acid and digestive fluids. With time, breaks occur in the lining, which can keep eroding and create a sore.

Alcohol, tobacco, and medications, such as nonsteroidal anti-inflammatory drugs , can also lead to stomach ulcers. Severe illness and radiation therapy have also been associated with stomach ulcers.

Many people around the world have H. pylori, but not everyone gets peptic ulcer disease like stomach ulcers. This means other factors are involved, including environmental and genetic factors.

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What Are The Complications Of Peptic Ulcers

Ulcers can cause serious problems if you dont get treatment.

The most common problems include:

• Bleeding. As an ulcer wears away the muscles of the stomach or duodenal wall, blood vessels may be hurt. This causes bleeding.
• Hole . Sometimes an ulcer makes a hole in the wall of your stomach or duodenum. When this happens, bacteria and partly digested food can get in. This causes infection and redness or swelling .
• Narrowing and blockage . Ulcers that are found where the duodenum joins the stomach can cause swelling and scarring. This can narrow or even block the opening to the duodenum. Food cant leave your stomach and go into your small intestine. This causes vomiting. You cant eat properly.

What Are Possible Complications Of Stomach And Duodenal Ulcers In A Child

Your child could have severe complications if his or her ulcer isnt treated well. The most common problems include:

• Bleeding. An ulcer can harm blood vessels. This can cause bleeding.

• Hole . An ulcer can wear a hole through the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the abdominal cavity . This can cause peritonitis. This is inflammation of the abdominal cavity and wall.

• Narrowing and blockage . Ulcers at the end of the stomach where the duodenum is attached can cause swelling and scarring. This can narrow or close the intestinal opening. This blockage can stop food from leaving the stomach and going into the small intestine. This can cause vomiting.

• Stomach cancer. H. pylori infection increases the risk for stomach cancer later in life.

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Can Peptic Ulcers Be Prevented

Doctors arent sure how H. pylori bacteria spread from person to person. The bacteria have been found in saliva , so kissing may be one way. They also may spread through food, water, or contact with vomit thats infected with the bacteria.

Regular use of NSAIDs can cause gastrointestinal problems and bleeding in some people. Acetaminophen does not cause stomach ulcers and is a good alternative to NSAIDs.

As with many infections, washing your hands well and often is an important part of ulcer prevention. This is extra important after you use the bathroom and before you eat. And take good care of your body by exercising regularly and not smoking or drinking.

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Could I Have An Ulcer And Not Know It

5 min Read Time

Around 25 million people will have a stomach ulcer in their lifetime, according to the Centers for Disease Control and Prevention. Despite their prevalence, the symptoms of an ulcer can frequently be mistaken for other conditions, like heartburnand some people may not show any signs at all. Its also unlikely that stress or your diet is the culprit. If youre concerned that your stomach pain could be something more serious, read on to find out the causes, proper treatment and prevention methods for peptic ulcers.

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If Your Ulcer Was Caused By Helicobacter Pylori

Most stomach ulcers are caused by infection with H. pylori. Therefore, a main part of the treatment is to clear this infection. If this infection is not cleared, the ulcer is likely to return once you stop taking acid-suppressing medication. For more information, see the separate leaflet called Helicobacter Pylori.

What Happens After Treatment

A repeat gastroscopy is usually advised a few weeks after treatment has finished. This is mainly to check that the ulcer has healed. It is also to be doubly certain that the ‘ulcer’ was not due to stomach cancer. If your ulcer was caused by H. pylori then a test is advised to check that the H. pylori infection has gone. This is done at least four weeks after the course of combination therapy has finished.

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Alternative And Complementary Therapies

Symptoms of heartburn may not always be the result of an organic cause. Patients may respond better to therapies targeting anxiety and symptoms of hyper-vigilance, through medications aimed towards a psychiatric etiology, osteopathic manipulation and acupuncture.

• Psychotherapy may show a positive role in treatment of heartburn and the reduction of distress experienced during symptoms.
• Acupuncture – in cases of functional heartburn acupuncture may be as effective if not more than PPIs alone.

What Are The Symptoms Of A Bleeding Ulcer

Bleeding ulcers dont always cause pain. Sometimes the first signs of a bleeding ulcer are signs of anemia. These include:

• Dizziness or lightheadedness.

You might have a heavier bleed if you notice:

• Blood in your poop, or black poop that resembles tar.

These symptoms require urgent medical attention.

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How Do Doctors Diagnose A Stomach Ulcer

Healthcare professionals diagnose stomach ulcers based on the patients symptoms, physical exam, and medical history, including a discussion about current medication use. Tell your healthcare provider about all over-the-counter and prescription drugs you take, as well as vitamins and herbal supplements. Laboratory tests and, in some cases, imaging tests may be necessary to confirm the diagnosis or determine its cause.

Diagnostic and imaging tests for stomach ulcers include:

• H. pylori test, which requires a breath, blood or stool test

• Barium swallow, which is an X-ray of your upper digestive tract after you drink a chalky liquid. The barium in the liquid makes it easier to see abnormalities like ulcers on X-rays.

• Upper endoscopy, which involves inserting a camera scope into your mouth and down your throat to examine the stomach lining. The doctor, usually a gastroenterologist, looks at the lining for signs of an ulcer or other abnormalities. He or she may perform a biopsy for a detailed analysis of the tissue. If there is active bleeding from the ulcer, the doctor may be able to treat the area with medicine during the endoscopy.

How Are Stomach Ulcers Diagnosed

Diagnosis and treatment will depend on your symptoms and the severity of your ulcer. To diagnose a stomach ulcer, your doctor will review your medical history along with your symptoms and any prescription or over-the-counter medications youre taking.

To rule out H. pylori infection, a blood, stool, or breath test may be ordered. With a breath test, youll be instructed to drink a clear liquid and breathe into a bag, which is then sealed. If H. pylori is present, the breath sample will contain higher-than-normal levels of carbon dioxide.

Other tests and procedures used to diagnose stomach ulcers include:

• Barium swallow: You drink a thick white liquid that coats your upper gastrointestinal tract and helps your doctor see your stomach and small intestine on X-rays.
• Endoscopy : A thin, lighted tube is inserted through your mouth and into the stomach and the first part of the small intestine. This test is used to look for ulcers, bleeding, and any tissue that looks abnormal.
• Endoscopic biopsy: A piece of stomach tissue is removed so it can be analyzed in a lab.

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How Can I Be Sure Its An Ulcer

The only way to be sure an ulcer is causing your discomfort is with a medical diagnosis. We will evaluate your medical history and conduct a thorough physical examination.

To determine the root cause of your ulcer, we may run blood, stool, or breath tests. These tests are designed to look for signs of helicobacter pylori, the bacteria linked to ulcers.

Depending on your unique symptoms, we may also order an endoscopy. During an endoscopy, we insert a tube with a tiny camera down your throat and into your stomach to take pictures of any potential damage and collect tissue samples for analysis.

Ronald Hsu Md Facg Facp Dds

Sutter Roseville Medical Center

Its impossible to ignore the gnawing, aching abdominal pains that accompany a stomach ulcer. About 25 million Americans suffer from an ulcer at some point in their lifetime, according to the Centers for Disease Control and Prevention.

Contrary to popular belief, ulcers are not caused by psychological stress or the ingestion of spicy foods. Ronald Hsu, M.D., a gastroenterologist with the Sutter Roseville Medical Center, says two Australian researchers discovered in the early 1980s that a bacterium called Helicobacter pylori is the root cause of most stomach ulcers.

Nobody believed them when this was discovered, Dr. Hsu says. The conventional thinking at that time was that bacteria couldnt live in the stomach on account of the strength of gastric acid.

Eventually, the medical community realized the two men were correct in their findings. Pathologist J. Robin Warren and physician Barry J. Marshall were awarded the Nobel Prize for Medicine and Physiology in 2005 for their discovery of H. pylori. Dr. Marshall famously infected himself with the bacterium in an attempt to prove its link to stomach inflammation and ulcers. It is now firmly established that the bacterium causes more than 90 percent of duodenal ulcers and up to 80 percent of gastric ulcers.

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When To Contact A Doctor

Anyone who thinks they may have an ulcer in their stomach should consult a doctor. Any stomach symptoms that last for more than a few days or keep happening need evaluation and treatment.

Symptoms of anemia, such as tiredness and breathlessness, may signal a slow-bleeding ulcer. More serious bleeding is an urgent medical problem, as people may vomit up blood, or stools are black and sticky.

Perforation is also an emergency. Without quick treatment, the wall of the stomach can become infected. Sudden stomach pain that gets worse can indicate perforation, and any signs of being very unwell with infection need treatment as soon as possible.

Complications Of Peptic Ulcers

Left untreated, peptic ulcers can result in severe complications and emergencies.

• Internal bleeding You can have bleeding in your stomach, esophagus, or duodenum when the ulcer opens a blood vessel. Ulcers can cause bleeding that occurs slowly over time or quickly, possibly resulting in hemorrhaging that can be life-threatening due to shock. Sometimes you may not notice a bleeding ulcer until you become anemic, a condition in which your body lacks red blood cells because of inadequate iron. This occurs when ulcers cause chronic, low-grade blood loss.
• A hole, or perforation, in the stomach wall You can develop a perforated ulcer, which means it has eaten through your stomach or intestinal wall.
• Obstruction This is when you have swelling or scarring related to your ulcer that is preventing your food from being digested properly.

The signs that you are having an ulcer emergency are:

• Blood in vomit or vomit that looks like coffee grounds
• Increasing pain
• Mental confusion
• Severe abdominal distension

If you think you or someone you know is having an ulcer emergency, seek immediate medical attention.

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What Tests Are There For A Stomach Ulcer

If your doctor thinks you may have a stomach ulcer, the initial tests will include some blood tests. These tests will help to check whether you have become anaemic because of any bleeding from the ulcer. The blood test will also check to see that your liver and pancreas are working properly.

The main tests that are then used to diagnose a stomach ulcer are as follows:

• A test to detect the H. pylori germ is usually done if you have a stomach ulcer. The H. pylori bacterium can be detected in a sample of stool , or in a ‘breath test’, or from a blood test, or from a biopsy sample taken during a gastroscopy. See the separate leaflet called Helicobacter Pylori for more details.
• Gastroscopy is the test that can confirm a stomach ulcer. Gastroscopy is usually done as an outpatient ‘day case’. You may be given a sedative to help you to relax. In this test, a doctor looks inside your stomach by passing a thin, flexible telescope down your gullet . The doctor will then be able to see any inflammation or ulcers in your stomach.
• Small samples are usually taken of the tissue in and around the ulcer during gastroscopy. These are sent to the laboratory to be looked at under the microscope. This is important because some ulcers are caused by stomach cancer. However, most stomach ulcers are not caused by cancer.