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Gastric ulcer

Definition

A gastric ulcer is a break in the normal tissue lining the stomach. See also duodenal ulcer, which is a break in the normal tissue lining the duodenum (the first part of the small bowel).

Causes, incidence, and risk factors

Benign gastric ulcers are caused by an imbalance between the secretion of acid and an enzyme called pepsin and the defenses of the stomach's mucosal lining. This leads to inflammation that may be aggravated by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs) such as ibruprofen.

Risk factors for benign gastric ulcers include the following:

Use of aspirin and NSAIDs
Helicobacter pylori infection
Chronic gastritis
Smoking
Increasing age
Mechanical ventilation (being put on a respirator)

Stress does not cause or worsen gastric ulcers.

Symptoms

Abdominal pain
- May wake you at night
- May be relieved by antacids or milk
- May occur 2 to 3 hours after a meal
- May be worse if you don't eat
Nausea
Abdominal indigestion
Vomiting, especially vomiting blood
Blood in stools or black, tarry stools
Unintentional weight loss
Fatigue

Note: There may be no symptoms.

Signs and tests

EGD (esophagogastroduodenoscopy) and biopsy showing a benign gastric ulcer
Upper GI series showing a gastric ulcer

Treatment

For people with Helicobacter pylori infection, the main goal is eradication of the organism that causes the problem. Multiple regimens are effective and usually include either an H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics.

For people without H. pylori infection, ulcer-healing medications such as antacids, H2 receptor antagonists, or proton pump inhibitors are usually effective. Long-term treatment may be required.

In the event of bleeding from the ulcer, endoscopic therapy can control bleeding in most cases.

Surgical intervention may be recommended for people who do not respond to medical therapy or to endoscopic therapy for bleeding. A vagotomy (cutting the vagus nerve, which controls the stomach's production of gastric acid) or a partial gastrectomy (removal of part of the stomach) may be necessary.

Self-help measures include:

Avoiding smoking
Avoiding tea, coffee, and soft drinks containing caffeine
Avoiding alcohol
Avoiding aspirin and NSAIDs
Eating several small meals a day at regular intervals

Expectations (prognosis)

Most ulcers heal with medication in 6 to 8 weeks. Recurrence is common, but is less likely if H. pylori infection is treated and acid-blocking medications are continued.

Complications