What is stomach ulcer and how is it treated?

Stomach ulcer is a local damage of the stomach wall that forms due to the effect of stomach juice, pepsin, and bile. It commonly also spreads to the duodenum.  The disease has a relapsing character, i.e. the relapses alter with remission. The relapses usually happen in spring and autumn. Healed stomach ulcer forms a scar.

Short information about stomach ulcer

The disease is found in around 4% of people in the world.

After the discovery of Helicobacter pylori bacteria's effect on the likelihood of ulcers onset in the early 1980s, the therapy of the disease has changed radically.

The major risk factors for stomach ulcer besides Helicobacter are an extended use of non-steroidal anti-inflammatory drugs (NSAIDs), and tobacco smoking.

 Symptoms of stomach ulcer

The manifestations are contingent on the duration of the damage presence, individual sensitivity to pain, and localization of the ulcer.

The main symptom is the pain in the upper abdomen.

With the localization of stomach ulcer that doesn’t spread on the duodenum, pain usually occurs on an empty stomach because stomach acid damages the mucosa.

Other symptoms of peptic ulcer may include:

- Sour belching or heartburn;
-  Weight loss;
- Vomiting and nausea after eating.

In a duodenal ulcer, pain usually occurs 2-3 hours after eating and disappears after eating or using heartburn medications. Often patients wake up from pain several hours after falling asleep. It is believed that with a stomach ulcer, pain, on the contrary, intensifies after eating, although this symptom does not allow to confidently distinguish a stomach and duodenal ulcer. In addition, most patients, especially those with stomach ulcers, complain of nausea and vomiting.

Often, however, peptic ulcer is asymptomatic. In addition, a reduction in pain does not mean that the therapy worked, as it can persist despite the healing of the ulcer or decrease while the ulcer has not healed.

Complications of stomach ulcer

The untreated disease can cause such aggravations as ulcer perforation (rupture of the stomach wall), bleeding, and inflammation of the abdominal cavity. These complications require immediate hospitalization and often surgical treatment.

Diagnostics of stomach ulcer

The diagnosis of peptic ulcer is based on esophagogastroduodenoscopy (endoscopy) or x-ray examination. The information content of the X-ray examination decreases with small sizes of the ulcer (up to 0.5 cm); besides, it doesn’t allow to take a biopsy. Therefore, if possible, if you suspect a peptic ulcer, it is better to do endoscopy.

In uncomplicated peptic ulcer disease, laboratory methods are uninformative, but they are of great importance for the detection of Helicobacter pylori infection - for this purpose, blood, feces, or expired air are examined by various methods, often repeatedly to determine if the treatment has helped.

Therapy for stomach ulcer

It was discovered that the relapse rate of ulcers decreases significantly after the destruction of Helicobacter pylori. If only classical anti-ulcer (antisecretory) agents are used, then 50–80% of the healed ulcers recur annually.

Peptic ulcer must not be treated without establishing whether the patient is infected with Helicobacter pylori or not. If the pathogen is not detected, a doctor should think about other reasons for ulcer development.

Traditionally, in peptic ulcer, bed rest, and diet were prescribed. It was believed that the patient needed a sparing diet and plenty of milk; fractional nutrition was also recommended in order to reduce gastric distension and thereby reduce acid secretion. It turned out, however, that these recommendations are useless, and the individual can eat the food to which he is accustomed, excluding only products that cause heartburn and other unpleasant sensations. It is also advised to quit smoking, not to drink alcohol, and, if possible, to cancel NSAIDs.

The main means used for the therapy stomach ulcer are antisecretory medicines and means to neutralize hydrochloric acid. These include antacids (magnesium hydroxide, aluminum hydroxide), H2 blockers (cimetidine, ranitidine, and others), sucralfate, prostaglandin analogs E1 (misoprostol, enprostil), proton pump inhibitors (omeprazole, lansoprazole, Pantoprazole, and others). The latter most actively inhibit the production of stomach acid. Moreover, since proton pump inhibitors are part of many antibiotic regimens used to kill Helicobacter pylori and are effective even in individuals who continue to take aspirin, they have become the basis for peptic ulcer therapy.

Treating Helicobacter pylori infection diminishes the frequency of flare-ups regardless of the stage of the ulcer. If bacteria are found, they should also be eliminated, even if the main reason for the ulcer is the use of NSAIDs. Often, a three-component treatment regimen is used, which includes Azithromycin or clarithromycin, a proton pump inhibitor, as well as metronidazole or amoxicillin.

To facilitate the healing of the ulcer, vitamins are used:

- Pantothenic acid (vitamin B5) has a powerful reparative effect on the stomach walls. High doses of pantothenic acid inhibit the secretory function of the stomach. Pantothenic acid also stimulates intestinal motility.
- Vitamin U (methyl methionine sulfonium chloride) helps to reduce gastric secretion and causes an analgesic effect.
  
Diet for stomach ulcer  

Although only diet cannot cure stomach ulcer, it can facilitate its treatment and promote healing. The products listed below must not be used in stomach ulcer as they damage the stomach walls or promote the release of stomach acid.

- Raw vegetables are rich in fiber and irritate the mucosa so they must be excluded from the diet.
- Grape, lemon, pomegranate, cranberries, and other sour grapes are prohibited in ulcer as they have active acids.
- Fatty heavy dishes, kebabs, fried pork, mutton cutlets, liver and lard are strictly prohibited.
- Nuts and seeds irritatingly affect the stomach walls and are prohibited.
- Mushrooms are very heavy for the stomach so they are not advised to be used even in remission.
- Hot spices such as garlic, ginger, and pepper are strictly prohibited.
- Greens irritate the stomach and stimulate gastric juice production so they should not be used raw.
- In a flare-up of ulcer, you should not eat dried fruits as they injure the weakened mucosa. But during remission, prune with honey prevents constipation.
- In a disease of the stomach, fatty dishes, sausages, liver, caviar, bologna, smoked meat, pickles, fried potato, fried meat, and other spicy or fat products are prohibited. Butter can be consumed in small portions.

This article is contributed to RXShop by Samuel Wrangler, M.D. from Gastro Health, Montgomery, Alabama