Advanced Gastroscopy (Upper GI Endoscopy) in Indore Accurate Diagnosis by Dr. Lalji Patel | GLEX – Gastro & Liver Excellence Center

Stomach ulcers, also known as gastric ulcers, are breaks in the lining of the stomach that develop due to damage. These ulcers can cause a burning or gnawing pain in the upper and middle abdomen. Treatments often involve acid-suppressing medication and expert care in avoiding trigger foods. In this article, we will cover: what stomach ulcers are, their symptoms, causes, commonality, complications, diagnosis, and what happens after treatment.

What are stomach ulcers? A stomach ulcer is a sore or shallow hole in the lining of the stomach.

Stomach ulcer symptoms: The primary symptom of a stomach ulcer is upper abdominal pain. Other common symptoms may include bloating (swelling of the abdomen due to gas), retching (appearing to be sick without actually vomiting), feeling sick, vomiting, and a sensation of fullness after meals. Stomach acid can also lead to heartburn, caused by acid reflux.

Stomach ulcer causes: The stomach contains high levels of acid that help break down food. A stomach ulcer occurs when damage is inflicted on the protective layer of the stomach lining, often beginning as redness and inflammation (gastritis). Over time, this inflammation can worsen, leading to ulcer formation. The main causes of this damage include:

- Infection with H. pylori: This bacteria is responsible for about 8 in 10 cases of stomach ulcers. For more information, see our separate leaflet on Helicobacter pylori.

- Anti-inflammatory medicines: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and aspirin can increase the risk of stomach ulcers when taken at high doses over extended periods. Indigestion medications like omeprazole or lansoprazole are sometimes prescribed alongside NSAIDs to prevent ulcers.

- Other factors: Smoking, certain viral infections, Crohn's disease, and Zollinger-Ellison syndrome can also contribute to the risk of developing stomach ulcers. Additionally, stomach cancer may initially resemble an ulcer, so a biopsy is often performed to rule out cancer in individuals with stomach ulcers.

How common are stomach ulcers? Stomach ulcers affect between 1 in 10 and 1 in 20 people during their lifetime. Since the 1980s, they have become less common due to more effective health services and treatments. Stomach ulcers are less frequent than duodenal ulcers.

Complications of stomach ulcers: While complications from stomach ulcers are now rarer thanks to improved treatments, they can still be serious and include:

- Bleeding ulcers: This can range from minor bleeding to life-threatening hemorrhages. Sudden heavy bleeding may cause vomiting of blood (haematemesis) and faintness. Gradual bleeding may result in dark brown vomit or black, sticky stools (melaena). Immediate medical advice should be sought for symptoms of a bleeding stomach ulcer.

- Perforation: This term describes a situation where the ulcer creates a hole through the stomach wall, allowing food and acid to leak into the abdominal cavity. This is a medical emergency and requires immediate hospital treatment.

- Stomach blockage: Though rare, an ulcer at the stomach's exit can narrow the outlet, causing obstruction and severe vomiting.

Stomach ulcer diagnosis: The following tests are commonly used to diagnose a stomach ulcer:

- H. pylori testing: This bacteria can be detected in stool samples or via biopsy during a gastroscopy.

- Blood tests: These can check for anemia from any bleeding and ensure that the liver, kidneys, and pancreas are functioning properly.

- Gastroscopy (endoscopy): This definitive test allows clinicians to view the stomach's interior and identify inflammation or ulcers.

- Biopsies: Tissue samples taken during gastroscopy are examined for possible cancer, as some ulcers may be cancerous, though most are not and can be treated effectively with medication.

Stomach ulcer treatment: Acid-suppressing medication is typically prescribed for 6 to 8 weeks to reduce stomach acid production. Common medications include proton pump inhibitors and H2 blockers, which are well-tolerated with few side effects. Antibiotics are also used if H. pylori infection is confirmed, as clearing this infection is crucial to prevent ulcer recurrence once acid-suppressing medication is stopped. If diagnosed with a stomach ulcer, anti-inflammatory medicines should be discontinued to allow healing, although acid-suppressing medication will also be necessary. In some cases, surgery may be required if severe complications arise.

General advice for preventing stomach ulcers includes lifestyle changes such as losing weight if overweight, avoiding trigger foods that cause acid reflux (like coffee, chocolate, and spicy foods), eating smaller meals, quitting smoking, and reducing alcohol consumption to recommended limits. 

What happens after stomach ulcer treatment? A follow-up gastroscopy is usually recommended 6 to 8 weeks after treatment to ensure the ulcer has healed and to confirm that it is not related to stomach cancer.

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