Stomach ulcer (and duodenal ulcer)

Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach. Contact your GP or GP out of hours service, or go to your nearest emergency department if you develop signs of a serious complication of a stomach ulcer (see symptoms below).

About duodenal ulcers

Ulcers can also occur in part of the intestine just beyond the stomach. These are known as duodenal ulcers.

Both stomach and duodenal ulcers are sometimes known as peptic ulcers.

On this page the term ’stomach ulcer’ is used, although the information is the same for duodenal ulcers.

Signs and symptoms

The most common symptom of a stomach ulcer is a burning or gnawing pain that develops in your abdomen (tummy). Some stomach ulcers aren’t painful and are only noticed when a complication of a stomach ulcer develops, such as bleeding from the ulcer.

Tummy pain

The pain caused by a stomach ulcer can travel out from the middle of your tummy up to your neck, down to your belly button, or through to your back.

It can last from a few minutes to a few hours. It often starts within a few hours of eating. You may also wake up in pain during the night.

Taking antacids (indigestion medication) may relieve the pain temporarily, but it will keep coming back if the ulcer isn’t treated.

Other symptoms

Less common symptoms of a stomach ulcer can include:

• indigestion
• heartburn
• loss of appetite
• feeling and being sick
• weight loss

Some people also find they burp or become bloated after eating fatty foods.

When to seek medical advice

Visit your GP if you experience persistent symptoms of a stomach (or duodenal) ulcer.

Contact your GP or GP out of hours service immediately, or go to your nearest emergency department, if you develop signs of a serious complication, including:

• vomiting blood – the blood can appear bright red or have a dark brown, grainy appearance, similar to coffee grounds
• passing dark, sticky, tar-like stools
• a sudden, sharp pain in your tummy that gets steadily worse

These could be a sign of a serious complication, such as internal bleeding (see possible complications below).

Causes of stomach ulcers

Stomach ulcers occur when the layer that protects the stomach lining from stomach acid breaks down. This means the stomach lining becomes damaged.

This is usually (but not always) a result of:

• an infection with Helicobacter pylori (H. pylori) bacteria
• taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin – particularly if they’re taken for a long time or at high doses

It used to be thought that stress or certain foods might cause stomach ulcers, but there’s little evidence to suggest this is the case.

Who is affected

Between one and three people in every 1000 in the population will develop peptic ulcer disease every year. This varies with age and sex.

The incidence of duodenal ulcers peaks at 45–64 years of age. It is twice as common in men as in women. The incidence of gastric ulcers increases with age, and is similar in men and women.

How stomach ulcers are treated

With treatment, most stomach ulcers will heal within a month or two. The treatment recommended for you will depend on what caused the ulcer.

Stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed.

Possible complications

Complications of stomach ulcers are quite uncommon, but they can be very serious and potentially life-threatening.

The main complications include:

• bleeding at the site of the ulcer
• the stomach lining at the site of the ulcer splitting open – known as perforation
• the ulcer blocking the movement of food through the digestive system – known as gastric obstruction

• Find out more about stomach ulcers on the NHS website

More useful links

• How to use your health services

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What Causes Ulcers – Stomach Ulcer Symptoms

What is an ulcer?

Ulcers are sores on the lining of your stomach or small intestine. Sores also could be on your esophagus (throat). Most ulcers are located in the small intestine. These ulcers are called duodenal ulcers. Stomach ulcers are called gastric ulcers. Ulcers in the throat are called esophageal ulcers.

Symptoms of an ulcer

Common ulcer symptoms include

• Discomfort between meals or during the night (duodenal ulcer)
• Discomfort when you eat or drink (gastric ulcer)
• Stomach pain that wakes you up at night
• Feel full fast
• Bloating, burning, or dull pain in your stomach
• Comes and goes days or weeks at a time
• The discomfort lasts for minutes or hour

If your ulcer becomes perforated (torn), it becomes a bleeding ulcer. This can cause the following symptoms:

• Nausea
• Vomiting blood
• Unexpected weight loss
• Blood in your stool or dark stools
• Pain in your back

What causes an ulcer?

Most ulcers are cause by Heliocobacter pylori (H. pylori). This is a bacterial infection. Acids from the foods we eat can make the pain and discomfort worse. Long-term use of aspirin or anti-inflammatory medicines (ibuprofen) are also a common cause of ulcers. Stress and spicy foods can make an ulcer worse.

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.

Can an ulcer be prevented or avoided?

You cannot prevent an ulcer caused by an H. pylori infection. However, you can reduce your risks by limiting aspirin and anti-inflammatory medicines. Avoid foods that are acidic (orange juice) and spicy to reduce discomfort. Avoid caffeine and alcohol.

Ulcer treatment

Your doctor will give you an antibiotic medicine to treat an H. pylori infection. You will have to take it for 2 to 3 weeks. Your doctor also might suggest triple therapy. This is a combination of 2 antibiotics and a protein pump inhibitor (PPI). PPIs are pills that reduce the amount of stomach acid made by glands in the lining of your stomach. Your doctor might suggest medicines to reduce stomach acids. You may have to take these for up to 8 weeks. Several other medicines can be used to help treat ulcers. Two types of medicines (h3 blockers and PPIs) reduce the amount of acid that your stomach makes. Over-the-counter antacid medicine provides temporary relief. Smoking and alcohol make the discomfort worse. In severe cases, you may need surgery. Ulcers get worse without treatment. If aspirin and anti-inflammatory medicine irritates your stomach, your doctor may suggest the medicine, misoprostol.

Living with an ulcer

If you have an ulcer, avoid the things that make your ulcer pain worse. This means to avoid spicy foods, alcohol, and smoking. If you take aspirin or ibuprofen for chronic pain, talk to your doctor. They may suggest an alternative. Keep your diet balanced. Try eating small, frequent meals when you’re having pain.

Questions to ask your doctor

• How can I tell the difference between an ulcer and the stomach flu?
• Where is my ulcer located?
• Am I at risk of getting multiple ulcers?
• What are the side effects of ulcer medicines?
• Are ulcers a sign of another health condition?

Resources

National Institute of Diabetes and Digestive and Kidney Diseases: Symptoms & Causes of Peptic Ulcers (Stomach or Duodenal Ulcers)

National Institutes of Health, MedlinePlus: Peptic Ulcer

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

causes, symptoms, diagnosis and treatment methods on the Alfa Health Center website

Peptic ulcer of the stomach is a pathology, which is characterized by the formation of defects in the mucous membrane. Violation affects not only the organ. In 10-15 times more often note the defeat of the duodenum. In about 25% of cases, the disorder affects several sections of the gastrointestinal tract, so in medical practice one can often hear the diagnosis of “gastric ulcer and duodenal ulcer.” From a clinical point of view, this is wrong. Diseases have a similar nature, but are considered independent.

An ulcer can occur with regular exacerbations, which requires treatment and monitoring.

General

Peptic ulcer is the most common pathology of the gastrointestinal tract. The first place is occupied by the defeat of the duodenum, 10-15 times less common violation of the integrity of the gastric mucosa. The disease is often detected – an ulcer is diagnosed in 8-15% of the world’s population. Residents of developed countries face the disease more often, the main proportion of patients are residents of megacities.

Peptic ulcer is the prerogative of men. In women, GU occurs 5-10 times less frequently. With what this is connected – it is impossible to say for sure. Doctors suggest that the matter is in the peculiarities of the hormonal background and a more attentive attitude of women to their health. By the age of 50+, gender differences disappear – older people suffer from GU equally often. Children, adolescents almost do not get sick – pathology is more inherent in adults.

Peptic ulcer of the stomach and duodenum is well studied. According to statistics, GU takes the second place among the causes of disability in the population, second only to diseases of the cardiovascular system.

Causes of peptic ulcer

Peptic ulcer is a polyetiological disorder. The causes of the pathology are cumulative – the more of them, the higher the risk of developing a disorder. Medical theory distinguishes two groups of causes: fundamental and high-risk factors. The main reasons include the state of health and lifestyle.

Possible factors include:

• Helicobacter pylori infection. According to statistics, about 80% of patients with gastric lesions are carriers of H. pylori. The bacterium fold increases the risk of inflammation, ulceration of the tissues of the duodenum. Where Helicobacter pylori comes from is a separate issue.
• Hereditary factor. Peptic ulcer disease is often genetically determined, but how much the genetic factor affects the incidence is still unknown.
• Taking non-steroidal anti-inflammatory drugs. The mucous membrane of the digestive tract is sensitive to NSAIDs and their metabolites. This is indicated in the annotations to the drugs of this group. The risk is especially great with the uncontrolled use of anti-inflammatory drugs to eliminate pain.
• HIV infection. Given that peptic ulcer disease is of bacterial origin, any decrease in immunity is detrimental to the stomach. This is true for other immunodeficiency states as well.
• Cirrhosis of the liver – the development of ulcerative lesions in liver cirrhosis is mainly associated with the course of an active process in the liver and a violation of its function, especially after porto-caval bypass surgery. The formation of hepatogenic ulcers is caused by a decrease in the inactivation of endogenous stimulants of gastric secretion (gastrin and histamine), as well as a disorder of the trophism of the mucous membrane of the gastroduodenal zone due to impaired blood flow in the portal system.
• Diseases of other organs and systems: heart, blood vessels, lungs, kidneys.

There are rare causes, one of these is Zollinger-Ellison syndrome. This is a tumor of the pancreas, provoking an excess of gastrin and an increase in the secretion of hydrochloric acid. The acidity of the environment increases, creating a risk of developing an ulcer. Several thousand such cases have been described in the literature throughout the history of observations and the development of clinical medicine.

Risk factors create favorable conditions for the formation of an ulcer. We are talking about the features of lifestyle, behavior. The following reasons play the most important role:

• Wrong diet. Peptic ulcer disease develops due to the abundant consumption of sour, spicy, fatty, fried foods, confectionery, foods with food additives, carbonated drinks.
• Stress. Unfavorable emotional background reduces immunity. In this condition, the adrenal glands begin to produce a large amount of adrenaline, which inhibits the body’s defenses. The more often a person experiences stress, the higher the risk of PUD.
• Smoking. With saliva, nicotine enters the duodenum. It is a universal toxin that destroys mucous membranes.
• Addiction to alcohol, especially strong. Alcohol breaks the acidity of the stomach, creating a favorable environment for the reproduction of H. pylori.

The etiology of the disease is complex. Peptic ulcer progresses slowly, so there is enough time for diagnosis and treatment. Prevention helps reduce the risk of the disorder.

Where does H. pylori come from?

The bacterium was discovered less than 50 years ago, and its role in causing stomach diseases became clear even later. It is known that it dies during disinfection, boiling.

outside the nutrient medium. H. pylori is transmitted in three ways:

• Fecal-oral. It is released into the environment with waste products. Infection occurs through the use of dirty water, non-compliance with the rules of personal hygiene, contact with sewage.
• Oral. H. pylori is transmitted through saliva.
• Iatrogenic. During medical manipulations, during diagnostic procedures. For example, endoscopy, FGDS. The reason for the transmission of H. pylori is insufficient antiseptic processing of devices.

Knowing these factors, you can avoid infection.

Classification, stages of gastric and duodenal ulcer

Peptic ulcer disease is classified according to seven criteria. The most obvious is the pathogenesis of the disorder. Mucosal involvement may be bacterial or symptomatic. In the first case, H. pylori is the culprit. This form of the disorder accounts for about 80% of clinical cases. Symptomatic peptic ulcers of the stomach and duodenum may be due to stress (stress ulcers) or medications.

Gastric ulcer is classified according to the nature of the flow. There are such forms:

• Newly diagnosed (acute) ulcer. The disease requires immediate treatment.
• Recurrent ulcer. Periodically aggravated, the number of exacerbations – 1 time in 2-3 years. Remission is long, acute periods last several months, but with proper treatment, the terms are reduced.
• Course with frequent relapses. Exacerbations occur 2-3 times a year, the defeat of the stomach is rapidly progressing.

According to the number of defects, peptic ulcer can be single or multiple. A single defect is characterized by a local lesion of mucosal tissues, while a multiple defect is widespread. The disease affects several areas of the inner shell. Exacerbations occur more often due to the presence of several foci of the disease.

Pathology is also classified according to the localization of defects. Allocate ulcers of the antrum of the stomach, cardia, pylorus, body, walls of the stomach, curvature. Localization plays an important role in the selection of treatment. Some forms proceed more aggressively, differ in therapeutic complexity. Separately, they talk about ulcerative lesions of the duodenum. Possible bulb, LDPC, or ascending/descending ulcer.

A significant role is played by the acidity of the stomach, against which pathology develops. According to this criterion, three more types of disease are determined:

• Acid ulcer is a classic case. Peptic ulcer becomes a consequence of long-term current gastritis.
• Disease with normal acidity – a little less common. Causes may be alimentary, stress related to H. pylori.
• Peptic ulcer with reduced acidity is a more dangerous situation. Complicated by atrophic gastritis. This disease is a precursor to cancer and therefore requires regular screening.

If peptic ulcer is determined by symptoms, clinical picture, typical and atypical forms are distinguished. Typical proceeds with classic symptoms. Diagnosis is possible even on the basis of anamnesis, complaints. Additional studies are prescribed to better understand the nature of the violation, to determine its type, origin. Atypical peptic ulcer can disguise itself as other pathologies (disorders of the heart, blood vessels) or proceed without symptoms (even at an advanced stage). Atypical lesions are potentially dangerous due to late visits to the doctor, incorrect diagnosis.

Classification according to the size of the defect includes the following types of ulcerative changes:

• Small (up to 5 mm). They do not give symptoms, they are discovered by chance – during a preventive examination.
• Medium (up to 20 mm). Symptoms are moderate, pain in the system with dyspepsia.
• Large (20 to 30 mm). The clinical picture is noticeable.
• Giant ulcers (more than 30 mm in diameter). A characteristic symptom is excruciating pain. The likelihood of complications is maximum.

Peptic ulcer goes through four phases.

The first – erosion – is not yet a full-fledged disease, but only the beginning of pathological changes. The defect has a rough surface, signs of acute inflammation are visualized on FGDS, symptoms are minimal or absent. With timely treatment, it is possible to reverse the violation, to achieve scarring.

Further, an ulcer develops – a full-fledged defect that extends to the walls of the stomach. If nothing is done, perforation is possible, which develops in advanced cases. A through wall defect is accompanied by bleeding and is life-threatening.

Final phase – healing – the ulcer begins to actively scar. Without quality treatment, the defect may not heal for years.

The classification is used in clinical practice to assess the severity of the disease, to develop tactics for treating the stomach.

Symptoms of gastric ulcer

Peptic ulcer of the stomach and duodenum occurs with alternating periods of exacerbation and remission.

Acute phase characteristics:

• Pain of varying intensity. By nature – dull, aching, pressing, cutting. Localized in the epigastric region – 4-8 cm above the navel. They can give to the right or left side – it all depends on the location of the defect. For the defeat of 12.pc, “hungry” pains are more characteristic. The peak pain syndrome reaches 30-60 minutes after eating, but after a few hours the condition improves. During the period of remission, the walls of the stomach can also hurt, but occasionally.
• Bad breath. It is caused by decay, delayed protein breakdown, general slagging of the body, and disruption of the intestines.
• Plaque on the tongue. It occurs in many diseases of the stomach. An ulcer is not the only diagnosis. The color of the plaque is gray or yellowish.
• Dyspeptic phenomena. Business card lesions of the duodenum and stomach, especially against the background of infection with H. pylori. Nausea, heartburn, vomiting, heaviness in the abdomen, stool disorders, flatulence are the main manifestations of dyspepsia. During periods of exacerbations, they accompany the patient constantly, significantly reducing the quality of life.

Abdominal pain (as well as other symptoms) occurs with a typical course of an ulcer, damage to the stomach and duodenum. Atypical forms of the disorder have an uncharacteristic clinical picture. Pain can be felt in the right iliac region (as with appendicitis) or in the left side of the sternum (simulating a heart attack or angina attack). In some cases, discomfort occurs in the lower back (as with radiculopathy).

The most dangerous case is a silent current. Peptic ulcer of the stomach and duodenum sometimes proceeds without any signs. But the violation progresses, so a person often turns to a doctor in an already neglected state or ends up in a hospital with bleeding, perforation of the wall. The atypical course is not associated with the cause of the pathology. It is possible with H. pylori infection, drug and stress factors. The main role is played by the localization of the mucosal defect.

Tests, ulcer diagnostics

Peptic ulcer of the stomach and duodenum is confirmed using instrumental and laboratory diagnostic methods. Patients with DU are managed by gastroenterologists.

To establish a diagnosis, carry out:

• At the initial consultation, the doctor clarifies complaints, collects an anamnesis. Typical forms of the disease are manifested by characteristic symptoms. An experienced doctor may suspect a disease of the stomach, duodenum even at the initial appointment.
• FGDS (fibrogastroduodenoscopy). It is considered the gold standard for diagnosis. Endoscopy allows you to identify changes, lesions of the stomach, determine the stage of pathology, localization, suggest the type. If necessary, the doctor can take a sample of gastric juice, organ tissues for laboratory evaluation. This is especially important for the detection of H. pylori. FGDS is informative in 95% of cases.
• Fluoroscopy of the stomach. X-ray diagnostic method allows you to examine the mucosa, identify cicatricial changes in the walls, evaluate the impact of ulcerative changes on surrounding tissues and organs. It is prescribed if peptic ulcer of the stomach and duodenum cannot be diagnosed by other methods. Informativeness is 70%.
• Tests for H. pylori. To recognize H. pylori, a series of studies is used: PCR, ELISA, breath test, biopsy. Having excluded the infection, they look for other causes of the disease.

If there is not enough information, resort to additional methods: ultrasound of the abdominal cavity, antroduodenal manometry, electrogastrography, pH-metry. The analysis of feces for occult blood is also informative. Traces of blood in the sample indicate inflammatory-erosive changes, polyposis or oncology. The diagnosis is made after a comprehensive diagnosis – on the basis of clinical data.

Gastric ulcer treatment

Peptic ulcer of the stomach and duodenum requires long-term treatment and correction of lifestyle. Treatment of ulcers is carried out both on an outpatient basis and in a hospital. Doctors prefer conservative methods of therapy, but if there is no effect, the problem is solved surgically.

It is impossible to completely cure the disease at this stage of the development of medicine. The task of specialists is to eliminate the symptoms, accelerate the healing of the ulcer, prevent complications, achieve a long-term remission, eliminate H. pylori, if any.

The disease requires drug and non-drug approaches:

• Medicines are needed to normalize acidity and fight H. pylori. This is where therapy begins. It is possible to get rid of the infection only in a complex way. Proton pump inhibitors, antibiotics, and other drugs are prescribed. How long to take the drugs – the doctor decides.
• Non-drug approach includes diet, avoidance of bad habits, avoidance of stress. According to indications, physiotherapy is prescribed, but only after the main treatment and elimination of ulcer formation factors.

It is necessary to treat the disease first as part of the correction of an acute condition, then to maintain the result. Surgical treatment of gastric and duodenal ulcers is indicated in some cases. Absolute indications are oncological formations, perforation of the wall, rough scarring of tissues. Acute attacks with gastric perforation require emergency surgical intervention.

The relative indication is the ineffectiveness of the therapy. However, an ulcer can be successfully treated with timely medical attention. In this case, remissions last for years, and the disease practically does not manifest itself.

Prevention

As part of the primary prevention of gastric and duodenal ulcers, following the rules of hygiene is shown. H. pylori infection should not be allowed – the bacterium enters the body through dirty hands, in contact with sewage, feces, saliva. Knowing this, you can protect yourself.

Secondary prevention aimed at preventing relapses involves quitting smoking, alcohol and other bad habits, and following a therapeutic diet. Patients should also visit a gastroenterologist once a year.

Peptic ulcer of the stomach and duodenum is not completely treated, but it is possible to achieve high-quality remission. When the first symptoms of pathology appear, you need to contact a therapist. He will conduct an initial diagnosis, refer him to a gastroenterologist (if there is evidence). The earlier an ulcer is treated, the higher the chance of a favorable outcome.

All information is for reference only. The doctor deals with issues of diagnosis, therapy, and prevention. Self-medication is extremely dangerous.

Sources:

1. Gastric ulcer. Clinical recommendations of the Russian Federation 2018-2020 (Russia)
2. O.L. Petrova, Ya.B. Petrova, T.V. Smirnova, V.N. Petrov. Peptic ulcer of the stomach and duodenum. // Nurse. No. 8, 2014.

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3. Shimes MP, Nesterova AP Peptic ulcer of the stomach and duodenum. – M .: State publishing house of medical literature, 2012.
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Peptic ulcer – a directory of diseases – ZdorovyeInfo