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by McCoy K
(Stomach Ulcer; Ulcer, Gastric; Ulcer, Stomach)

Definition

A gastric ulcer is a sore in the lining of the stomach.

Gastric Ulcer
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Causes

Upsets in the balance of stomach acid and juices can lead to an ulcer. This can be caused by:

  • Helicobacter pylori (H. pylori) infection
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Less common causes include any of the following:

Risk Factors

Factors that increase your chances of gastric ulcer include:

  • H. pylori infection
  • Taking NSAIDs for a long time and at higher doses
  • Prior peptic ulcer disease
  • Cigarette smoking
  • Excessive alcohol intake

Symptoms

Gastric ulcers do not always cause symptoms. Symptoms may come and go and can occur at any time. Having an empty stomach may make them worse. Symptoms may include:

  • Gnawing pain:
    • May awaken you from sleep
    • May change when you eat
    • May last for a few minutes or several hours
    • Feels like unusually strong hunger pangs
    • May be relieved by taking antacids
  • Nausea
  • Vomiting
  • Loss of appetite
  • Bloating
  • Burping
  • Weight loss

Ulcers can worsen. This can lead to serious problems and severe belly pain such as bleeding. Bleeding symptoms may include:

  • Bloody or black, tarry stools
  • Vomit that looks like coffee grounds or blood
  • Weakness
  • Lightheadedness

An ulcer can break through the wall of the stomach. It is called a perforated ulcer. It causes sudden and severe pain.

Diagnosis

Your doctor will ask about your symptoms and past health. A physical exam will be done.

An upper endoscopy will confirm an ulcer. Other tests may be done to look for a cause.

Treatment

Treatment options may include one or more of the following:

Medication

Medicine may help to treat cause or ease symptoms. Choices include:

  • Antibiotics—if an infection is present or possible
  • Over-the-counter antacids
  • Proton pump inhibitors
  • H2 blockers
  • Medicine to coat ulcer
  • Medicine to protect stomach against NSAIDs

Lifestyle Changes

Changes in everyday habits may help. They may ease symptoms and help the ulcer heal. Helpful steps are:

  • Quit smoking . Smoking worsens symptoms and slows healing.
  • Limit alcohol intake.
  • Avoid NSAIDs. This includes common over-the-counter drugs like aspirin and ibuprofen.

Surgery and Endoscopy

Procedures may be needed for:

  • An ulcer that will not heal
  • Ulcers that keep coming back
  • A bleeding ulcer
  • An ulcer that has spread through stomach wall
  • Ulcers that make it hard for food to pass out of stomach
Endoscopy

An upper GI endoscopy may be done to stop bleeding. A tube is passed down the throat into the stomach. Heat, electricity, medicine, or a special glue will be used to stop bleeding.

Surgery

Surgery for gastric ulcers is rare. It may be done to remove the ulcer or stop bleeding. Tissue from somewhere else on the body may also be used to patch the ulcer.

Prevention

Not all ulcers can be prevented. To help reduce the chances of H. pylori infection:

  • Wash your hands often. This is very important after using the bathroom and before you eat or make meals.
  • Drink water from a safe source.
  • Do not smoke. Smoking increases the chances of getting an ulcer.

To help reduce the chances of a gastric ulcer from NSAIDs:

  • Use other drugs when possible for managing pain.
  • Take the lowest possible dose.
  • Do not take drugs longer than needed.
  • Do not drink alcohol while taking the drugs.
  • If you regularly take NSAIDs
    • Ask your doctor if there is another treatment.
    • Ask about medicine to protect your stomach.

RESOURCES

American College of Gastroenterology  http://patients.gi.org 

American Gastroenterological Association  http://www.gastro.org 

CANADIAN RESOURCES

Canadian Association of Gastroenterology  https://www.cag-acg.org 

Canadian Digestive Health Foundation  http://www.cdhf.ca 

References

Fashner J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection. Am Fam Physician. 2015;91(4):236-242.

Peptic ulcer disease. American College of Gastroenterology website. Available at: http://patients.gi.org/topics/peptic-ulcer-disease. Accessed January 13, 2020.

Peptic ulcer disease. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T116374/Peptic-ulcer-disease  . Updated April 2, 2018. Accessed January 13, 2020.

Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers. Accessed January 13, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
  • Review Date: 09/2019
  • Update Date: 01/13/2020