Definition of Gastric ulcer:

A gastric ulcer is a break in the normal tissue that lines the stomach.

See also: Duodenal ulcer

Causes, incidence, and risk factors:

Non-cancerous (benign) gastric ulcers are caused by an imbalance between stomach acid, an enzyme called pepsin, and the natural defenses of the stomach's lining. This imbalance leads to inflammation, which can be made worse by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen.

Risk factors for benign gastric ulcers include:

• Use of aspirin and NSAIDs
• Helicobacter pylori (H. pylori) infection
• Chronic gastritis
• Smoking
• Increasing age
• Mechanical ventilation (being put on a breathing machine)
• Certain blood clotting problems

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 to get rid of the bacteria that causes the infection. Many different medicines work. They 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.

After you finish your medicines, your doctor will likely order a test to make sure that the H. pylori infection is gone.

Those who do not have an H. pylori infection may be prescribed ulcer-healing medications such as antacids, H2 receptor antagonists, or proton pump inhibitors. Long-term treatment may be needed.

If the ulcer bleeds, endoscopy can control bleeding in most cases.

Surgery may be recommended for persons who do not respond to medicines or endoscopy. Surgical procedures for gastric ulcers include:

• Vagotomy -- cuts the vagus nerve, which controls the stomach's production of gastric acid
• Partial gastrectomy -- removes part of the stomach

Self-help measures include eating several small meals a day at regular time periods and avoiding the following:

• Smoking
• Tea, coffee, and soft drinks containing caffeine
• Alcohol
• Aspirin and NSAIDs

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:

• Bleeding from the ulcer
• Perforation (hole) in the stomach
• Blockage in the stomach that prevents movement of stomach contents

Complications can often be corrected by medication, endoscopy, or (in rare cases) with surgery.

Calling your health care provider:

Call your health care provider if symptoms of gastric ulcer develop.

Prevention:

If you are at risk for ulcers, use caution when taking aspirin and NSAIDs.