A gastric ulcer or ulcus ventriculi is an inflammatory disease of the stomach and in particular of the stomach lining. Gastric ulcers are among the most common stomach diseases in Germany. Especially older people are affected. The main causes are increased gastric acid production and disturbed stomach movement or digestion.
What is a stomach ulcer?
In a peptic ulcer or ventriculi ulcer, the mucous membranes in the stomach are inflamed. However, it is not a malignant ulcer, as is the case with stomach cancer, for example. It is mainly the deeper layers of the stomach wall that are damaged by inflammation in this case. Mainly a gastric ulcer occurs in the area of the small inner curvature in the stomach, which is also known as small curvature in medicine. Along with gastritis and irritable stomach, gastric ulcer is one of the most common diseases of the stomach. However, the disease usually occurs in older age, i.e. approximately between the 50th and 70th year of life. Most of the patients suffer from recurrent gastric ulcers, so that in these cases one can almost speak of a chronic inflammation of the stomach. The disease can be hereditary and is very likely to occur even in the old age of descendants of a person suffering from peptic ulcer. A special form of this disease is duodenal ulcer.
Causes
The causes of peptic ulcer can be varied. However, all causes have in common that the protective balance of the gastric mucosa in the stomach is disturbed. In particular, the gastric juices produced by the gastric mucosa are no longer produced at a normal level. As a result, digestive disorders occur within the stomach. In particular, it is the highly corrosive gastric acids that can have an inflammatory effect on the gastric mucosa. Broadly speaking, therefore, internal and external causes of gastric ulcer can be found. Internal causes include: Increased production of gastric acid, disturbances in gastric function during the digestive process, impaired in certain proteins to repair the gastric mucosa and wall, Zollinger-Ellison syndrome, and parathyroid hyperfunction with an overproduction of calcium that promotes strong gastric acid. External factors are mainly: heavy alcohol consumption and smoking, the bacterium Helicobacter pylori, medications that severely stress and attack the stomach, such as cortisone and probably most often stress, mental stress and hasty eating.
Symptoms, complaints and signs
A stomach ulcer can cause very different symptoms. Typical are pains in the upper abdomen, which occur mainly before or during food intake. In addition, there is nausea and vomiting, often associated with heartburn and diarrhea. Patients are usually sensitive to certain foods that were previously well tolerated. The gastrointestinal complaints often lead to weight loss and thus cause deficiency symptoms. In the course of the disease, gastric bleeding may occur. The affected area is tender and painful, and the pain increases when touched and may radiate to the sternum, lower abdomen and back. Many sufferers experience the characteristic pain after ingesting food. For others, the discomfort occurs when the stomach is empty, although the fasting pain usually occurs at night and is less intense. People with peptic ulcer usually notice changes in the color and consistency of stools. The excretions may be black in color and mucousy, or watery and light in consistency. Externally, a gastric ulcer is usually not visible. Only the changes in stool and the sickly appearance that develops in the course of the disease indicate a serious condition. In severe cases, a slight swelling may be noticed externally at the site of the peptic ulcer.
Course of the disease
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Infographic of the anatomy and structure of the stomach with gastric ulcer. Click to enlarge. |
Schematic diagram showing the anatomy of the stomach with gastric ulcer. Click to enlarge. |
If a gastric ulcer is not treated by a doctor, life-threatening complications can arise in the course of the disease. Above all strong bleedings can lead to a break-through of the stomach wall. This circumstance must be avoided in time in any case. People who are prone to stomach ulcers more often are particularly at risk.The older the patient is, the larger the ulcer is, and the more frequent gastric ulcers occur in the patient, the greater the chance of further complications. Other complications may include: reduction in the size of the stomach wall, gastric stenosis, and stomach cancer. Risk groups also include more men than women. Likewise, people with kidney weakness and cirrhosis of the liver are more likely to be at risk. Although it is always advisable to seek medical help for this condition, in about 40 percent of those affected, the ulcers heal on their own. Modern medicine increases the likelihood to more than 90 percent.
Complications
Various complications can occur as a result of a gastric ulcer. In fact, in about one-third of all patients, the ulcer is first discovered because of its sequelae. Among the most common effects of peptic ulcers are bleeding, which can take either an acute or a chronic course. It is not uncommon for the bleeding to result in coffee-ground-like vomiting, bloody vomiting, or the appearance of tarry stools. If ulcer bleeding occurs, it can even threaten the patient’s life. Therefore, in this case, an immediate emergency gastroscopy is required to stop the bleeding. The mortality rate from gastric bleeding is about ten percent. Another feared complication of gastric ulcer is gastric perforation (ulcer perforation). About two to five percent of all patients suffer from this effect. Particularly affected by perforation are gastric ulcers caused by the use of non-steroidal anti-inflammatory drugs. The reason for this is their often late diagnosis and treatment. The perforation of the stomach in turn brings with it the risk of peritonitis. Since this can assume life-threatening proportions, its rapid surgical treatment is necessary. In some patients, ulcer penetration occurs. This means that the ulcer penetrates into an adjacent organ. Covered perforation predominantly affects the pancreas, which is due to its close proximity to the stomach. Another complication is gastric stenosis. It occurs due to scarring caused by repeated gastric ulcers.
When should you go to the doctor?
Pain and swelling around the stomach should be examined and treated by a doctor. Consultation with a medical professional is advised before taking a pain-relieving medication to avoid further complications. If nausea, vomiting, diarrhea or intestinal obstruction occurs, a physician is needed. If there are changes in skin appearance, a decrease in performance level, or a general feeling of malaise, a physician should be consulted. Pain on touch and pressure should be clarified by a doctor. A feeling of illness, a pale appearance, and internal weakness are signs of an irregularity that should be treated. Heartburn, a decrease in body weight, and deficiency symptoms are indications of an existing irregularity. A visit to the doctor is necessary so that treatment can be initiated. Abnormalities when going to the toilet are further signs of a disease. Discoloration or peculiarities of the odor indicate a disease. If the consistency of the stool changes, flatulence occurs or there is mucous discharge, a doctor should be consulted. If complaints of the stomach occur although the person is sober, this is considered unusual. In most cases, the affected person wakes up from night sleep due to the symptoms and suffers sleep disturbances as a result. A visit to the doctor is recommended if there are problems several nights as a result.
Treatment and therapy
First of all, a doctor should be consulted in any case if a stomach ulcer is suspected. Depending on the diagnosed cause, an individual treatment is then initiated. In addition, all foods and medications should be stopped immediately, as well as smoking and alcohol consumption. It is also recommended not to consume fatty foods and coffee. The doctor can prescribe suitable medications to inhibit the formation of acid. By the thereby initiated decreased gastric acid production, especially the gastric mucous membranes of the stomach wall are spared and painful discomfort is alleviated. Typical medications prescribed for peptic ulcer include acid blockers, proton pump inhibitors (pantoprazole, omeprazole), histamine receptor blockers and antacids.For better stomach movement and digestion, prokinetics are considered, which can provide relaxation, especially for severely cramped stomachs. In case of infection by bacteria, the antibiotics clarithromycin, metronidazole or amoxicillin are also administered. If the gastric ulcer does not heal despite the therapy by medications listed above, surgery should be considered. In any case, surgery for gastric ulcer is appropriate if complications such as gastric rupture, gastric cancer, bleeding or gastric stenosis occur.
Outlook and prognosis
If left untreated, gastric ulcer can be expected to increase health impairments. In addition, the risk of suffering secondary diseases is increased. If a peptic ulcer develops into cancer, the prospects for recovery are significantly diminished. If no medical treatment takes place, the affected person is at risk of premature death. The prognosis is usually favorable when treatment is sought. Medication is administered and the ulcer is removed. Although the surgical procedure is associated with risks, there is still a good chance of recovery. In the long term, the cause of the peptic ulcer should be determined and corrected. In case of a condition of emotional stress, a change in lifestyle is necessary. If the diet plan is not optimal, restructuring measures should also be initiated. Otherwise, the likelihood of a gastric ulcer forming again is greatly increased. If the disease recurs, the prognosis is also favorable with prompt and rapid medical attention. In people with a weakened or not yet fully mature immune system, complications are to be expected. Therefore, in them, the chances of recovery are lowered. A chronic course of the disease may develop, characterized by complaints such as stomach pain, nausea, vomiting or irritation of the stomach.
Prevention
As always, the best protection against a stomach ulcer is a healthy lifestyle. This includes, above all, sufficient exercise and sports in nature, a healthy diet rich in fiber, abstaining from alcohol, smoking and too much coffee. Likewise, one should try to live a life without stress and psychological strain, as far as this is possible.
Aftercare
After the successful treatment of a peptic ulcer, what counts most is sensitive aftercare to prevent the recurrence of the disease. The quality of life of affected persons is considerably limited by the disease, so they should move gently through everyday life even after recovery. Excessive physical activity should be avoided, as this could only put unnecessary strain on the sensitive abdominal area. Gentle food and a generally stress-free life are the best prerequisites for maintaining long-term health.
This is what you can do yourself
If a stomach ulcer has been diagnosed, there are a few things people can do to ease discomfort and promote recovery. The doctor will first recommend some dietary measures. Appropriate foods may include whole grains, brown rice, steamed vegetables, fruits and potatoes. High-fat foods (e.g., fried foods, sweets and ready-to-eat foods) as well as coffee and alcohol, on the other hand, should be avoided. Nicotine and other stimulants are also blacklisted in the case of a stomach ulcer and may only be taken in consultation with the doctor. Furthermore, sports and exercise in nature are recommended in case of a peptic ulcer. A healthy lifestyle has a positive effect on a peptic ulcer and reliably prevents the development of further ulcers. Before that, however, the cause of the disease should be determined and specifically treated. If the peptic ulcer is caused by stress or other psychological problems, it is advisable to talk to a therapist. Often, a change of job or a move to a new apartment can also help. The individual causes of the illness can often be determined with the help of a complaints diary and then addressed together with the doctor or psychologist.
