Some stomach ulcers may go away on their own without treatment, especially if you follow a strict diet and avoid triggers. However, ulcers can worsen if left untreated, so it is best to seek medical attention to prevent complications such as internal bleeding. Even with treatment, though, there is a chance that the stomach ulcer will come back.
Stomach ulcers are most likely to persist or recur even after treatment in the following conditions:
- Helicobacter pylori (H pylori) bacteria that are resistant to antibiotics
- Regular tobacco use
- Regular use of pain relief medications such as nonsteroidal anti-inflammatory drugs or steroids
- Zollinger-Ellison syndrome or gastrinoma (a rare condition in which a tumor of acid-producing cells forms in the digestive tract)
- Crohn's disease (a type of inflammatory bowel disease or IBD)
- Stomach cancer
How are stomach ulcers treated?
Depending on the cause, initial treatment of stomach ulcers usually includes medications:
- Antibiotics: If your doctor detects an H pylori infection, they may recommend a combination of antibiotics for 2 weeks. These may include:
- Proton pump inhibitors (PPIs): PPIs are a class of medications that reduce the production of stomach acid by blocking the cells that produce the acid. These drugs include:
- Histamine (H-2) blockers: Also called acid blockers, these drugs reduce the amount of stomach acid released into the digestive tract and help heal the ulcer. These drugs include:
- Antacids: These are combinations of medicines that neutralize stomach acid and provide rapid pain relief. One such popular antacid is bismuth subsalicylate. Unlike proton pump inhibitors and H2 blockers, these do not have any role in ulcer healing. Ingredients include:
- Aluminum hydroxide
- Magnesium carbonate
- Magnesium trisilicate
- Magnesium hydroxide
- Calcium carbonate
- Sodium bicarbonate
- Cytoprotective agents: These medications protect the lining of the stomach and prevent further ulcer formation. These include:
If you have serious complications from an ulcer, such as bleeding or perforation, you may require surgery.
What causes stomach ulcers?
Contrary to the previous misconception that stress or certain foods cause stomach ulcers, studies suggest that the two most common causes of stomach ulcers are:
- H pylori bacteria
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
H pylori bacteria
H pylori bacterium commonly infects the stomach, although not everyone with an infection will develop symptoms. About 50% of the world’s population has an H pylori infection, but only about 10%-15% develop stomach ulcers.
H pylori causes inflammation of the stomach and damages its protective lining. When acid breaks through the lining and further irritates it, it can lead to a stomach ulcer.
NSAIDs can wear away at the protective mucus layer in the digestive tract, including the stomach. NSAIDs include:
The risk of developing stomach ulcers increases with H pylori infection and frequent, higher doses of NSAIDs. Other risk factors include:
- Age 70 or older
- Female sex
- History of ulcers
- Family history of ulcers
- Liver, kidney, or lung diseases
- Use of corticosteroids and NSAIDs at the same time
- Zollinger-Ellison syndrome
- Alcohol intake
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What are the signs and symptoms of a stomach ulcer?
Stomach ulcer symptoms depend on the severity of the condition.
The most common symptom is a burning sensation or pain in the middle of the upper abdomen (near the solar plexus). The pain is more intense when the stomach is empty and lasts for a few to several hours. Other common signs and symptoms include:
- Pain that is relieved when eating or drinking
- Early satiety
- Lack of appetite
- Weight loss
Over time, stomach ulcers can also cause:
- Anemia (reduced number of red blood cells or hemoglobin)
- Dark, tarry stools
- Bloody or brown vomit
How are stomach ulcers diagnosed?
Typically, symptoms and physical examination are enough for your doctor to diagnose a stomach ulcer. However, to confirm a diagnosis, your doctor may order a barium meal and endoscopy tests:
- Barium meal involves liquid ingestion, followed by a series of X-rays of the stomach and intestine. If you have a stomach ulcer, the X-ray will show that portion in the stomach highlighted by the liquid.
- Endoscopy involves inserting a thin, flexible long tube-like camera (endoscope) into the mouth that reaches the stomach and small intestine. The procedure allows your doctor to visualize the inside of the stomach for any signs of ulcers. A small piece of the lining may be removed to test for H pylori.
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Anand BS. Peptic Ulcer Disease. Medscape. https://emedicine.medscape.com/article/181753-overview
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