Stomach Ulcer – Ulcus ventriculi, Symptoms and Complications

A stomach ulcer is also known as an ulcus ventriculi. It is a relatively common disorder of the digestive tract. It occurs locally on the stomach wall. In a stomach ulcer, the stomach lining and the deeper layers of the stomach wall are inflamed.

The so-called lesser curvature—that is, the inner curve of the stomach—is most commonly affected by a stomach ulcer. However, a stomach ulcer can also occur in other parts of the stomach.

Approximately 50 people per 100,000 residents develop a stomach ulcer each year. Stomach ulcers are among the most common diseases of the digestive tract.

Overall, about 10 percent of the population will develop a stomach ulcer at least once in their lifetime.

People between the ages of 50 and 70 are most commonly affected.

The location of the stomach in the human body © peterschreiber.media | AdobeStock

A stomach ulcer is always caused by an imbalance between

• aggressive factors that damage the stomach lining (e.g., stomach acid, bile acid) and
• factors that protect the stomach lining (e.g., adequate blood flow, mucus production),

. Such an imbalance can have various external or endogenous causes.

External (exogenous) factors that contribute to this imbalance include, above all,

• the bacterium Helicobacter pylori,
• excessive use of medications such as aspirin, NSAIDs, or cortisone,
• excessive consumption of nicotine and alcohol, as well as
• psychological factors such as stress and depression.

Endogenous factors include

• increased production of stomach acid, as well as
• disturbances in gastric motility.

Early signs of a stomach ulcer often include a feeling of pressure and pain in the center of the upper abdomen. This pain may radiate toward

• back,
• sternum, or
• lower abdomen

.

This pain may be either worsened or relieved by eating.

In addition, those affected often complain of

• an intolerance to certain foods as well as
• so-called fasting pain—that is, pain on an empty stomach—which occurs primarily at night.

Other symptoms include

• nausea,
• vomiting,
• loss of appetite,
• heartburn, and
• weight loss

are among the possible symptoms of a stomach ulcer. However, in many people, a stomach ulcer causes no symptoms and therefore goes unnoticed for a long time.

To make a diagnosis, the doctor will first ask the patient about their symptoms during a medical history interview. During the subsequent physical examination, the doctor will palpate the patient’s upper abdomen. If this palpation of the upper abdomen is painful for the patient, it may already be an indication of a stomach ulcer.

Other diagnostic methods that may be used include

• a blood test to check certain blood values,
• an ultrasound examination of the upper abdomen (upper abdominal sonography), and
• an X-ray of the stomach using a contrast agent.

However, a definitive diagnosis of a stomach ulcer can only be made through an endoscopy (gastroscopy). During this procedure, tissue samples are taken from the affected area in the stomach. These samples are then examined histologically in the laboratory.

A stomach ulcer caused by the bacterium Helicobacter pylori © crevis | AdobeStock

Various treatment options are available for a stomach ulcer. They are used depending on the severity and cause of the condition.

Typically, the patient is first prescribed medication to inhibit acid production.

If this does not lead to healing or if complications arise, surgery is necessary. Complications can include stomach bleeding or the stomach ulcer perforating the stomach wall.

Various irritants can irritate and damage the stomach lining and contribute to the development of a stomach ulcer. These factors should be avoided during and after treatment. They include, for example,

• nicotine,
• alcohol,
• coffee,
• spicy, fatty, and fried foods, as well as
• certain pain relievers such as aspirin.

Medication for Stomach Ulcers

Medication for a stomach ulcer usually involves taking various acid-suppressing drugs. These acid blockers are designed to inhibit stomach acid production and, in this way,

• relieve pain and
• promote healing of the stomach lining.

Medications available for this purpose include, among others,

• proton pump inhibitors (e.g., omeprazole, pantoprazole) or
• H2-receptor blockers (e.g., cimetidine, ranitidine).

If the bacterium Helicobacter pylori is the cause of the stomach ulcer, antibiotics are used to kill the bacteria.

Surgical Treatment of a Stomach Ulcer

Treatment with acid-blocking medications leads to the healing of the stomach ulcer in 90 percent of cases. However, if a stomach ulcer does not heal after several months despite medication, or if complications arise, surgery should be performed.

There are two different surgical methods to choose from: the Billroth procedure (Billroth method) and selective proximal vagotomy:

• In the Billroth procedure, the surgeon removes two-thirds of the stomach.
• In selective proximal vagotomy, the surgeon severs the vagus nerve, which normally stimulates the acid-producing cells in the stomach.

The prognosis for a stomach ulcer is generally good. In about 40 percent of those affected, the ulcer heals on its own without treatment. The cure rate for those who undergo drug therapy is 90 percent.

However, people who have had a stomach ulcer in the past often experience recurrences. In other words, the ulcer frequently returns. The main contributing factors for this are

• advanced age,
• being male, and
• the use of certain pain relievers (e.g., aspirin).

What are the typical symptoms of a stomach ulcer?

Typical symptoms of a stomach ulcer include pain in the upper abdomen, which often occurs after eating. Other possible signs include nausea and vomiting, loss of appetite, or a feeling of pressure in the stomach. In some cases, a stomach ulcer remains asymptomatic for a long time and is only discovered when a complication, such as bleeding, occurs.

What causes a stomach ulcer?

The most common causes include infection with the bacterium Helicobacter pylori and the use of certain medications such as NSAIDs, ibuprofen, or diclofenac. An unhealthy diet and lifestyle habits can also contribute to the development of a chronic stomach ulcer. Other causes include severe inflammation of the stomach lining or chronic gastritis.

How is a stomach ulcer diagnosed?

A definitive diagnosis of a stomach ulcer is usually made through an endoscopy or gastroscopy. During this procedure, a tissue sample may be taken to rule out the presence of a stomach ulcer or even stomach cancer. Detection of the bacterium Helicobacter pylori also plays an important role.

How is a stomach ulcer treated?

Treatment for a stomach ulcer depends on the cause. If the ulcer is caused by an infection with the bacterium Helicobacter pylori, treatment involves antibiotics and proton pump inhibitors, which reduce stomach acid production. In cases of complications such as severe bleeding or perforation, surgical treatment may be necessary.

Can a stomach ulcer be prevented?

It is possible to prevent a stomach ulcer by reducing risk factors. This includes the responsible use of pain relievers, particularly NSAIDs, as well as the early treatment of gastritis. A healthy lifestyle and avoiding unnecessary medication use can significantly reduce the risk of developing a stomach or duodenal ulcer.