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Stomach Ulcers: Causes, Symptoms, Treatment, and Self-Care

October 14, 2020 - Updated on February 4, 2021
7 min read
By Marina Kim, DO | Gastroenterologist

In this article:

  • About Stomach Ulcers
  • Causes of Peptic Ulcers
  • Symptoms of Peptic Ulcers
  • Medical Treatment for Ulcers
  • Identifying Peptic Ulcer Pain
  • What You Can Do at Home
  • Dietary Suggestions
  • Risk Factors for Developing Ulcers
  • Complications Associated With Untreated Ulcers
  • Final Word

Ulcers refer to sores that develop on the inner lining of the stomach or intestine and cause pain.

stomach ulcers

Peptic ulcers are a common problem with a lifetime prevalence of 5%–10% in the United States. The likelihood of getting a stomach ulcer increases with age.

While most ulcers resolve on their own or with simple treatments, frequent and persistent ulcers may indicate an underlying problem.

About Stomach Ulcers

what are stomach ulcers?

Stomach or gastric ulcers (1) are shallow areas where there is a breach in the top layers of the stomach lining, leading to a sore.

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Ulcers caused by acids are known as peptic ulcers, of which gastric ulcers are the most common type. Erosions are smaller and more superficial than ulcers.

Causes of Peptic Ulcers

Peptic ulcers are mostly caused by the overuse of nonsteroidal anti-inflammatory medications (NSAIDs) or an unresolved infection of the bacteria called H. pylori.

An infection with H. pylori triggers an inflammatory response in the body’s mucosal immune system, affecting the degradation of the epithelial layer cells. A similar mucosal injury is also caused by the use of NSAIDs through several mechanisms. (2)

These injured areas develop into peptic ulcers upon contact with gastric acid.

Symptoms of Peptic Ulcers

common symptoms that accompany peptic ulcers

Most patients with a peptic ulcer are actually asymptomatic. However, the most common symptom when present is epigastric abdominal pain or a sharp pain generally between the belly button and the ribcage.

If the ulcer is present at the end of the stomach in an area called the pyloric channel, a blockage may occur due to the inflammation and swelling, and the following symptoms may manifest:

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  • Bloating
  • Gas
  • Abdominal fullness
  • Nausea
  • Early satiety
  • Heartburn

The patient may develop some severe symptoms that indicate underlying complications, including:

  • Vomiting of bright-red blood
  • Black stools (melena due to a slow bleeding ulcer)
  • Difficulty swallowing with the feeling that food is getting caught in the chest
  • Weight loss

However, in some cases, the patient may even gain weight due to overeating in an attempt to prevent the pain from an ulcer.

Typical symptoms, such as epigastric pain, in conjunction with alarm symptoms, should trigger an urgent consultation. Alarm symptoms include:

  • Age over 60
  • Family history of stomach cancer
  • Iron deficiency anemia

Medical Treatment for Ulcers

The treatment for peptic ulcers is very straightforward. The first step is to stop NSAIDs, if medically feasible, or to treat an underlying H. pylori infection.  

Next, rapid ulcer healing can be achieved with standard doses of proton-pump inhibitors (PPIs), which are more effective than H2 receptor agonists, antacids, or cytoprotective agents such as misoprostol. The treatment for an ulcer typically runs for 1–2 months.

Identifying Peptic Ulcer Pain

It is possible for people to mistake normal stomach pain for ulcer pain, or vice versa. However, typically, the pain from a stomach ulcer feels sharp, burning, or gnawing and stays in one place (does not radiate).

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It may also be described as a vague abdominal discomfort, nausea, aching, fullness, pressure, or a hunger sensation, and the symptoms tend to recur in episodes.

What You Can Do at Home

home remedies for peptic ulcer relief

Various home remedies may help treat ulcers. However, they have not been established as efficacious treatments by any scientific studies.

While certain herbal supplements, such as Korean red ginseng, (3) ginger, (4) garlic, (5) and aloe vera, (6) have been suggested in the literature to have anti-inflammatory properties, they have not been tested in human subjects yet.

Therefore, you may try these remedies in moderation and with caution only if you are not allergic to any of the ingredients.

Dietary Suggestions

Contrary to popular belief, there is no evidence that specific foods or alcohol cause ulcers or that a bland diet treats ulcers.

However, certain dietary modifications can help reduce the symptoms of acid reflux, heartburn, and pain.

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  • It is best to make a note of the foods that bother you and avoid them in the future.
  • If you suffer from symptoms of acid reflux, avoid fatty meals in the evenings. (7)(8)
  • Avoid consumption of meat in excess as it increases the risk of H. pylori infection and thus the development of ulcers. 
  • Eat home-cooked meals as eating outside more than once a week can contribute to the development of an H. pylori infection. (9)

Risk Factors for Developing Ulcers

An infection with H. pylori and the use of NSAIDs are the cause of 80%–90% of ulcer cases. (2) However, the following factors can predispose you to develop peptic ulcers:

1. Smoking

Smoking impairs ulcer healing. (10) It also contributes to the development of an H. pylori infection.

Therefore, smokers are at a moderately increased risk for peptic ulcers, and this risk is proportional to the amount smoked.

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2. Steroids

A high dose of steroids, in combination with NSAIDs, greatly increases the risk of ulcers, higher than that from NSAIDs alone.

3. Obstructive sleep apnea

It is found to have approximately a 2.4-fold risk for the development of peptic ulcers. (11)

4. Certain chronic illnesses

Chronic obstructive pulmonary disease (COPD), (12) liver cirrhosis, systemic mastocytosis, (13) and uremia are associated with an increased risk of developing ulcers.

5. Weight loss surgery

Patients who had weight loss surgery, called Roux-en-Y, are at an increased risk of developing ulcers at surgical sites called marginal ulcers. (14)

Complications Associated With Untreated Ulcers

complications of untreated peptic ulcers

Oral medications help to accelerate ulcer healing. However, without treatment, there is a risk of ulcer complication and non-healing.

While most ulcers will remain uncomplicated, 2%–4% have serious complications such as perforation and bleeding. 

Perforation is suggested by sudden, severe abdominal pain that may spontaneously improve. The patient may also experience low blood pressure. Examination of the abdomen will generally yield a rigid and tight abdomen that is tender diffusely. 

Final Word

While it is commonly said that the intake of spicy foods leads to ulcers, infection with H. pylori and the use of NSAIDs are the most common cause of ulcers.

The symptoms of an ulcer are similar to those caused by GERD, non-ulcer dyspepsia, biliary tract disease, pancreatitis, and cancer.

Therefore, it is best to consult a doctor for the proper diagnosis and treatment of the symptoms. If found to have ulcers, you may be suggested to take PPIs, make lifestyle changes, and, in severe cases, undergo surgery.

References
  1. A; PVS. An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults. Annals of medical and health sciences research. https://pubmed.ncbi.nlm.nih.gov/24669326/. Published 2014.
  2. E; NMRKMM. Peptic Ulcer Disease and Helicobacter pylori infection. Missouri medicine. https://pubmed.ncbi.nlm.nih.gov/30228726/. Published 2018.
  3. Bae M; Jang S; Lim JW; Kang J; Bak EJ; Cha JH; Kim H; Protective effect of Korean Red Ginseng extract against Helicobacter pylori-induced gastric inflammation in Mongolian gerbils. Journal of ginseng research. https://pubmed.ncbi.nlm.nih.gov/24558304/. Published 2014.
  4. Zaghlool SS; Shehata BA; Abo-Seif AA; Abd El-Latif HA; Protective effects of ginger and marshmallow extracts on indomethacin-induced peptic ulcer in rats. Journal of natural science, biology, and medicine. https://pubmed.ncbi.nlm.nih.gov/26283843/. Published 2015.
  5. JJ; P. The Garlic Preparation as an Alternative Way for Gastroprotection: From Bench to Clinic. Gut and liver. https://pubmed.ncbi.nlm.nih.gov/27114428/. Published 2016.
  6. Rahmani AH; Aldebasi YH; Srikar S; Khan AA; Aly SM; Aloe vera: Potential candidate in health management via modulation of biological activities. Pharmacognosy reviews. https://pubmed.ncbi.nlm.nih.gov/26392709/. Published 2015.
  7. C; CDMH. Gastroesophageal Reflux Disease (GERD). Missouri medicine. https://pubmed.ncbi.nlm.nih.gov/30228725/. Published 2018.
  8. Kubo A; Block G; Quesenberry CP; Buffler P; Corley DA; Dietary guideline adherence for gastroesophageal reflux disease. BMC gastroenterology. https://pubmed.ncbi.nlm.nih.gov/25125219/. Published 2014.
  9. Mhaskar RS; Ricardo I; Azliyati A; Laxminarayan R; Amol B; Santosh W; Boo K; Assessment of risk factors of helicobacter pylori infection and peptic ulcer disease. Journal of global infectious diseases. https://pubmed.ncbi.nlm.nih.gov/23853433/. Published 2013.
  10. Maity P; Biswas K; Roy S; Banerjee RK; Bandyopadhyay U; Smoking and the pathogenesis of gastroduodenal ulcer–recent mechanistic update. Molecular and cellular biochemistry. https://pubmed.ncbi.nlm.nih.gov/14619984/. Published 2003.
  11. Ali T; Choe J; Awab A; Wagener TL; Orr WC; Sleep, immunity and inflammation in gastrointestinal disorders. World journal of gastroenterology. https://pubmed.ncbi.nlm.nih.gov/24409051/. Published 2013.
  12. Huang KW; Kuan YC; Chi NF; Huang YH; Luo JC; Chien LN; Chronic obstructive pulmonary disease is associated with increased recurrent peptic ulcer bleeding risk. European journal of internal medicine. https://pubmed.ncbi.nlm.nih.gov/27727075/. Published 2017.
  13. P; LJKWSJERAZ. Gastrointestinal manifestations of systemic mastocytosis. World journal of gastroenterology. https://pubmed.ncbi.nlm.nih.gov/19058339/. Published 2008.
  14. Azagury DE; Abu Dayyeh BK; Greenwalt IT; Thompson CC; Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. https://pubmed.ncbi.nlm.nih.gov/21997722/. Published 2011.
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