Each year, more than 3 million people in America are diagnosed with a form stomach ulcer. The statistic works out to be approximately 1 in every 54 people, or around 18.4% of the population in the United States.
Stomach Ulcers & Statistics
The health care industry reports some $6 billion in costs for the treatment of peptic ulcers and indirect costs due to loss of work and productivity.
What is a Stomach Ulcer?
The term “peptic ulcer,” or PUD, peptic ulcer disease is used to describe the various types of ulcers that occur in the digestive system of the human body. A Stomach ulcer is also referred to as a gastric ulcer, an ulcer in the duodenal is called a duodenal ulcer, an esophageal ulcer forms in the esophagus and a Merkel's Diverticulum is called Merkel's Diverticulum ulcer.
Peptic ulcers also have five different types. Type I occurs along the lesser curve of the stomach, Type II means there are two ulcers present, one gastric and one duodenal, Type III is a Pre-pylori ulcer, Type IV is a proximal gastresophageal ulcer and Type V can occur anywhere along the gastric body and is NSAID induced.
What causes a Stomach Ulcer?
Almost 80% of all ulcers are caused by the bacterium Helicobacter pylori, H. pylori, while some 4% of ulcers may be as a result of a malignancy. Another factor that is known to cause stomach ulcers is the prolonged usage of anti-inflammatory medications (NSAIDs) such as Aspirin naproxen, ibuprofen and others that are available via prescription. Zollinger-Ellison syndrome results from excessive acid production from gastinomas, tumors of the acid producing cells in the stomach that increase the release of acid, may also produce stomach ulcers.
H. Pylori when combined with over use of NSAIDs leads to a weakening of the stomach lining and makes the likelihood of developing an ulcer more likely. The mucous layer is what protects the stomach and intestines from the damages of digestive juices. With the rise in prescriptions for NSAIDs there has been a small increase in the number of gastric ulcer incidences.
Symptoms of a Stomach Ulcer
The most common symptom that presents with every stomach ulcer is consistent pain and discomfort in the stomach. You may notice the pain presents itself daily and then is followed by periods of no pain; it may come and go for no apparent reason. Some other symptoms of a stomach ulcer are as follows:
- Abdominal pain which may have an increased severity relating to mealtimes, such as 3 hours after eating (a duodenal ulcer may experience relief after eating while a gastric ulcer may be further irritated by consumption of food)
- Bloating and a feeling of abdominal fullness
- Waterbrash (over production after regurgitation and occurs as a way to dilute to amount of acid in the esophagus)
- Nausea, followed by excessive vomiting
- Loss of appetite and weight loss
There is a possibility some or even none of the symptoms listed will be experienced. But, an ulcer is present in the body and spreading in the stomach and sometimes the symptoms only happen once an ulcer has reached an advanced level. The symptoms listed below require a person to seek immediate medical attention:
- Hematemesis (throwing up blood) which can be a result of bleeding from the gastric ulcer, or from esophageal damage because of severe/continuous vomiting.
- Melana: a thick dark foul smelling stool resulting from oxidize iron from blood
- Rarely, but not uncommon, an ulcer may lead to a gastric or duodenal perforation. This is an extremely painful condition that requires medical attention and surgery.
- Any type of unexplained sudden, sharp, burning in the stomach that does not subside should be checked by a medical professional as soon as possible.
One of the complications that may arise from stomach ulcers is gastrointestinal bleeding which is a common complication. The condition occurs when the ulcer has eroded a blood vessel, sudden large bleeding can be life threatening and needs prompt medical attention.
Perforation is a hole in the wall of the small intestine or stomach, and can have catastrophic consequences. When the intestinal wall is eroded, the fissure from the ulcer can allow spillage of stomach or intestinal contents into the abdomen. This can lead to either peritonitis or pancreatitis depending upon where the perforation has occurred.
Other complications resulting from ulcers are penetration of other organs, narrowing of the duodenum and gastric outlet obstruction which can cause swelling and scarring. Pyloric Stenosis is a narrowing of the opening from the stomach to the intestines and causes severe vomiting in an individual with a stomach ulcer.
How to Diagnose a Stomach Ulcer
If the person is under 55 years old and has no previous history of ulcers, the doctor will likely begin treating with medications based upon the symptoms and the results of a medical history and physical examination. For a person age 55 years or older, more extensive testing would be necessary because of an increased risk of stomach cancer.
The tests required for diagnosing and ulcer typically begin with the breath, blood and stool for H. pylori infection. Though the instance of cancer being the cause is relatively low, it is important to distinguish the difference between a gastric and duodenal ulcer. Individuals older than 55 years old, who do have an ulcer, will have to have it tested for the presence of cancer.
If the person is older than 55 years old further testing is needed, especially if the following criterion is met:
- First time ulcer symptoms
- Symptoms of an ulcer than have returned before or after treatment has concluded.
- Previous history of stomach cancer in the family
Other symptoms present that may indicate a more serious problem, such as stomach cancer. The symptoms include:
- Bloody show in stool
- Losing more than 10% of body weight
- Anemia (a common blood disorder)
- Swallowing is difficult (dysphasia)
- Jaundice (yellow of the eyes and skin)
- Abdominal Mass
- Anorexia ( severely limiting food intake)
Tests Used to Diagnose a Stomach Ulcer
If a person shows the signs and symptoms of having a stomach ulcer, the following tests may be used to search for the ulcer:
- Endoscopy: An endoscopy is used by the doctor to look inside the stomach and areas of the upper small intestines to check for ulcers. Using an endoscopy also allows a piece of tissue to be taken for a sample and check for H. pylori or other conditions that may be present in the stomach.
- Upper gastrointestinal (UGS) series: An X-ray exam series of the esophagus and stomach (Upper GI Series) can be used in the diagnosis of peptic ulcer disease, though the test is now being used on a less frequent basis.
A fecal occult blood test (FOBT) is used to detect the presence of blood in the stool and this may be caused by a peptic ulcer or some other form of problem, such as colon cancer. An FOBT is not used to diagnose a peptic ulcer, but will show if it is bleeding. A complete blood count (CBC) may also be done to check for anemia, which can be caused by a bleeding ulcer.
Many people may be infected with H. pylori and not even know it, because of this fact, the American College of Gastroenterology recommends H. pylori testing for the following people:
- Those who have been diagnosed with peptic ulcer disease or those who have a past history of peptic ulcers.
- Those with a family history of gastric mucosa-associated lymphoid tissue (MALT) lymphoma, which is a form of stomach cancer.
- People who present a new case of dyspepsia (abdominal disorders or conditions), younger than 55 years old, sudden weight loss and any other symptoms that may be an indication of a more serious condition.
The most common ways to detect H. pylori bacteria are as follows:
- Blood test for H. pylori antibodies
- Urea breath test
- Stool antigen test
- Biopsy of the stomach lining
Treatment and Prognosis for Stomach Ulcers
The treatment of a stomach ulcer is going to depend upon many factors. If the ulcer is caused by an infection from H. pylori, then a round of antibiotics are needed to kill off the bacteria. If an ulcer is caused by overuse of NSAIDs, the doctor may recommend discontinuing the medications and allow the ulcer to completely heal. Another way to treat ulcers is through the use of medications that reduce the amount of stomach acid. These medications include H2 Blockers and proton pump inhibitors (PPIs).
Another factor that influences how the body responds to ulcer treatment is lifestyle habits. A doctor will recommend making lifestyle changes such as quitting smoking, refraining from alcohol, each of these factors will help the ulcer heal more quickly. For males this means limiting consumption of alcohol to two or less drinks per day and for females this means one drink per day is allowed.
For ulcers that do not respond to traditional treatments and may develop complications, may actually be a result of cancer. Sometimes when the symptoms do not respond to treatment or worsen, it may be the result of something else that may or may not be a serious issue.
Because of the improvements in the medications that are used to treat ulcers, surgery is rarely an option used in treatment. Surgery is generally only considered when a life-threatening complication of ulcers arises, such as severe bleeding, perforation or obstruction. In some instances, even these conditions may be treated and resolved without surgery.
With the right medication, lifestyle changes, dietary recommendations and proper treatment, those who suffer from stomach ulcers can live a pain free life. Stomach ulcers may recur if left untreated so it is very important to follow the treatment plan recommended by the physician because it lessens the likelihood an ulcer will return.