Stomach ulcers are open sores in the stomach lining that occur when the thick layer of mucus protecting the stomach from digestive juices wears away. This allows the tissues covering the stomach to wear away due to exposure to digestive acids, which leads to the formation of the ulcer.

Stomach ulcers are a form of peptic ulcer disease that can affect either the stomach or the duodenum. They are typically easy to treat, but they can become severe and dangerous if left untreated.

Causes of Stomach Ulcers

The causes of stomach ulcers include the following:

• Helicobacter pylori (H. pylori) Infection:
  This Helicobacter pylori lives in the stomach lining, causing irritation and making the lining more susceptible to damage from stomach acid. Infection with H. pylori is common and can occur without the person realizing it. In some cases, it may not cause any symptoms. It can affect individuals of all ages.
• Overuse of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
  NSAIDs are used to treat fevers and inflammations. While the vast majority of users do not experience side effects, there is a constant risk of developing complications, including stomach ulcers, especially when used for long periods or in high doses. This category includes drugs such as Aspirin, Ibuprofen, and Diclofenac.
• Lifestyle:
  Lifestyle choices can contribute to the development of stomach ulcers, such as consuming spicy and highly seasoned foods, drinking alcohol, and being exposed to psychological stress. Smoking also increases the risk of ulcers and may render treatment ineffective.
• Less Common Causes:
  Rare causes of stomach ulcers include viral infections, Celiac disease, and a severe imbalance between gastric acids and the stomach’s protective mucosal lining.

Symptoms

A group of symptoms is associated with stomach ulcers, and their severity depends on the severity of the ulcer itself. The most common symptom is a burning sensation in the mid-abdomen between the chest and the navel. This burning may radiate upward to the neck, downward to the navel, or even to the back. It is usually more intense a few hours after eating and may awaken the patient at night. The burning sensation can last from a few minutes to several hours. Other symptoms include:

• Stomach pain.
• Weight loss.
• Loss of appetite due to pain.
• Nausea and vomiting.
• Bloating.
• Feeling of satiety (fullness).
• Burping.
• Pain that improves after eating, drinking, or taking antacid medications.
• Anemia.
• Passing dark, tarry stools.
• Hematemesis (Vomiting blood) which may look like coffee grounds.

Diagnosis of Stomach Ulcers

To diagnose stomach ulcers, the physician takes the patient's medical history, notes clinical symptoms, and reviews the list of medications used, whether prescription or over-the-counter. The most important diagnostic tests include:

1. Blood or Stool Tests: To confirm the presence or absence of H. pylori bacteria.
2. Urea Breath Test: To check for H. pylori. The patient drinks a clear liquid and then breathes into a bag which is then tightly sealed. If the bacteria are present, the breath sample will contain higher-than-normal levels of carbon dioxide.
3. Barium Swallow: During this test, the patient swallows a thick white liquid that coats the upper digestive system, helping the physician see the stomach and small intestine in X-ray images.
4. Esophagogastroduodenoscopy: A thin, illuminated tube is inserted through the mouth into the stomach and duodenum to detect ulcers, bleeding, or any abnormal tissue.
5. Endoscopic Biopsy: A sample of stomach tissue is taken and tested.

Treatment of Stomach Ulcers

Stomach ulcers are treated primarily by addressing the cause. Most cases are treated with a medical prescription, while rare cases may require surgical intervention.

Management of H. pylori-induced Stomach Ulcers:

If the ulcer is caused by an H. pylori infection, it is treated using:

• Antibiotics: Amoxicillin, Clarithromycin, and Metronidazole are the most commonly used antibiotics for this purpose.
• Proton Pump Inhibitors (PPIs): Drugs that inhibit the secretion of stomach acid, such as Omeprazole and Pantoprazole.
• H2 Receptor Blockers: Drugs sometimes used instead of PPIs as they also reduce acid secretion.
• Antacids: Additional medications used for short-term symptomatic relief.
• Probiotics: Beneficial bacteria that may play a role in killing H. pylori.
• Bismuth Supplements.

Management of NSAID-induced Stomach Ulcers:

If the cause of the ulcer is the use of Non-Steroidal Anti-Inflammatory Drugs, the treatment includes:

• Proton Pump Inhibitors (PPIs) or alternatives known as H2 Receptor Blockers.
• Advising the patient to use alternative analgesic medications.

Ulcer symptoms usually resolve quickly with treatment; however, even if symptoms disappear, the medication prescribed by the physician must be continued. This is especially vital in H. pylori infections to ensure the complete eradication of the bacteria.

Side effects of stomach ulcer medications include:

• Nausea
• Dizziness
• Headache
• Diarrhea
• Abdominal Pain.

It is advised to perform a gastroscopy 4 to 6 weeks after treatment to determine if the ulcer has healed.

Lifestyle Management for Stomach Ulcers:

Regarding lifestyle habits, the following is advised:

• Avoiding psychological pressure and staying away from stress triggers.
• Avoiding alcohol.
• Avoiding spicy and seasoned foods.
• Avoiding smoking, as it reduces symptoms and facilitates the healing process.

In rare cases, stomach ulcers may require surgical intervention, including:

• Persistence or recurrence of stomach ulcers that do not respond to medication.
• Gastrointestinal bleeding.
• Gastric perforation.
• Gastric outlet obstruction (food cannot pass from the stomach to the small intestine).

Surgery may involve:

• Excision of the entire ulcer.
• Taking tissue from other parts of the intestine and patching it over the ulcer site in the stomach.
• Ligating the bleeding artery.
• Vagotomy: Cutting the nerve supply to the stomach to reduce the production of stomach acid.
• Herbal Treatment of Stomach Ulcers.

Complications of Stomach Ulcers

Complications of stomach ulcers include the following:

1. Internal Stomach Bleeding.
2. Perforation of the inner lining of the stomach at the ulcer site.
3. Gastric Obstruction caused by the ulcer stopping the movement of food through the digestive tract.