Gastric ulcer

A gastric ulcer usually occurs as a result of an infection with certain bacteria or due to long-term use of anti-inflammatory drugs for pain relief. Gastric ulcers are normally easy to treat. What are the typical symptoms, what complications can arise, and how exactly is a gastric ulcer treated? The answers to these and other questions can be found here.

At a glance

  • A gastric ulcer is most often the result of an infection with Helicobacter bacteria or the use of painkillers over a longer period of time.
  • When caused by painkillers, a gastric ulcer often goes unnoticed until it causes complications such as bleeding. In rare cases, gastric ulcers can cause a perforated stomach.
  • Typical symptoms of a gastric ulcer include upper abdominal pain, a feeling of fullness, loss of appetite, nausea, and vomiting.
  • The risk of developing a gastric ulcer increases with age.
  • Most often, a gastroscopy with biopsy is sufficient for diagnosis.
  • Gastric ulcers are treated with medication that prevents the buildup of gastric acids – sometimes in combination with antibiotics.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Gastric ulcer: woman standing in her apartment holding her stomach. She looks tense, as if she is in pain.

What are the potential complications?

If a gastric ulcer remains undetected and untreated for a long period of time, serious complications can arise. The most common complication is bleeding.

Therefore, it is important to speak with a doctor, in a timely manner, if the following symptoms arise:

  • black-colored stool
  • vomited blood (red or black in color)
  • signs of anemia such as abnormal fatigue, shortness of breath during physical exertion or pallor

Frequent vomiting after eating is also a warning sign that a doctor needs to be consulted without delay – this symptom may be caused by scars on the pylorus (the outlet between the stomach and the large bowel) due to ulcers repeatedly occurring in the area. The scarring may cause the pylorus to narrow. As a result, the stomach contents are sometimes vomited because they can no longer be transported into the intestines.

In very rare cases, a gastric ulcer can lead to a perforation of the stomach wall. This causes sudden, very intense stomach pain and is life-threatening. If perforation of the stomach wall is suspected, it is important to call 112 for emergency help.

What is a gastric ulcer?

A gastric ulcer, also known as a stomach ulcer, is a deep wound in the stomach wall. It occurs when the gastric mucosa is damaged, most often by an infection with Helicobacter pylori bacteria. Additionally, regular use of non-steroidal anti-inflammatory drugs can cause an ulcer. The likelihood of getting a gastric ulcer increases with age.

The main indication of a gastric ulcer is pain in the upper abdomen. To diagnose a gastric ulcer, doctors usually perform a gastroscopy and take a tissue sample.

Treatment with proton pump inhibitors, which inhibit the build-up of gastric acid, and antibiotics is usually sufficient. If a gastric ulcer is not detected and treated, complications can arise.

What are the symptoms of a gastric ulcer?

Most gastric ulcers cause no or just a few problems and become noticeable only when there are complications – especially if they have been caused by use of pain-relieving drugs.

Many of the symptoms that occur with an ulcer are quite non-specific.

A gastric ulcer may cause the following symptoms: a feeling of pressure and fullness, loss of appetite, nausea and vomiting, irregular bowel movements and gas, heartburn and acidic burps, and pain in the upper abdomen.

These include:

  • a feeling of pressure and fullness
  • loss of appetite
  • nausea, sometimes with vomiting
  • irregular bowel movements and gas
  • heartburn and acidic burps
  • pain in the upper abdomen – often not connected with meals or more likely to occur after a meal than before

How does a gastric ulcer develop?

The two most common causes of a gastric ulcer are an infection from the bacteria Helicobacter pylori or the long-term use of non-steroidal anti-inflammatory drugs.

Helicobacter pylori bacteria can multiply in the gastric mucosa and cause an infection there. This damages the mucosa and increases acid formation in the stomach. As a result, the mucosa of the stomach loses its ability to protect the body.

The following are non-steroidal anti-inflammatory drugs, also known as NSAIDs: acetylsalicylic acid (ASA), ibuprofen, naproxen, and diclofenac. These medications inhibit the formation of the hormone prostaglandin, which regulates the neutralization of gastric acid, among other things. If prostaglandin is missing, the mucous membrane is more prone to damage from gastric acid and pathogens.

In some cases, a gastric ulcer may develop due to a combination of both causes.

Important: Non-steroidal anti-inflammatory drugs taken with cortisone can make damage to the gastric acid more severe.

How can a gastric ulcer be prevented?

It has not been scientifically proven that external factors such as nutrition, smoking, or persistent stress can cause the formation of a gastric ulcer. Nevertheless, those who notice that symptoms are triggered by greasy foods, alcohol, or stressful situations, for example, should try to avoid these triggers.

Additionally, regular use of painkillers can trigger a gastric ulcer. For this reason, doctors sometimes advise their patients to also take medication that inhibits the build-up of gastric acid. Determining the personal risk of a gastric ulcer and which medication should be considered to protect the stomach should be discussed with a doctor.

How is a gastric ulcer diagnosed?

If a doctor suspects a gastric ulcer, they will begin by palpating the stomach, i.e. examining it by hand. This is normally followed by a gastroscopy to examine the esophagus and stomach. A tissue sample (biopsy) is taken and tested for Helicobacter pylori bacteria, indications of an infection, and changes in the tissue similar to those seen in cancer.

If a doctor suspects a gastric ulcer, they will first palpate the stomach, i.e. examine it by hand. This is usually followed by a gastroscopy.

How is a gastric ulcer treated?

A gastric ulcer sometimes heals on its own without treatment within 2 to 3 months. However, it often develops again after a while.

Treatment depends on the results of the gastroscopy and the biopsy.

If doctors don’t detect Helicobacter bacteria or cancer, proton pump inhibitors (PPIs) such as omeprazole and pantoprazole are normally prescribed. These reduce the build-up of gastric acid. The medication is taken over a period of 4 to 8 weeks.

If a non-steroidal anti-inflammatory drug (NSAID) is the cause of a gastric ulcer, it should no longer be taken or an alternative should be used instead. Furthermore, people with a gastric ulcer should not smoke or drink alcohol, or at least take a break from them for a while.

If an infection with Helicobacter pylori bacteria is the cause, two additional antibiotics with different active ingredients are prescribed, together with proton pump inhibitors (triple therapy).

Quadruple therapy with three antibiotics and a proton pump inhibitor may also be an option – for example, in the case of antibiotic resistance. In both cases, the medications are taken simultaneously over the course of 1 to 2 weeks. If symptoms are still present, treatment with proton pump inhibitors alone can be continued.

Approximately 4 weeks after the end of treatment with an antibiotic, a doctor checks to ensure that the treatment was successful. Typically, the doctor performs a special breath test (13C breath test) to determine if the Helicobacter bacteria are still in the stomach. If the test is positive, treatment with other antibiotics and a proton pump inhibitor can be repeated.

If severe bleeding occurs, the ulcer is treated with minimally invasive surgery (endoscopy), involving a small incision in the wall of the abdomen. Open surgery is sometimes also required.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen – IQWiG).

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