Gastric ulcer

Gastric ulcer means that ulcers have formed in the lining of the stomach or duodenum. Most people with stomach ulcers get stomach upset, usually in the middle of the upper part of the stomach. Stomach ulcers are usually caused by a bacterium, but even some medications can cause stomach ulcers. Most people become good at treatment.

symptoms

It is common to have one or more of the following gastric ulcer symptoms:

  • You are hurting in the middle of the upper part of the stomach, the so-called stomach pit.
  • You feel sick and can vomit.
  • You are in pain for periods, for example, you may have a few weeks of pain and be symptom free in between.
  • You feel the symptoms change as you eat, they can either be alleviated or worsened.
  • You may get stomach upset and the pain can be experienced as hunger.

The symptoms of ulcers can vary between different people.

Bleeding or broken ulcer

An ulcer can start to bleed or develop into a broken ulcer. A broken stomach ulcer is when the wound passes through the wall of the stomach or duodenum, and the stomach contents leak. Both bleeding and broken stomach ulcers are serious conditions that can be life-threatening.

You may have a bleeding or broken stomach ulcer even without having known any of the symptoms above. Common symptoms of bleeding or broken ulcer are otherwise to have one or more of the following symptoms:

  • You suddenly get a lot of pain in the upper abdomen, it can feel like hunger.
  • The pain can be made worse by eating, but also relieved by food or drink.
  • You get stomach upset at night.
  • You feel sick or vomit and the stomach contents look like coffee grounds or contain blood.
  • You have black poop.
  • You lose weight.

A bleeding from the stomach can lead to anemia, which in turn can make you tired and short of breath.

Stomach pain may be due to something else

Many people have stomach ache without having a stomach ulcer. For example, it could be any of the following:

  • Sensitive stomach, also called dyspepsia.
  • Sensitive bowel also called IBS.

The symptoms can be similar to the symptoms you get during gastric ulcer.

An ulcer in the lining of the stomach can sometimes cause the same symptoms as stomach cancer, but the risk of it being cancer is small. Cancer of the duodenum is very uncommon.

When and where should I seek care?

If you think you have a stomach ulcer and especially if any of the following is true of you, contact a health care provider:

  • You are over 50 years old and you get symptoms from your stomach that you have not had before.
  • You lose weight quickly or have less desire to eat.

Wait until it becomes everyday, if it’s a weekend. You can contact many receptions by logging in .

If it’s in a hurry

If any of the following is true of you, contact a health center or an on-call reception immediately :

  • You suddenly get a lot of stomach ache.
  • You vomit and the stomach contents look like coffee grounds or contain blood.
  • You have black poop or bloody poop.

If closed, seek care at an emergency room.

So you can reduce the risk of stomach ulcers

There are some things you can do yourself to reduce the risk of getting stomach ulcers, especially if you’ve had stomach ulcers before.

Do not use certain medicines

Avoid using medicines for pain or fever that are anti-inflammatory or that contain acetylsalicylic acid. Anti-inflammatory drugs are also called NSAIDs.

These drugs increase the risk of peptic ulcer. The risk increases even more if you use different types of these medicines at the same time.

Instead, use medicines containing paracetamol if you have pain or a fever.

Read what painkillers for pain and fever you can use and which ones to avoid here .

Ask if you are unsure about your medication

Ask a pharmacy if you need painkillers and are unsure what to use.

Tell your doctor that you have or have had a stomach ulcer, and if you need to use NSAID or Thrombyl for a long time. You can then get medicines that prevent stomach ulcers.

Do not smoke

It is good to quit smoking or reduce smoking if you smoke. There is help to get if you smoke and want to quit.

What can I do for myself?

You may notice that you are getting worse from some food or drink, for example, strong or deep-fried foods may cause symptoms in some. Others may be impaired by coffee and alcohol.

What gives you trouble and how you react can be different from what others get into. Try to notice if there is something special you are getting worse off, and then avoid eating or drinking it.

In the past, special foods were recommended to avoid getting stomach ulcers again. But that no longer applies.

Investigations and investigations

You should always be examined if you think you have a stomach ulcer.

You have to tell us

When you come to a doctor you will be told about your symptoms. It may be difficult for the doctor to determine if you have a stomach ulcer or sensitive stomach , for example , because the symptoms are similar to each other.

You can tell if you have had stomach ulcers before, and if you have become better with medicines that reduce the amount of hydrochloric acid in your stomach. You can also tell if you are using any non-prescription or prescription drugs, especially painkillers and anti-inflammatory drugs.

Gastroscopy

You may need to be examined with gastroscopy, which allows the doctor or nurse to see the inside of the esophagus, stomach and duodenum.

Using the gastroscopy, the doctor or nurse can see if there is a wound. They can also take tissue tests to see if there are cell changes in the wound or if you have the bacterium Helicobacter pylori in your stomach. The bacterium can cause stomach ulcers.

You are always examined with gastroscopy after a treatment if you have had a ulcer in the stomach. The doctor needs to check how the wound has healed, as it can sometimes be difficult to distinguish stomach ulcers from cancer.

If you have had ulcers in the duodenum and become symptom free, you do not need to be re-examined after treatment.

Blood tests and other tests

The bacterium Helicobacter pylori can also be detected by a blood test. The blood test shows whether the body’s immune system has reacted to the bacterium. The blood test cannot tell if you have the bacterium at the time of sampling, or if you have had the bacterium before. However, the sample can show if you do not have the bacteria.

You may also be required to submit an exhalation or stool test to see if you have Helicobacter pylori. These samples are safer than blood tests, especially to rule out if you have the bacteria. The exhalation test is called the Urea Breath Test and can be shortened UBT.

It may be enough for the doctor to examine you with a blood test, a breath test or a stool test. The test can sometimes determine what you get for treatment, and you may not need to be examined with gastroscopy. This is especially true if you are younger than 50 years.

Treatment

A stomach ulcer can heal on its own, but usually comes back. Therefore, a peptic ulcer should always be treated as it can otherwise develop into a bleeding or broken ulcer.

There is good treatment, and most get healthy with the help of drugs. What treatment you receive depends on why you received the stomach ulcer:

  • Due to the gastric ulcer of Helicobacter pylori, you receive different types of antibiotics in combination with drugs that reduce the production of hydrochloric acid.
  • If you have used medicines that cause stomach ulcers, it may be enough to stop using the medicine. But you always get treatment if the doctor has seen you have a gastric ulcer at a gastroscopy.

You are treated differently for a long time, depending on whether the wound is in the stomach or in the duodenum.

Medicines that affect the amount of hydrochloric acid

There are various groups of drugs that reduce the amount of hydrochloric acid in the stomach:

  • Proton pump inhibitors are the group of drugs that are most effective and most commonly used. The drugs reduce the formation of hydrochloric acid in the stomach.
  • Histamine-2 blockers also reduce the formation of hydrochloric acid, but not as effectively as proton pump inhibitors and are therefore not used in the treatment of peptic ulcer.
  • Antacids can sometimes be used. Antacids neutralize the hydrochloric acid contained in the stomach, but do not affect the formation of hydrochloric acid.

Proton pump inhibitors enter the cell which forms hydrochloric acid and reduces the amount of hydrochloric acid that is formed. Examples of drugs containing the active substance are omeprazole, esomeprazole, lanzoprazole or pantoprazole.

You can get both proton pump inhibitors and histamine-2 blockers on prescription, but they are also available for purchase without prescription. Use mainly non-prescription drugs if you have temporary problems with acid reflux and heartburn.

Another name used for proton pump inhibitors is the abbreviation PPI.

Treatment with antibiotics

You are treated with proton pump inhibitors and two kinds of antibiotics for one week if the stomach ulcer is due to Helicobacter pylori. Removing the bacterium with this combination of drugs is called eradication therapy.

You need to continue using proton pump inhibitors if the wound is in the stomach, usually for three weeks after you stop taking antibiotics.

Almost everyone who has Helicobacter pylori and is treated becomes healthy. Gastric ulcer due to Helicobacter pylori is always treated with antibiotics, although the gastric ulcer can heal with only proton pump inhibitors or by itself. This is because the risk of having stomach ulcers again is great if the bacterium remains.

Some antibiotics can cause allergic problems. Tell your doctor if you have been treated with antibiotics before and have had an allergic reaction. The doctor may then choose to give you another type of antibiotic.

You may need to be re-examined

You are always checked with gastroscopy until the wound is healed, if you have had a stomach ulcer. If you have had Helicobacter pylori, you are also checked to see that the bacterium has disappeared.

An ulcer in the duodenum does not need to be checked with gastroscopy if you have become completely trouble free.

The doctor may want to check the ulcer in the duodenum if you are still having trouble after being treated. The wound can then be checked by examining whether the infection with Helicobacter pylori has healed. It can be done with an exhalation test or with a stool test. When doing these tests, you should not have used proton pump inhibitors for at least one week before the examination, otherwise the answer may be incorrect.

Sometimes hospital care is needed

A broken stomach ulcer needs to be operated quickly in hospitals. During surgery, the doctor sews the wound together so that the stomach contents do not come out and damage the organs that are located around the stomach. The doctor can also glue or stick together a bleeding ulcer through a gastroscope, thus without having to operate through the abdomen.

You also need hospital care if you have a bleeding ulcer, or if the blood value is so low that you need a blood transfusion.

What happens in the body?

The stomach produces approximately two liters of strongly acidic gastric juice every day. Stomach juice consists of mucus, hydrochloric acid and the enzyme pepsin. Pepsin and hydrochloric acid are needed to break down protein found in food. In addition, many bacteria die in the strong acid.

The hydrochloric acid is formed in the lining of the stomach, in special cells containing so-called proton pumps. The hydrochloric acid is corrosive, but the mucous membrane is not damaged as the stomach also forms various protective substances.

Thus, there is a balance between harmful and protective substances in the stomach and duodenum. If this balance is disrupted, an injury in the form of a wound can occur in the mucosa. It is most common to get ulcers in the duodenum.

It usually takes a couple of weeks for a stomach ulcer to develop.

Another name for gastric ulcer is the Latin name ulcer.

What causes stomach ulcers?

Helicobacter pylori

The bacterium Helicobacter pylori is the most common cause of peptic ulcer. Ulcers in the duodenum are almost always due to the bacteria. Most people have the bacterium without getting stomach ulcers or other problems. It is unclear why the bacteria causes stomach ulcers only in some.

Many are already infected when they are children. Probably the bacteria spreads within one’s own family. The bacterium can be absorbed with food or with water, and it is probably spread through feces. Washing your hands after your own toilet visit probably reduces the risk of infection.

Drug

You may get stomach ulcers from some anti-inflammatory and analgesic drugs, as well as medicines containing acetylsalicylic acid.

The drugs reduce the formation of a substance that protects the stomach. If you take such medicines often, the protection of the stomach can be reduced to such an extent that you get stomach ulcers. You can avoid this by simultaneously using drugs that reduce the amount of hydrochloric acid in the stomach, such as a proton pump inhibitor.  

Read more here about non-prescription medicines you can use for temporary pain . 

Unknown reason

Gastric ulcer can also occur without an obvious cause. Stress is no longer considered to cause stomach ulcers unless you are otherwise healthy.

Complications and sequelae

t is uncommon to have stomach ulcer complications, but those that can occur are as follows:

  • Bleeding ulcer.
  • Broken stomach ulcer.
  • Scarring that causes narrowing of the lower abdomen.

Bleeding ulcer

A bleeding ulcer is when a blood vessel in the mucosa breaks due to the stomach ulcer. It then begins to bleed inside the stomach or duodenum. The bleeding can cause the pouch to turn black, and if you vomit, the stomach contents will look like coffee grounds.

The fact that the poop turns black is because the blood from the stomach ulcer becomes dark when it comes into contact with the hydrochloric acid in the stomach juice. You may also get black poop if you take iron tablets at low blood levels, but then there are no signs that something is wrong.

An untreated bleeding can lead to anemia .

Broken stomach ulcer

Broken gastric ulcer is called if the ulcer passes through the wall of the stomach or duodenum so that the contents of the stomach protrude into the abdominal cavity. It is uncommon for a stomach ulcer to develop into a broken stomach, but if that happens, you usually get a lot of stomach ache.

A broken stomach ulcer needs to be treated in hospital directly.

Scarring

If you get wounds around your lower stomach several times, scars will form when the wounds heal. The scar can cause the stomach mouth to become narrower, and it becomes more difficult for the gastric contents to pass to the intestine. Symptoms that your stomach has become too tight are, among other things, that you vomit easily.

With an operation, the mouth can be enlarged again. It is uncommon to have narrowing of the lower stomach.

Discomfort after previous surgery

Before the bacterium was discovered, many were operated on with ulcers. During the operation, part of the stomach was removed. There was also a method where a surgeon cut off the nerve fibers that controlled the formation of stomach acid. 

Stomach ulcer and pregnancy

Tell your doctor if you are or planning to become pregnant and have a stomach ulcer.

You can use proton pump inhibitors with the active substance omeprazole or lanzoprazole if you are pregnant or breast-feeding. But you should avoid the antibiotics that remove Helicobacter pylori. You will be treated with antibiotics when you stop breastfeeding, if your stomach ulcer is due to the bacteria.

Influence and participate in your care

As a patient, you have under the Patient Act chance to affect your health.

You can seek care at any  medical center or open specialist clinic you want throughout the country. Sometimes referral  to the open specialized care is required  .

You should understand the information

In order for you to be involved in your care and treatment, it is important that  you understand the information you receive  from the healthcare staff. Ask questions if you don’t understand.

You have the opportunity to get help from an  interpreter. You also have the opportunity to get help from an  interpreter if you have a hearing loss.

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