Our stomach is the gateway to our gastrointestinal system. Unlike the esophagus or mouth, our stomach holds food for hours and is the first site at which extensive digestion occurs. Stomach ulcers are one of the commonest stomach complaints and are considered a serious health risk. Many patients can remain undiagnosed for years, making complications more likely. Its symptoms also resemble a number of other conditions, making its diagnosis quite challenging. Understanding the causes and symptoms of stomach ulcers is essential due to their public health burden, and also to help you prevent their occurrence. In this article, we will also discuss the home remedies of such ulcers, when to seek medical care and how stomach ulcers are diagnosed and treated.
Why is our stomach important?
Contrary to what you might think, humans can live without their stomachs and still eat most types of food. The stomach is reduced in size or completely removed in many types of operations and patients continue to live normally afterward for decades. The importance of our stomach, therefore, is not as vital, so what is the big deal with stomach ulcers?
Our stomach secretes a strong acid called hydrochloric acid and a potent enzyme called pepsinogen. The acid activates the enzyme into its functioning form, also called pepsin. Pepsin can digest complex proteins into simpler forms and therefore aids in their absorption. The acid is so corrosive that the stomach has a thick, regenerating layer of mucus protecting it from the effect of such acid. This layer can become thinner or completely absent in a wide variety of medical conditions, exposing the stomach wall to the corrosive acid it produces. Acid can also be produced in excess, overcoming the protective effect of such mucus layer.
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Stomach ulcers due to their acid are called peptic ulcers, and they can usually heal within days on their own, but if acid production stays high, more erosion can occur, and severe bleeding can result. Bleeding can be fatal in some conditions and other complications may develop. You should know that the stomach isn’t the common site for peptic ulcers, however, and that it comes second to the duodenum -the first portion of the small intestines-.
Causes of stomach ulcers
- Helicobacter Pylori infection: Helicobacter pylori is quickly becoming the most diagnosed gastrointestinal bacterial infection in humans. These bacteria live in the stomach, withstanding its acidity, and impairing the natural mucosal defenses. This predisposes the stomach to form ulcers. Helicobacter pylori are not the sole cause of stomach ulcers, but they should be excluded especially in younger individuals.
- Analgesics: Non-steroidal analgesics are the second most common cause of peptic ulcer disease. They include medications like Aspirin, Diclofenac, Ibuprofen, and Naproxen. These medications are both acidic and impair the production of some chemical substances called prostaglandins. Prostaglandins are essential for regenerating the mucosal barrier of the stomach. Nonsteroidal analgesics induced gastric ulcer is commonly seen in the elderly who are chronically medicated for arthritis. That is why doctors prescribe other medications called proton pump inhibitors with such analgesics, to decrease the stomach’s acid production and protect it from ulcers.
- Smoking: Smoking is one of the risk factors of peptic ulcers because of its damaging effects on the blood vessels supplying the stomach’s wall and the mucosal barrier integrity. It is also proven that it increases the risk of H. Pylori infection. Nicotine in cigarettes has a deleterious effect on such protection, and smokers are more liable to develop stomach ulcers the longer they smoke.
- Stressful conditions: Stress whether physical or psychological predisposes to stomach ulcers by increasing the release of corticosteroids (one of the stress hormones). Corticosteroids impair mucosal protection and diminish blood flow to the stomach wall. Medical conditions associated with gastric ulcers include:
- Intensive care unit admission
- Severe infection (sepsis)
- Brain trauma
- Brain tumors (also called Cushing ulcers)
- Severe hypotension (a drop of blood pressure)
- Other associated diseases and conditions may be present including:
- Gastrinoma: A pancreatic tumor that secretes a hormone called gastrin, which causes acid hypersecretion by the stomach.
- Systemic mastocytosis: A condition in which a certain cellular subtype increases dramatically in number. These cells secrete histamine, a chemical substance that induces stomach cells to secrete acid.
- Burns: Minor burns don’t increase the risk of stomach ulcers, but major burns are severe stressful conditions that can cause a special type of stomach ulcer known as Curling ulcer.
Stomach ulcer symptoms
Stomach ulcers are not always symptomatic, and most patients can remain without symptoms for years. When it becomes symptomatic, however, it can be quite distressing. The symptoms of stomach ulcers include:
- Upper abdominal pain: Upper abdominal discomfort or pain is the commonest symptom of gastric ulcer. It is not a specific symptom and can occur in other diseases like gastroesophageal reflux and duodenal ulcers. The main difference between stomach and duodenal ulcers is the time at which such pain occurs. In stomach ulcers, it starts immediately after eating, while it takes two to three hours after meals for duodenal ulcers to cause pain.
- Vomiting blood: Vomiting blood is a rare symptom of stomach ulcers and can be indicative of severe bleeding. It can, however, exist in minor bleeding if the stomach is irritated.
- Black stools: Black, tarry stools can be the only symptom of a bleeding stomach ulcer. Blood gets altered by the stomach,s acid and becomes more maroon in color than black.
- Symptoms of complications: Stomach ulcer can present first by its complications, and they include:
- Perforation: If the ulcer perforates through the stomach, it can cause severe abdominal pain and a drop in blood pressure.
- Penetration: Stomach ulcers can perforate and penetrate surrounding structures like the pancreas or the liver. Damaging the pancreas is a severe condition known as acute pancreatitis. Patients can experience severe abdominal pain that radiates to the back and a quick deterioration with hypotension and dehydration.
- Loss of weight: Weight loss can occur when the stomach is obstructed by 2 opposite ulcers or even when the patient avoids eating for the discomfort it causes, but it is a warning sign that gastric cancer is probable.
- Bleeding: Stomach ulcers can erode into a blood vessel causing severe bleeding. It can present by vomiting blood or the passage of dark, tarry stools. Bleeding in such cases can be life-threatening.
Home remedies for stomach ulcers
Stomach ulcers have different grades, and while minor cases can be treated at home, more severe cases need hospital admission and medical care. It is essential to know red flags and to know when you should consult your physician. Common home remedies for stomach ulcers include:
- Avoiding spicy and acidic foods: Irritant food will place an additional burden on your stomach’s healing. Other food to avoid includes coffee, tea, fried food, and soda or fizzy drinks.
- Cut down on alcohol consumption because alcohol can irritate the stomach lining and cause vomiting. Both of which prevents the stomach from healing properly.
- Eat a healthy diet of whole grains, vegetables, and fruits. A healthy diet is key to keeping an overall healthy gastrointestinal tract and to help prevent future stomach ulcers.
- Make sure to have garlic in your daily meals: Garlic has antibacterial properties and limits the growth of the bacterium H. Pylori.
- Eat lots of flavonoids: Flavonoids are chemical substances present in certain foods like berries, grapes, and legumes. These substances protect and fight against H. Pylori.
- Contrary to popular belief, milk is not a good home remedy for stomach ulcers. Milk is an alkali that neutralizes acid, but it also stimulates the stomach to secrete more acid. The result is more acid production and worsening of the ulcer. With that said, some patients may feel better about ingesting milk, and if you are one of them, you can continue taking it moderately.
- Try honey: Honey is one of the oldest ulcer remedies known to man and is still used in medical practice. Honey is an antibacterial medium, which helps against H. Pylori, and provides a good environment for healing stomach ulcers. A tablespoon in the morning and using it instead of sugar with yogurt can be wise.
When to consult your physician
Although most stomach ulcers can heal on their own, you should know when you should seek medical advice regarding your condition. Here are some cases when you should consider paying your doctor a visit:
- If you have had persistent stomach pain for a long time. It might mean that your condition is chronic and medical treatment is a must in such cases.
- If you vomit blood or have black tarry stools. In both cases, a bleeding stomach ulcer is a cause, and bleeding stomach ulcers need hospital admission.
- If you have a noticeable weight loss. Weight loss is a side effect of stomach ulcers because patients tend to eat less to avoid pain, but a noticeable weight loss can also be because of underlying cancer. Visiting your doctor is justified in such cases.
- If you feel any difficulty or pain in swallowing. Stomach ulcers shouldn’t cause any problem with swallowing, and if they are present, then you are likely having an esophageal problem which should be investigated.
- If you have severe abdominal pain. Stomach ulcers don’t cause severe pain unless a complication has occurred.
What will your doctor do?
Diagnosing stomach ulcers has become easier nowadays for doctors. Several options are available including lab investigations, imaging tests, and endoscopy. Lab investigations that your doctor might order include a complete blood picture to assess blood loss from the ulcer as well as other routine investigations including liver and kidney function tests. There aren’t many options for imaging a stomach ulcer, but your doctor may use barium meal -which is a type of contrast with Xray- to see the ulcer.
Diagnosing H. Pylori infection is also of utmost importance. It includes a stool antigen test and a urea breath test. Both of which can be done quickly and non-invasively. They check for markers of H. Pylori infection and in the follow-up of cases who received treatment. Another option is to
detect H. Pylori infection through tests done on samples taken by endoscopy from the stomach. In general, endoscopy is only done for a select few cases when the diagnosis of stomach ulcer is unclear or to exclude cancer.
Medical treatment
Medical treatment of stomach ulcers aims at helping the body heal the ulcer by reducing stomach acidity and eliminating H. Pylori infection. In that case, several drugs may be employed:
- For eradicating H. Pylori infection, many regimens of antibiotics with proton pump inhibitors -medications to reduce stomach acidity- are given.
- If the stomach ulcer is of another cause, proton pump inhibitors and diet control can be enough.
- If another underlying disease is present, it should be investigated as in the case of gastrinoma.
Surgical treatment is only used if complications develop and for cases of stomach cancer. It is reserved for last because of its complications. Surgery of peptic ulcers is done in the following cases:
- When severe bleeding occurs
- If the ulcer perforates
- If many ulcers are present
Surgery generally includes a procedure known as vagotomy, which is the severing of the vagus nerve, interrupting the nerve supply to the acid-secreting glands of the stomach. This can be followed by the resection of a part of the stomach.
Can my stomach ulcer turn into cancer?
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One of the most unsettling thoughts of stomach ulcer patients is whether their benign stomach ulcer will turn into a malignant one. The answer is not simple since there is much scientific debate regarding the matter. Most doctors and textbooks believe that stomach ulcers are either benign or malignant from the start and that the benign ones do not turn malignant. Even so, you should pay close attention to any alarming symptoms of your stomach ulcer including:
- Rapid loss of weight
- Persistent vomiting of everything you eat or drink.
- Feeling a mass in your abdomen or neck
- Persistent bloody vomiting
- If your treatment does little to alleviate your symptoms
- If you develop any symptoms related to liver disease (jaundice, sleepiness, severe fatigue).