What is a stomach ulcer?

A stomach ulcer is a deep wounds in the lining of the stomach that spreads to the underlying tissue layers and can penetrate to the muscles of the stomach wall. Since a gastric ulcer is called "ulcer" in technical terms, medical professionals also refer to it as gastric ulcer, ulcus ventriculi (the Latin word "ventriculus" means "stomach") or peptic (digestive) ulcer.

A stomach ulcer occurs when the protective layer of the techsupportreviews stomach lining is defective and the aggressive stomach acid has caused a wound there. This happens if, for example, the protective layer has been weakened by taking medication, there is too much stomach acid or Helicobacter pylori bacteria colonize the gastric mucosa (see also the “Causes” section).

Stomach ulcers develop in certain areas of the stomach: In 60 percent of cases, an ulcer occurs in the inner curve of the stomach, the so-called small stomach curvature. It is also common in the stomach outlet. If it develops elsewhere in the stomach, it could indicate stomach cancer .

A stomach ulcer is one of the most common diseases of the digestive tract, affecting around 50 out of 100,000 people each year. Peptic ulcers are equally common in women and men.

Gastric ulcer: symptoms

A stomach ulcer can be recognized by the following symptoms:

• Mild to severe pain in the upper abdomen, i.e. in the area above the navel, which can be pressing, stabbing, boring or burning. They sometimes radiate into the back in a stomach ulcer.
• Belching, heartburn
• Sensation of pressure and fullness
• Nausea can indicate a stomach ulcer, as well
• Vomiting ( vomiting can also occur, which indicates severe gastric bleeding and is a medical emergency - call the emergency services immediately!)
• Loss of appetite
• Weight loss
• Irregular stool, diarrhea, and gas
• Blood in the stool - with a stomach ulcer, the stool is usually pitch black (so-called tarry stool), less often there is lighter-colored blood in the feces.
• Chronic, light bleeding is noticeable as anemia (anemia). Those affected are pale, less productive and tired, suffer from headaches , difficulty concentrating and breathing problems.
• fever
• Circulatory problems

Food consumption can also have an impact on the appearance of symptoms. Many patients feel the physical discomfort directly during or shortly after eating , because more gastric acid is produced during digestion. If, on the other hand, the symptoms occur mainly in the fasting state and are more severe at night, this usually indicates a duodenal ulcer .

In about ten percent of all cases, gastric ulcers proceed without pain . This is often the case when those affected regularly take certain medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Because the drugs suppress the pain in the person affected, the gastric ulcer fatally goes undetected for a long time. Usually, the ulcer is only noticed by chance during a medical examination, in 20 percent of patients only when severe complications such as bleeding occur.

Gastric ulcer: complications and consequences

The most common complication is bleeding . It occurs when a blood vessel in the lining of the stomach is injured. If the bleeding is acute, the person has severe pain, vomits blood (the vomit may look like coffee grounds) and / or has pitch-black or bloody stools.

Even if the ulcer forms near the stomach outlet, it can be dangerous: This can narrow the stomach outlet and the chyme is no longer transported further unhindered. Doctors call this a gastric outlet obstruction. Affected people feel unusually full after eating, a bloated stomach and vomit the food.

An ulcer can sometimes also grow through the muscle wall of the stomach into neighboring organs such as the pancreas . Patients experience severe, sharp pain that typically occurs not only in the abdomen but also in the back.  

In rare cases, the gastric ulcer damages the stomach wall so badly that a tear appears in the stomach wall. Experts call this a gastric perforation or perforation. Colloquially, one sometimes speaks of a "burst stomach ulcer". This causes food and aggressive stomach acid to enter the abdominal cavity, causing peritonitis - a life-threatening disease that can be fatal and requires immediate surgery .

If the stomach ruptures, the person affected suddenly gets violent, stabbing abdominal pain , which can also radiate to the shoulders and back, cold sweats, a racing heart , fever and may vomit. The abdominal wall is tense and sensitive to touch. The uncomfortable feeling increases when the doctor presses on the stomach and then lets go. Doctors speak of the pain of letting go.
 

How can stomach cancer be diagnosed? In rare cases, a gastric ulcer will develop into a carcinoma. The symptoms of stomach cancer are similar to those of a stomach ulcer. To make the diagnosis, the doctor does a gastroscopy , during which he examines the condition of the stomach lining and takes tissue samples (biopsies). Four percent of stomach ulcers are malignant.

Gastric ulcer: causes

An ulcer only develops when the stomach lining is attacked and the stomach wall is no longer adequately protected.

The following factors can damage the stomach lining:

• Repeated or long-standing inflammation of the lining of the stomach ( gastritis ) increases the risk of a stomach ulcer.
• The bacterium Helicobacter pylori often causes inflammation of the gastric mucosa and is detectable in 75 percent of all patients suffering from gastric ulcer. The germs settle on the stomach lining, irritate it and lead to an increased production of stomach acid.
• Certain pain relievers , especially so - called non - steroidal anti-inflammatory drugs (NSAIDs), which contain the active ingredients ibuprofen, diclofenac, naproxen or acetylsalicylic acid (ASA), inhibit the production of the tissue hormone prostaglandin. If it is missing, the formation of gastric mucosa is disturbed and it is more prone to inflammation. NSAIDs increase the risk of developing a stomach ulcer by 5 times. If the person concerned also takes glucocorticoids (drugs containing cortisone), the risk is 10 to 15 times higher.
• Certain antidepressants called serotonin reuptake inhibitors (SSRIs for short) can cause bleeding in the digestive tract. The risk of this is significantly higher if patients are taking certain painkillers (NSAIDs) at the same time.
• Cytostatic drugs (drugs that are used, for example, in chemotherapy and prevent tumor cells from dividing and multiplying) damage the cells of the mucous membrane in the digestive tract.
• Alcohol consumptions can lead to inflammation of the mucous membranes, smoking stimulates gastric acid production.
• Even stress can be a factor in gastric ulcers : stress hormones lead to increased production of stomach acid. Depression also appears to promote the development of gastric ulcers.
• Serious physical stress such as an accident, sepsis or major surgery can lead to a stomach ulcer.
• Another factor can be a disturbed digestive process : If the stomach empties continuously with delay, this can promote a stomach ulcer.

Some diseases favor a stomach ulcer:

• Zollinger-Ellison syndrome (a tumor disease that triggers an overproduction of the messenger substance gastrin, which in turn causes increased production of stomach acid)
• Hyperparathyroidism (an overactive parathyroid gland) 

Since stomach ulcers are more common in some families, there also appears to be a genetic predisposition to them. Those with blood group 0 also have a higher risk of developing a peptic ulcer.

Gastric ulcer: diagnostics

First, the doctor conducts a detailed examination interview with the patient and asks, for example:

• What complaints does the patient have and how long have they existed?
• Where can the pain be felt and how (e.g. stabbing or piercing) is it expressed?
• Whether the person concerned regularly takes medication (e.g. painkillers with the active ingredient ibuprofen)?
• And whether he or she has a lot of stressful stress?

This is followed by the physical examination . The doctor first feels the patient's abdomen and checks whether the abdominal muscles are tense. This can already indicate an ulcer. In order to confirm the diagnosis of "gastric ulcer", the patient's blood values are usually also examined.

• If the hemoglobin level is low, it could indicate a bleeding ulcer. Hemoglobin is a protein and an important part of red blood cells. It gives the blood its red color and transports oxygen (O2) through the blood vessels. On the laboratory report, hemoglobin is abbreviated as “Hb”; the normal value is between 12 - 18 g / dl.
• A reduced hematocrit value (abbreviated to HCT) can also be an indication of bleeding in the gastrointestinal tract. It indicates the percentage by volume of blood cells in the blood and shows how fluid the blood is. For women the value should be between 37-48%, for men between 40-52%.  
• If the white blood cells and CRP levels are high, this indicates inflammation in the body. The protein CRP is part of the immune system and is increasingly released into the blood when there is inflammation. The normal CRP value is no more than 5 mg / l.

The doctor can do an ultrasound to take a close look at the abdominal area (abdomen in technical terms) . However, a reliable diagnosis is only possible with gastroscopy :

• Here, the doctor inserts a flexible, thin tube (endoscope) with a mini camera at the front into the patient's throat and pushes it through the esophagus to the stomach.
• For this somewhat uncomfortable procedure, the patient is given a local anesthetic on his throat, which also suppresses the gag reflex. In addition, the person concerned can also receive a light anesthetic, which puts him into a twilight sleep for the duration of the examination.  
• The doctor uses the endoscope to closely examine the condition of the gastric mucosa and takes tissue samples from abnormal areas, which are then examined in the laboratory. A microscopic examination in the laboratory can be used to determine whether it is a gastric ulcer or gastric cancer. But also whether Helicobacter pylori bacteria are present in the patient's digestive tract. The pathogens can alternatively be detected using a special breath test or a blood test. 

Gastric ulcer: treatment

The therapy of a gastric ulcer depends on its cause. If no Helicobacter pylori germ can be detected in the patient, it is usually sufficient to take medication that inhibits gastric acid production: proton pump inhibitors (PPIs for short, also called acid blockers). If the harmful effect of this aggressive acid is missing, the gastric ulcer usually heals well on its own.

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