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Stomach ulcers are sores in the lining of the stomach or small intestine. They occur when the protective mucus that lines the stomach loses its effectiveness.

The stomach produces a strong acid to help digest food and protect against microbes. To protect the bodily tissues from this acid, the stomach also secretes a thick layer of mucus.

If the mucus layer is worn away and stops functioning effectively, the acid can damage the stomach tissue, causing ulcers.

An estimated 1 in 10 people in Western countries will have an ulcer in the stomach or small intestine at some point in their lives.

Stomach ulcers are relatively easy to cure, but they can cause significant problems if left untreated.

Fast facts on stomach ulcers

  • Stomach ulcers are common in the West and easy to treat but can become serious.
  • The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs (NSAIDs).
  • The classic symptom of a stomach ulcer is indigestion.
  • Treatment for stomach ulcers normally focuses on removing the cause.

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The classic symptom of a stomach ulcer is indigestion, also called dyspepsia.

Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.

Acid reflux or gastroesophageal reflux disease may cause heartburn. It occurs slightly higher up from the stomach, and people will feel it in the lower part of the chest.

Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague.

An ulcer also tends to produce a burning or dull pain in the center of the abdomen. People sometimes describe the pain as a biting or gnawing pain. Some individuals may describe a hungry sensation.

Other symptoms include:

Individuals may also be able to relieve pain by eating, drinking, or taking antacids.

Some stomach ulcers go unnoticed and show no typical indigestion-type pains. These ulcers are less common, and doctors tend them after they have started bleeding.

Some ulcers can cause a hole in the stomach wall. Health experts call this perforation, which is a severe condition.

Stomach ulcer symptoms often change over time and can be difficult to spot.

Dietary changes can help prevent stomach ulcers from developing.

People at risk of stomach ulcers should include more of the following nutrients in their diet:

  • Fruit and vegetables: Eating a variety of fruit and vegetables is key to a healthy digestive tract lining. These foods are rich in antioxidants, inhibit acid secretion, and contain cytoprotective and anti-inflammatory properties. A 2017 study states that these are all important factors for preventing and treating ulcers.
  • Fiber: Diets high in soluble dietary fiber reduce the risk of developing stomach ulcers.
  • Probiotics: Food that contains active bacterial content, such as probiotic yogurt, can help reduce a Helicobacter pylori (H. pylori) infection. Probiotics have been shown to slightly improve symptoms of indigestion and the side effects of antibiotics.
  • Vitamin C: This powerful antioxidant may be effective in helping eradicate H. pylori, especially when taken in small doses over an extended period. Fruit, legumes, and vegetables, such as oranges and tomatoes, contain high levels of vitamin C.

Avoiding alcohol and caffeine can also help reduce the risk, as they both cause the body to produce more gastric acid. This in turn can lead to stomach ulcers.

However, for the most effective outcome, instead of relying only on a diet, it is important to follow dietary recommendations alongside a treatment plan.

The two main causes of ulcers of the stomach and the small intestine are H. pylori bacteria and a class of pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs).

Less common causes of stomach ulcers include excess stomach acidity, or hyperacidity, and Zollinger-Ellison syndrome.

Excess stomach acidity can occur for a range of reasons, including genetics, smoking, stress, and some foods.

Zollinger-Ellison syndrome is a rare condition that causes an excess of stomach acid to be produced.

NSAIDs and stomach ulcers

NSAIDs carry a risk of stomach ulcers. The two most popular NSAIDs are aspirin and ibuprofen.

The risk of ulcers increases if the drugs are taken in high doses or regularly for a long time.

Stronger NSAIDs, such as those available on prescription, carry a greater risk of stomach ulcers than those that people can buy over the counter.

A person should always check labels and consult a pharmacist or a doctor about any concerns regarding using pain relief medication. They may recommend an alternative, such as acetaminophen.

Risk factors

Certain factors increase the likelihood of developing a stomach ulcer, including:

  • using steroids often
  • having hypercalcemia, or too much calcium in the blood
  • frequently consuming alcohol

Stomach ulcers are more common in individuals over 60 years. People can develop a stomach ulcer at any age, but they are much less common in children. The risk in children is higher if their parents smoke.

If a doctor thinks a person has a stomach ulcer, and if they suspect the cause is an NSAID, they may try changing the type of pain reliever the person is using and recommend another one, such as paracetamol.

However, if the doctor suspects the stomach ulcer is due to H. pylori bacteria, they may try the “test-and-treat” approach. This approach involves a noninvasive test, such as a urea breath test or stool test for H. pylori infection, followed by eradication of the bacteria if they are present.

Once the doctor determines what may be causing the ulcer, they will try to treat its symptoms by protecting it from acid while it heals.

Doctors may prescribe the following drugs:

Symptoms often subside quickly following treatment. However, doctors continue the treatment, especially if the ulcer is due to an H. pylori infection.

It is also important to avoid drinking alcohol, smoking tobacco, and consuming any trigger foods during treatment.

Surgical treatments

In certain cases — for instance, if the ulcer continues to return, will not heal, bleeds, or prevents food from leaving the stomach — surgery may be an option.

Surgery can include:

  • removing the ulcer
  • tying off bleeding blood vessels
  • sewing tissue from another site onto the ulcer
  • cutting the nerve that controls stomach acid production

Complications from stomach ulcers such as bleeding or perforation are rare. Either of these complications requires urgent medical attention.

Stomach ulcers are one type of peptic ulcer. Two other types are esophageal and duodenal ulcers.

Esophageal ulcers develop inside the esophagus or food pipe. Duodenal ulcers occur in the uppermost part of the small intestine, or duodenum.

The ulcers have similar characteristics, but doctors identify them by their location in the body.

Doctors follow the symptoms of a stomach ulcer by asking questions about how the pain feels, where and when it happens, and how frequent and long lasting it has been.

This process helps determine whether there is a stomach ulcer or not. A doctor may also order a stool test or a breath test to find out whether the stomach ulcer is due to H. pylori bacteria.

If there are more severe symptoms, such as bleeding, the doctor may require further testing. This may include endoscopy or the barium enema test.

During endoscopy, a doctor inserts a camera at the end of a long, thin, flexible tube to look at the gut lining. They may also carry out a biopsy.

The barium enema test involves using a thick liquid that allows X-rays to be taken of the gut.

Anyone who thinks they may have an ulcer in their stomach should consult a doctor. Any stomach symptoms that last for more than a few days or keep happening need evaluation and treatment.

Symptoms of anemia, such as tiredness and breathlessness, may signal a slow-bleeding ulcer. More serious bleeding is an urgent medical problem, as people may vomit up blood, or stools are black and sticky.

Perforation is also an emergency. Without quick treatment, the wall of the stomach can become infected. Sudden stomach pain that gets worse can indicate perforation, and any signs of being very unwell with infection need treatment as soon as possible.

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