Stomach ulcer


Carola Felchner

Carola Felchner is a freelance author at lifelikeinc.com and a certified exercise and nutritionist. She worked at various trade magazines and online portals before becoming self-employed in 2015 as a journalist. Before her traineeship, she studied translating and interpreting in Kempten and Munich.

More about the lifelikeinc.com experts stomach ulcer (Medical Ulcer Ventriculi) is a deep wound in the gastric mucosa. It is typically noticeable by upper abdominal pain. Gastric ulcers are mainly caused by an excess of stomach acid. Often a colonization of the gastric mucosa is responsible for the bacterium Helicobacter pylori. With medication, a gastric ulcer can usually be completely cured. Find out, among other things, which risk factors favor a stomach ulcer, which warning signs you should look out for and how the treatment and prognosis look like.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. K29K25

Avoid stress because it is a risk factor for stomach ulcers.

Dr. med. Mira SeidelArticle overviewStomach ulcer
  • symptoms
  • Causes & Risk Factors
  • Treatment & Prevention
  • Examinations & Diagnosis
  • History & Forecast
  • prevention

Quick Overview

  • What is a stomach ulcer? deep wound in the gastric mucosa; Men and women are about equally affected.
  • Causes: Infection with the gastric bacterium Helicobacter pylori, disturbed gastric emptying, disturbed gastric acid production, certain drugs, genetic stress, unfavorable living habits (stress, alcohol, etc.)
  • symptoms: Upper abdominal pain, nausea, feeling of fullness, loss of appetite, possibly tarry stool, anemia
  • complications: Bleeding from the ulcer, stomach opening with peritonitis
  • Examination: Doctor-patient interview (anamnesis), physical examination, blood test, ultrasound, gastroscopy, breath test
  • Therapy: medication; in case of complications surgery
  • Forecast: good for early treatment and stomach-friendly lifestyle
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Gastric ulcer: symptoms

Gastric ulcers are among the most common gastrointestinal diseases. Even more often occurs only Duodenal ulcer (medical ulcer duodeni).

Both gastric and duodenal ulcer typically cause oppressive or burning pain in the upper abdomen (Epigastrium = between costal arch and navel). The complaints often occur in connection with eating or drinking. However, people with a duodenal ulcer often have pain with an empty stomach (fasting pain) and at night. In contrast, an increase in pain shortly after eating is a typical ulcer.

Furthermore you can anorexia, bloating, Nausea and vomiting such as weight loss indicate a gastric ulcer. Some patients also develop signs of bleeding gastric ulcer anemia (Anemia).

Some gastric ulcers do not cause any discomfort. They are then often discovered by chance during an examination or become noticeable only in the case of complications.

Rarely, gastric cancer can trigger similar symptoms as gastric ulcer. Clarity brings then a gastroscopy, in the context of which one takes a tissue sample (biopsy) and histologically examined histologically.

Gastric ulcer: complications

Certain analgesics and anti-inflammatories such as acetylsalicylic acid (ASA), ibuprofen or diclofenac can cause stomach ulcers on the one hand. On the other hand, if taken regularly, they can suppress the pain stimulus so that sufferers do not notice the typical gastric ulcer symptoms. As a result, unnoticed (severe) complications may develop.

The most common complication of gastric ulcers (and duodenal ulcers) is one Bleeding from the ulcer, One possible sign of this is a pitch-black stained chair (tarry stool). The black color develops when the blood from the ulcer is decomposed by the acid gastric juice.

Sometimes the bleeding from the gastric ulcer is so small that the stool does not discolor. However, persistent blood loss is reflected in a decreased hemoglobin level in the blood.

If a gastric ulcer bleeds heavily, the person may even vomit the blood (vomiting blood or hematemesis). This is life threatening and must be treated immediately!

Rarely does a gastric ulcer break through the stomach wall into the abdominal cavity. Digested food and acid can enter the abdominal cavity through this hole Peritonitis (Peritonitis). Affected then feel massive pain throughout the abdomen (peritonitis) and get a fever.

The breakthrough of a gastric ulcer is an emergency that needs to be treated as quickly as possible!

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Gastric ulcer: causes and risk factors

Mental factors: "With so much stress you'll get a stomach ulcer sooner or later" - such warnings are heard more often. In fact, stress in a professional or private environment seems to increase the risk of gastric ulcer. This is probably due to the fact that the body produces excessive stomach acid while maintaining stress, while at the same time producing less protective mucus.

Even acute stress or shock situations and depression seem to favor the development of gastric ulcers. However, they are most likely not the only triggers. Rather, they only work in combination with other risk factors.

Too much stomach acid: A gastric ulcer occurs when the aggressive gastric acid and the protective factors of the gastric mucosa (for example mucus and acid-neutralizing salts) are in imbalance. If the acid is too strong or the protective factors are too weak, the mucous membrane is damaged and a gastric ulcer can develop. By such an imbalance inflames first the gastric mucosa (gastritis). If the inflammation persists for a long time or returns again and again, a gastric ulcer may develop over time.

Disturbed processes in the stomach: Disturbed stomach movements are also suspected of causing gastric ulcer. If the stomach defecates and at the same time more bile acid flows back into the stomach, this may favor the development of a gastric ulcer. An increased ulcer tendency is also seen in humans, who produce only reduced amounts of the protein that repairs the gastric mucosa.

That's how the stomach is builtThe stomach is a hollow muscle and lined inside with a mucous membrane. It protects the stomach from stomach acid. For digestion in the stomach food and stomach acid are mixed together and transported by muscle work further towards the intestine.

Colonization with Helicobacter plyori: This bacterium, which does not mind aggressive stomach acid, is the main cause of gastric ulcer. In 75 percent of all patients with a gastric ulcer and in up to 99 percent of all patients with a duodenal ulcer, the bacterium can be detected. The stomach germ is not responsible for an ulcer alone. Only in combination with other risk factors can ulceration occur. These risk factors include the use of certain medications and unfavorable dietary habits (see the following).

Gastric mucosal inflammation by bacterial bacteria-induced gastritis, the protective mucus layer is destroyed by the germs. The stomach acid now attacks the mucous membrane directly and a gastric ulcer may arise.

Taking certain medications: Particularly susceptible to gastric ulcer are people who regularly take painkillers and anti-inflammatory drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs or NSAIDs). These include active ingredients such as acetylsalicylic acid (ASA), ibuprofen and diclofenac. Particularly problematic is the combination of cortisone (glucocorticoids) and non-steroidal anti-inflammatory drugs.

Unfavorable dietary and lifestyle habits: Smoking, alcohol and coffee increase gastric acid production and thus increase the risk of gastric ulcer. Certain foods (such as spicy foods) can also irritate the stomach lining. What is tolerated is individual but very different.

Genetic preload: In some families gastric ulcers occur frequently. This suggests involvement of genetic factors in ulcer formation.

Other causes: Gastric ulcers can very rarely also be caused by metabolic diseases such as hyperparathyroidism (hyperparathyroidism) or a tumor disease (gastrinoma, Zollinger-Ellison syndrome). Even after major operations, accidents or burns, stomach ulcers can develop. Since in these situations different "stress reactions" take place in the body, such a gastric ulcer is also called a stress ulcer. In addition, people over the age of 65 and those with blood type 0 are more susceptible to gastric ulcers. In addition, in people who have ever had such an ulcer, can easily form a new one.

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Gastric ulcer: treatment and prevention

How doctors treat a gastric ulcer depends mainly on the cause. A particularly important factor is whether the gastric bacterium Helicobacter pylori was detected in the stomach in the patient. If this is the case, the doctor prescribes gastric ulcer therapy in the first place antibiotics one to eliminate the infection. To do this, the person takes two different antibiotics (clarithromycin and amoxicillin or metronidazole) daily for seven days. In addition, the doctor will use an acid-reducing drug (for example, a so-called "Proton pump inhibitors"). As a "stomach protection" they inhibit the production of stomach acid, so that the attacked mucous membrane can recover.

Helicobacter antibiotic treatment is referred to as "Helicobacter pylori eradication therapy". It is successful in more than 90 percent of patients with gastric or duodenal ulcer. In rare cases, however, the pathogens of gastric ulcer are resistant to one of the antibiotics. Then effective gastric ulcer therapy is more difficult.

If the bacterium Helicobacter pylori can not be detected, no antibiotics are used, only acid-reducing drugs, especially "proton pump inhibitors". The therapy is symptomatic. This means that it only alleviates the symptoms. Without the damaging effect of stomach acid, the gastric ulcer usually heals by itself. In addition, however, it must be ensured that the person concerned completely avoids stomach-irritating substances and foods (alcohol, coffee, nicotine) until the gastric ulcer has healed.

In addition to proton pump inhibitors, H2-antihistamines and antacids also have an acid-reducing effect. Read more about the effects and use of these drug classes in gastric ulcer treatment:

Proton pump inhibitor ("stomach protection")Proton pump inhibitors block a specific enzyme in the gastric mucosa (H + / K + -ATPase = "proton pump"). This enzyme is very important for gastric acid production. By inhibiting the enzyme gastric acid production is completely suppressed for a period of about 24 hours. Since excess stomach acid is a major cause of gastric ulcer, proton pump inhibitors are an important part of the therapies. They are usually taken in the morning, because the enzyme to be blocked is formed mainly in the morning. Typical representatives of proton pump inhibitors are the active ingredients omeprazole and pantoprazole.

H2 antihistaminesH2-antihistamines such as cimetidine or ranitidine occupy the target sites of histamine, an important messenger for the formation and release of gastric acid. Since gastric acid formation occurs mainly at night, antihistamines should be taken at night. In some cases, an additional dose per day is necessary. As part of gastric ulcer treatment, an H2-antihistamine may also be combined with a proton pump inhibitor.

antacidsSo-called antacids are used only rarely in gastric ulcer therapy because of the good efficacy of the proton pump inhibitors and the H2-antihistamines. They bind stomach acid and neutralize it, but do not inhibit gastric acid production. A typical antacid is the active ingredient sucralfate.

Gastric ulcer treatment: gastroscopy

After completion of the medical gastric ulcer treatment, gastroscopy is performed within about six to eight weeks (gastroscopy). It is checked if the ulcer is really completely healed.

In addition, a gastroscopy can be performed to treat complications: If the ulcer bleeds, the doctor can inject a special protein glue (fibrin glue) into the wound in the context of gastroscopy to so stop the bleeding.

Gastric ulcer treatment: surgery

Gastric ulcers are rarely operated on today. For example, with a very stubborn boil, it may be useful to remove part of the stomach. As a rule, the vagus nerve (vagus nerve) is also severed (vagotomy) in order to reduce gastric acid production.

Complications of a gastric ulcer may also require surgery. For example, a stomach opening must always be surgically treated.