Overview

A gastric ulcer, also known as a stomach ulcer, is a sore or erosion that develops on the lining of the stomach. It is a common type of peptic ulcer disease (PUD) and results from the breakdown of the protective mucous layer that shields the stomach lining from digestive acids. Gastric ulcers can cause significant discomfort and, if left untreated, may lead to complications such as bleeding or perforation. They are most frequently diagnosed in adults and can affect both men and women.

Causes

Gastric ulcers are primarily caused by an imbalance between aggressive factors like stomach acid and protective factors like mucus. Common causes include:

• Helicobacter pylori infection: A bacterial infection that weakens the stomach lining, making it more susceptible to acid damage.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Frequent use of medications such as ibuprofen, aspirin, or naproxen can damage the stomach lining.
• Excessive alcohol consumption: Alcohol irritates the stomach lining and increases acid production.
• Smoking: Tobacco use impairs stomach lining protection and promotes ulcer formation.
• Stress: While stress does not directly cause ulcers, severe physical stress (like serious illness or injury) can contribute to their development.
• Other causes: Rarely, gastric ulcers may be linked to Zollinger-Ellison syndrome, a condition causing excessive acid production.

Symptoms

The most common symptom of a gastric ulcer is a burning or gnawing pain in the upper abdomen. Other symptoms include:

• Upper abdominal pain, especially after meals
• Bloating or a feeling of fullness
• Heartburn or acid reflux
• Nausea or vomiting
• Unintentional weight loss
• Dark or tarry stools (indicating bleeding)
• Vomiting blood in severe cases

Diagnosis

Diagnosing a gastric ulcer typically involves a combination of history-taking, physical examination, and diagnostic tests:

• Medical history: Discussion of symptoms, medication use, and risk factors.
• Upper endoscopy (EGD): A small camera is used to visually inspect the stomach lining and take biopsies if necessary.
• Helicobacter pylori testing: Through breath, stool, blood, or biopsy tests to identify H. pylori infection.
• Barium swallow X-ray: Occasionally used to visualize ulcers via contrast imaging.
• Laboratory tests: Blood tests may be ordered to check for anemia from chronic blood loss.

Treatment

Treatment for gastric ulcers focuses on relieving symptoms, healing the ulcer, and preventing complications:

• Proton pump inhibitors (PPIs): Medications like omeprazole and pantoprazole reduce stomach acid, promoting healing.
• Antibiotics: If H. pylori infection is present, a combination of antibiotics is prescribed to eradicate the bacteria.
• H2-receptor blockers: Medications like ranitidine reduce acid production.
• Antacids: Over-the-counter antacids provide temporary relief from pain by neutralizing stomach acid.
• Stopping NSAIDs: Discontinuing or replacing NSAIDs with safer alternatives when possible.
• Lifestyle changes: Reducing alcohol intake, quitting smoking, managing stress, and avoiding spicy or irritating foods.
• Endoscopic therapy: In cases of bleeding ulcers, endoscopic procedures can be used to stop bleeding.

Prognosis

The prognosis for gastric ulcers is generally excellent with proper treatment. Most ulcers heal within several weeks with medication. Eradicating H. pylori significantly reduces the risk of recurrence. Untreated ulcers, however, can lead to complications such as bleeding, perforation, or gastric outlet obstruction. Early diagnosis, adherence to treatment, and lifestyle modifications lead to successful healing and prevent future episodes for the majority of patients.