Stomach Ulcer

1 What is a stomach ulcer?

Do you have recurring bouts of burning pain in the abdomen? You might have a stomach ulcer, and that can bring you frequent discomfort and cause complications too. A stomach ulcer is a wound inside the walls of the stomach. Ulcers are open wound. Stomach ulcers develop and damage the lining of the stomach.

The stomach has a layer of muscles that enables it to grind food into semi-liquid form. The stomach is also like an expandable bag that stores the digested food temporarily.

To digest food, the stomach has a layer that releases hydrochloric acid, a powerful acid that breaks down food and kills bacteria. This hydrochloric acid is strong enough to eat the stomach itself. Therefore, the stomach is also lined with a layer of mucus-producing cells that constantly produce mucus and shields the inside walls from destruction.

Stomach ulcers are sores that are very painful. They can be found in the small intestine or in the stomach lining. These ulcers are also known as peptic ulcers.

Stomach ulcers start to develop when hydrochloric acid makes it through mucus defenses and digests the stomach lining. This forms an open wound. The stomach is always moving because it grinds food, so the wound remains open and causes intense pain.

These ulcers occur when the thick mucus layer which protects the stomach from digestive juices is reduced. This in turn enables the digestive acid to eat away at the lining tissues of the stomach.

Having stomach ulcers causes a burning stomach pain relieved by eating food. Food in the stomach partially dissolves the acid, but discomfort often starts again when the stomach is almost empty. A stomach ulcer can also cause a feeling of bloating, intolerance to fatty food, heartburn, and nausea.

Severe stomach ulcers can cause so much bleeding that you may experience vomiting blood, blood clots, or passing out tarry stools. You may have trouble breathing, fainting, unexplained weight loss, changes in appetite, or nausea and vomiting.

You can have stomach ulcers due to various reasons. Stomach ulcers are often caused by infection with a bacteria called H. pylori. Taking drugs like pain relievers and certain drugs such as steroids, anticoagulants, low-dose aspirin, and drugs for osteoporosis may also cause stomach ulcers.

Certain things can also greatly increase your risk of stomach ulcers, like smoking, drinking excessive amounts of alcohol, sustaining intense physical stress, or eating spicy foods.

Stomach ulcers, if treated on time, can be cured easily, but if ignored then the severity of these ulcers increases with time.

Stomach ulcers require treatment because they become worse over time. A stomach ulcer can deepen, or ulcers can appear in other areas of the stomach. This can result in intense inflammation and bleeding, which may cause vomiting of blood or passing out stool with traces of blood.

Stomach ulcers bleed almost constantly, causing anemia. Sometimes, the ulcer itself can become infected and introduce bacteria into the bloodstream.

Doctors can diagnose stomach ulcers by assessing your symptoms and performing tests to check for the presence of H. pylori. In some cases, the doctor may order X-rays with swallowed contrast agent and endoscopy to check the insides of your stomach.

Stomach ulcers can be treated, even the more severe ones. Antibiotics, prescribed medicines, and antacids can relieve acidity and allow stomach ulcers to heal. In many cases, the patient must change his or her lifestyle to prevent stomach ulcers from returning.

2 Causes

Stomach ulcers are not just caused by one factor. There are several things cause stomach ulcers. Ulcers usually develop when certain factors cause problems in mucus production in the stomach.

H. pylori infection

H. pylori infection is a common finding in people with stomach ulcers. H.pylori irritates the stomach, and infection often triggers development of stomach ulcers. H. pylori are often able to thrive in the acidic conditions of the stomach. Also, H. pylori infection is associated with stomach cancer. The exact way that it causes infection is still unknown.

Long-term use of painkillers

Many oral painkillers used to treat pain due to arthritis or physical injuries can cause stomach ulcers as a side effect. Drugs belonging to the NSAID (nonsteroidal anti-inflammatory drugs) group are often implicated in causing stomach ulcers.

NSAIDs include Ibuprofen, Aspirin, Diclofenac, Ketoprofen, Naproxen, and Celebrex. These drugs often hurt the stomach lining and cause ulcer formation. The longer the drugs are used, the greater the risk for stomach ulcers.

As a side effect of certain drugs

Aside from NSAIDs, there are other drugs that can cause stomach ulcers as a side effect. Some of these drugs include antidepressants, drugs that inhibit blood clotting, steroid drugs, Alendronate, and Risedronate (used to treat osteoporosis). Low-dose aspirin is often a maintenance drug for heart disease, but it can also cause stomach ulcers too.

Stress

Stress ulcers tend to occur in individuals that sustained intense physical stress, such as suffering critical illness, sepsis, or sustaining severe injuries including burns or a head injury. The exact manner on how this occurs is not well understood. Experts believe that stress may cause increased production of acids in the stomach, causing ulcers.

Smoking

Smokers face increased risk of stomach ulcers. Many components in tobacco smoke are highly irritating to the stomach.

Spicy foods

Spicy foods may not directly cause stomach ulcer, but they do irritate the stomach and worsen discomfort caused by existing ulcers.

Drinking excessive amounts of alcohol

Alcohol is known to irritate the stomach, and drinking excessive amounts for long periods of time greatly increases your risk of having stomach ulcers. Alcohol increases production of hydrochloric acid in the stomach, so consuming large quantities can cause ulcers.

Hyperacidity or excess acidity in the stomach also is a leading factor that contributes to stomach ulcer. This can be related to the person’s lifestyle, genetics where there is a family history of stomach ulcers, certain type of foods.

Stomach ulcers should not be left untreated. Doing so worsens the ulcers and can cause more bleeding. Ulcers cause internal bleeding, which can become so bad that you vomit blood or pass bloody or tarry stools.

Ulcers may also become infected, or become so deep that they form a hole in the stomach and cause infection to other organs. Stomach ulcers may also swell and cause obstruction in the digestive tract. This obstruction causes bloating or fullness that can make you lose weight, or worse, it can lead to blockage of the stomach. Other parts of the stomach may also form ulcers.

Symptoms

There are number of symptoms associated with stomach ulcers. They can range from mild to severe. The severity is also related to the severity of the ulcer.

StomachUlcerSymptoms

Here are some symptoms associated with stomach ulcers:

  • Pain or burning sensation in the chest area (heartburn)
  • Burning sensation in the belly button area
  • Feeling bloated most of the time
  • Loss of weight
  • Dull pain in stomach
  • No interest in eating due to the constant pain
  • Nausea or vomiting
  • Burping

Normally the pain an individual experiences will be more intense on empty stomach. Such pain may lasts for few minutes to several hours.

Consult your doctor if you experience any of these symptoms. Do not take it as just another mild pain. Such discomfort even though mild can worsen with time if left untreated.

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3 Diagnosis and treatment

Diagnosis

You should see a doctor if you have recurrent pain in the abdomen, especially if the pain intensity changes before and after eating. Any intense stomach discomfort that occurs while you are taking prescribed medication should be reported to the doctor.

Diagnosing stomach ulcer starts by assessing your symptoms. Your doctor will ask you to list and elaborate your symptoms. You also need to tell the doctor all the medicines you take as well as intake of alcohol. Blood tests may be done to detect anemia or check for other conditions.

In some cases, the doctor needs to know the extent of damage caused by stomach ulcers. This can be done by an upper GI series, which involves swallowing a contrast agent and then having an x-ray in the abdomen. The contrast agent allows the upper digestive tract to show up clearly on X-ray film, and the doctor can see if there are any ulcers in the stomach.

The doctor may also choose to do an endoscopy. This involves insertion of a thin flexible tube with a camera at one end to visualize the inside of your esophagus, stomach, and duodenum. Endoscopy allows the doctor to see the ulcer (or ulcers), check for bleeding, swelling, or check for the presence of foreign objects. You will be sedated while endoscopy is taking place.

H.pylori infection is detected by assessing your breath after consuming food or drink with a tiny quantity of radioactive carbon. H. pylori break down the carbon and turn it into carbon dioxide, so the presence of radioactive carbon in your breath sample confirms the diagnosis.

Another means of diagnosis can be done by removing a small piece of stomach tissue for further analysis. This method is known as endoscopic biopsy.

Treatment

Treating stomach ulcers requires lifestyle changes that treat the cause of ulcer formation. If you have an H. pylori infection, your doctor may prescribe antibiotics. Most commonly prescribed antibiotics include Amoxicillin, Clarithromycin, Metronidazole, Tinidazole, Tetracycline, and Levofloxacin. Antibiotic regimens for H. pylori infection lasts for two weeks.

Along with antibiotics, the doctor may prescribe proton-pump inhibitor (PPI) or histamine blocker (H2) drugs. PPI drugs include Omeprazole, Lansoprazole, Raberprazole, Esomeprazole, and Pantoprazole, and they work by blocking the production of acid in the stomach.

H2 drugs such as Ranitidine, Famotidine, Cimetidine, and Nizatidine  work the same way. All of these drugs work to help heal the stomach and reduce acid production.

Your doctor may also prescribe antacids and cytoprotective agent drugs. Antacids (like aluminum or magnesium hydroxide, and calcium carbonate) neutralize stomach acids while cytoprotective agents ‘coats’ the inside of your stomach and intestine to protect it. Examples of cytoprotective agent drugs include Sucralfate. Sucralfate is often given to patients at risk of having stress ulcers.

Most treatments for stomach ulcer are successful. Drugs can heal the ulcer in many cases. The doctor can see if the ulcer is healing using endoscopy.

In some cases, an ulcer fails to heal despite treatment. This is often caused by the habitual use of tobacco, antibiotic resistance of H. pylori, regular use of NSAIDS, or noncompliance with treatment. In some cases, a recurrent stomach ulcer is caused by a tumor in the glands producing stomach acids, stomach cancer, infections other than H. pylori, or having Crohn’s disease.

To treat a stomach ulcer, your doctor may have to change some of your prescribed NSAID and other medicines. You also have to avoid alcohol and tobacco smoke, which often causes stomach ulcer to recur.

Ulcer symptoms may quickly subside with treatments suggested by the doctor. However, one should make a note to continue medications prescribed by the doctor even if the symptoms disappear. This is especially important in the case of H.pylori infections to ensure that all the bacteria causing this infection are destroyed.

There can be certain cases wherein an individual may face certain side effects of medications used during stomach ulcer treatment.

A few of these are;

Is there a need for surgical treatment?

In very rare cases a stomach ulcer that has become severe would require surgery.

  • Individual experiencing bleeding
  • Ulcer not healing even with the help of medications or lifestyle changes
  • Ulcers continues to return post medications
  • Tear the small intestine or stomach

The doctor would consider the following treatments:

  • The entire stomach ulcer would be removed
  • Tissue of another part of the intestine would be taken and then sewn over the ulcer site
  • Cutting off the nerve supply to the stomach so as to reduce the production of stomach acid which leads to ulcer formation

Risks or complications associated with stomach ulcers

Someone who experiences these symptoms should immediately seek medical help for the treatment of a stomach ulcer. Keeping an ulcer unattended or delaying the treatment of the ulcer will lead to several complications.

There are certain symptoms that show that the ulcer has eroded through the stomach or a blood vessel has been broken.

  • Stools are black or blood color
  • Vomiting blood
  • Sharp continuous pain

All of these cases should be considered an emergency, as they would require intensive medication and therapy for healing.

Internal bleeding is one of the most common risks associated with stomach ulcer. When the ulcer develops at the site of the blood vessel it leads to internal bleeding.

The bleeding can be:

  • Slow and long-term leading to anemia. This causes tiredness, fatigue, paleness, and breathlessness
  • Severe bleeding which causes the individual to vomit blood or black stools               

The root cause of bleeding would be identified with the help of endoscopy. During endoscopy the doctor would perform the treatment and stop the bleeding. Surgery may occasionally be required to repair the blood vessel which has been affected.

Perforation is a very rare complication which is associated with stomach ulcers. In this case the lining of the stomach splits open. This can become very serious because it enables the bacteria that live in your stomach to escape which infects the lining of the abdomen. This carries the risks of multiple organ failure and can be life threatening if left untreated. Surgery would be needed to get this complication fixed before it turns out fatal.

A swollen or inflamed stomach ulcer can obstruct the normal flow of food through the digestive system. This is known as gastric outlet obstruction. In this complication the person feels bloated and full even after eating less food. They can experience sudden weight loss which cannot be explained, along with continuous vomiting of undigested food.

The doctor would perform an endoscopy to confirm if there is an obstruction. Surgery may be needed if the obstruction is caused by scarred tissue. At some times, the doctors can get this treated by passing a small balloon through an endoscope. This is then inflated to widen the site of the obstruction.

Prevention of stomach ulcers

To avoid the spreading of bacteria and risk of bacterial infection, one should be sure to wash hands regularly with antiseptic liquid or soap, especially before having food or handling food items.

Food should be thoroughly cleaned and cooked to avoid the growth the bacteria.

Avoid using medications or limit the usage of medicines to prevent ulcers which are caused by nonsteroidal anti-inflammatory drugs. Consult your doctor to identify the correct dosage if there is a need to take these medications. While on these medications, avoid consuming alcohol or smoking.

Lifestyle changes are a must when it comes to prevention of stomach ulcers. Managing stress on a daily basis, avoiding tobacco items, avoiding very spicy food, or certain foods which can lead to stomach ulcers are important. Small changes in life can lead to a healthy stomach lining.

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