What is a stomach ulcer?

A stomach ulcer, also called a gastric ulcer, is a raw area or open sore in the lining of the stomach.

How does it occur?

The stomach's lining has a protective layer of cells that produce mucus. The mucus prevents the stomach from being injured by stomach acids and digestive juices. When this protective layer is damaged, an ulcer may occur.

Stomach ulcers may develop from:

• Decreased resistance of the lining of the stomach to gastric acids
• Increased production of gastric acids
• Bacteria called Helicobacter pylori (H. pylori).

Stomach ulcers are more likely to occur in people who:

• Take anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen
• Drink alcohol
• Smoke tobacco
• Often feel stressed.

What are the symptoms?

Symptoms include:

• Gnawing, burning, aching, or hunger like pangs about 1 hour after a meal or, less often, before a meal
• Pain that is relieved by eating, taking antacids, or vomiting
• Nausea and vomiting
• Weight loss
• Fatigue.

How is it diagnosed?

Your health care provider will review your symptoms, ask about your medical history, and examine you. You may have one or more of these tests:

• An x-ray of your upper digestive tract (an upper GI series)
• Blood tests to look for H. pylori bacteria
• Tests of a sample of your bowel movement to check for blood (which might come from a bleeding ulcer)
• a blood test for anemia (which may be a sign of internal bleeding)
• An endoscopy or gastroscopy, which usually allows your provider to see the ulcer by inserting a thin tube with a tiny camera through your mouth to your stomach
• A biopsy, which involves taking a piece of tissue during an endoscopy and sending it to the lab for testing (this is another way to test for H. pylori).

How is it treated?

The goals of treatment are pain relief, healing of the ulcer, and prevention of complications. Treatment can also help prevent recurrence of the ulcer.

You may stay in the hospital for the first stage of treatment if your symptoms are severe or if you are having complications, such as bleeding.

Your health care provider may prescribe:

• Antacids (the liquid form is more effective than the tablet form)
• Medicine to reduce the amount of acid your stomach makes
• Antibiotics to treat H. pylori
• Sucralfate, a medicine that helps to form a protective barrier over the lining of your stomach.

Antacids can have side effects after you have used them for a while. Follow your health care provider's instructions carefully, and report any problems promptly.

Because stress can contribute to the development of gastric ulcers, you may need to make changes in your lifestyle (see "How can I take care of myself?").

How long will the effects last?

Stomach ulcers respond well to treatment but they can recur. You can help reduce the chance that an ulcer will recur by taking your medications.

Possible complications of untreated ulcers are:

• Hemorrhage (massive bleeding)
• Perforation (a hole through the stomach wall produced by an ulcer)
• Obstruction (ulcer scarring that prevents passage of food).

These complications may require surgery.

Two to three percent of stomach ulcers become stomach cancer. Make sure you report all continuing or recurrent symptoms to your health care provider.

How can I take care of myself?

Follow the full treatment prescribed by your health care provider. Keep your follow-up appointments. Also, you may want to make lifestyle changes such as:

• Avoid tobacco.
• Avoid alcohol.
• Avoid drugs that cause stomach inflammation, such as aspirin, ibuprofen, and naproxen. (Ask your provider if you can use acetaminophen instead.)
• Avoid strong tea, caffeinated and decaffeinated coffee, and colas.
• Eat balanced, nutritious meals. Several small meals may be better than two or three large ones.
• Learn how to manage stress. Seek professional help for dealing with events that cause anxiety and stress.
• Get plenty of rest.
• Exercise as recommended by your health care provider.

If you continue having symptoms or your symptoms get worse, tell your health care provider.

How can I help prevent stomach ulcers?

• Follow your health care provider's treatment plan and keep your follow-up appointments.
• Change your lifestyle in ways that will help prevent ulcers.