Anyone with symptoms of stomach ulcers should seek medical attention before complications develop. While gastric ulcer can be easily treated in the early stage, the treatment is prolonged and complications such as perforation bleeding may develop in the advanced period.

Stomach Ulcer (Peptic Ulcer) 

They are wounds that develop due to the abrasion of the membrane covering the inner surface of the stomach for various reasons. It is a common situation. Serious complications can develop if not treated properly.

Gastric ulcer can develop in any part of the stomach in different sizes and depths. If the ulcer develops in the duodenum (the part of the small intestine where the stomach connects to the small intestine, duodenum), it is called a duodenal ulcer. Often the symptoms are the same as with a stomach ulcer. Their treatments are also similar.

Gastric ulcer is the result of increased gastric acid secretion and decreased mucus secretion. Although the events causing this are different, it is still an important disease and cause of economic loss worldwide. The most important and life-threatening complications are bleeding and gastric perforation.



The incidence of both gastric ulcer and duodenal ulcer increases with age.

What are the causes of stomach ulcer, peptic ulcer?

  • Helicobacter pylori (most common cause, transmitted by contaminated food, some may remain in the body for a long time without symptoms)
  • Some painkillers (non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, predispose to the development of ulcers in the stomach and duodenum)
  • Stress (does not directly cause ulcers, ulcers may develop due to physical or psychological stress),
  • Smoking,
  • Alcohol consumption,
  • Caffeine consumption
  • Chemotherapy,
  • Radiotherapy,
  • Long-term corticosteroid therapy
  • Excessive salt consumption
  • Swallowing food without chewing it thoroughly (more acid will be secreted from the stomach to digest it,
  • Stay hungry for a long time,
  • Intense workload.

The symptoms of stomach ulcer, peptic ulcer ?

  • Burning: The most common symptom. It is seen in the upper part of the abdomen.
  • Abdominal pain: Some stomach ulcers do not have pain.
    • It is seen in the upper part of the abdomen.
    • It occurs when the stomach is empty, at night or 2-3 hours after meals.
    • It is usually a gnawing pain with burning.
    • Does not wake up at night (may awaken duodenal ulcer).
    • Pain is more common in older ages.
    • It can take from a few minutes to several hours.
    • Temporarily relieved by antacids, ulcer recurs if not treated.
  • Indigestion,
  • Feeling of nausea relieved by vomiting,
  • Anorexia,
  • weight loss,
  • Painful burning sensation in the chest,
  • Sometimes a feeling of burping after fatty meals,
  • Bleeding as a complication may be signs of perforation of the stomach.

When should I apply to the health institution? 

Anyone with symptoms of stomach ulcers should seek medical attention before complications develop. While gastric ulcer can be easily treated in the early stage, the treatment is prolonged and complications such as perforation bleeding may develop in the advanced period.

  • Fresh blood coming from the mouth
  • Blackening of stool color,
  • In case of severe, increasing abdominal pain, you should seek immediate medical attention due to the risk of ulcer complications.

Diagnosis of stomach ulcer, peptic ulcer 

A good anamnesis and physical examination can suspect gastric ulcer but do not make a definitive diagnosis.



The necessary tests for the diagnosis of stomach ulcer are:

  • Endoscopy: It is a method of visualizing the esophagus, stomach and duodenum. It is entered through the patient’s mouth through a flexible tube. It is a short-term test, but it is definitively diagnostic.
  • Gastric barium X-ray: The patient is given a barium drink, and the structure of the stomach and duodenum is monitored as the barium passes.
  • Biopsy: Biopsy samples are also taken from patients undergoing endoscopy. Apart from gastric ulcer, it is also useful for the pre-diagnosis of cancer.
  • Blood tests: It is used to diagnose possible bleeding symptoms such as anemia.
  • Stool test: If the bleeding is invisible, it shows hidden bleeding.
  • Helicobacter pylori tests:
  • Histological tests: Biopsy samples are taken during the endoscopy procedure. The presence of bacteria in these samples is investigated.
  • Rapid urease test: The biopsy material taken during endoscopy is thrown into a special liquid containing urea. Here, the bacteria convert the urea to ammonia and the pH increases. The pH indicator turns the liquid red.
  • Urea breath test: The patient is given a special liquid or tablet that contains urea-containing isotopes. When the bacteria comes into contact with this liquid, it converts the urea into carbon dioxide and ammonia. The patient blows into a tube or balloon. If marked isotopes are found on examination of the inspired air in the tube or balloon, it indicates the presence of bacteria.
  • Blood test: Antibodies against the bacteria are examined.
  • Stool test : Bacterial antigens are checked.

Gastric ulcer, peptic ulcer treatment 

The basis of treatment in gastric ulcers is drug therapy and regulation of life-eating habits. In some cases, surgical treatment can be applied.



Most stomach ulcers heal within a few months with medication. Sometimes the duration of treatment may be longer.

Drugs used in stomach ulcer:

  • Antibiotic: The most basic drug in the treatment of gastric ulcer, especially in which Helicobacter pylori bacteria is detected, is the appropriate antibiotic. Generally, a triple combination of dual antibiotics and proton pump inhibitors is preferred. Amoxicillin, metronidazole or clarithromycin can be given as antibiotics. Antibiotics can cause a metallic taste in the mouth, diarrhea or nausea. After 4 weeks of antibiotic treatment, the Helicobacter pylori research is renewed. If the presence of bacteria still persists, different antibiotic options can be tried.
  • Proton Pump Inhibitors: They aim to reduce stomach acid secretion. In this way, the stomach ulcer is prevented from encountering more acidic environment, and healing is accelerated. Omeprazole, pantoprazole, lansoprazole can be used. Treatment usually takes 4-8 weeks. Abdominal pain, headache, nausea, vomiting, diarrhea, constipation may be seen in some patients, but it is usually mild.
  • H2 Receptor Blockers: It is aimed to reduce stomach acid secretion. Ranitidine is commonly used. No serious side effects are observed.
  • Antacids: Neutralizes the hydrochloric acid secreted by the stomach, reduces acidity. Thus, the gastric mucosa is prevented from being exposed to more acid content. It relieves ulcer pain, facilitates healing, prevents recurrence, some protect the ulcerated area from acid destruction by covering the stomach surface with a protective layer. Aluminum hydroxide, magnesium hydroxide, aluminum carbonate, calcium carbonate, sodium bicarbonate, hydrotalcite can be used for this purpose. Antacids can be taken when symptoms begin, after meals or at bedtime.

Regulation of living habits: 

  • Avoiding smoking and alcohol
  • Not consuming coffee and tea
  • Not using aspirin and NSAID painkillers, preferring painkillers such as paracetamol instead,
  • Avoiding foods and drinks that increase stomach pain,
  • Resting and paying attention to sleep patterns,
  • eat little food,
  • To comply with meal times, not to eat at short intervals or long intervals,
  • Preferring pulpy fruits and vegetables,
  • Avoiding excessively spicy, salty, pickled foods,
  • Not consuming acidic drinks,
  • Avoiding very hot or very cold foods and drinks,
  • Eating food slowly and thoroughly.

Herbal support for stomach ulcer: 

  • Licorice root: It has ulcer healing properties, it is also used in the composition of some drugs.
  • Turmeric: There are studies that reduce stomach acid, increase pepsin secretion, reduce free oxygen radicals and support ulcer treatment.
  • Gum drop: It is reported to reduce stomach acid secretion.
  • Cabbage: It is reported to support healing in stomach ulcers.

Surgical Treatment :

  • Medication failed,
  • bleeding,
  • stomach perforation,
  • Complications such as congestion,
  • Surgical treatment for gastric ulcer can be applied in patients with gastric cancer.

In surgical treatment, part of the stomach, only the injured area, duodenum can be removed. In some patients, the vagus nerve, which stimulates gastric acid secretion, can be removed.

Stomach Ulcer Complications 

Stomach ulcers usually do not show complications. However, stomach ulcers can sometimes show life-threatening complications in patients who do not receive proper treatment, do not improve their lifestyle, and do not pay attention to their eating habits.



Possible complications of stomach ulcers include:

Bleeding:

It is the most common complication of stomach ulcers. Most stomach ulcer bleeding is not noticed by the patient. Bleeding slowly and for a long time can be the cause of anemia. This situation can be detected in the blood counts of patients who apply with complaints such as weakness, respiratory problems, and fatigue.

Bleeding in stomach ulcers happens inside the gastrointestinal tract. In more profuse bleeding in the area close to the esophagus, sometimes blood may come from the mouth. Red or dark, black blood coming from the mouth is called hematemesis. The dark, black color is due to the fact that the blood stays in the stomach and is exposed to secretions.

In some stomach ulcer bleeding, especially bleeding in the stomach areas close to the small intestine, the blood passes into the intestine. Stool is black and sticky. This is called melena.

Gastric ulcer bleeding does not only cause anemia. Bleeding that is not diagnosed and treated in the early period may lead to the development of shock in the later period.

In the treatment of gastric ulcer bleeding, endoscopic applications, sometimes treatments with x-rays, and sometimes surgical intervention may be required. Depending on the amount of blood lost, blood transfusions may be performed.

Perforation:

It is very rare. However, in cases where the stomach ulcer progresses to the deep layers and with the use of NSAIDs, the gastric membrane may be perforated. Severe abdominal pain occurs due to emptying of stomach contents into the abdomen. This condition requires urgent surgical intervention. Otherwise, peritonitis and infection of the blood (sepsis) may occur. This situation is life threatening.

Blockage:

Some stomach ulcers spread to a larger area and cause edema of the gastric mucosa. In some stomach ulcers, scar tissue and narrowing occur depending on the disease itself or the surgical procedures applied. Both scar tissue and edema can cause narrowing of the gastric cavity and stop the passage of food through the cavity. It may present with abdominal bloating, fullness, rapid satiety despite eating very little, nausea and vomiting attacks. Endoscopy can be applied. Proton pump inhibitors, H2 receptor antagonists can be used. Surgical intervention may be required for the treatment of scar tissue.

Gastric cancer:

Gastric cancer is not seen as a complication of gastric ulcer. However, stomach ulcers that persist for a long time may impair cell regeneration, and gastric cancer may occur due to abnormal cell development.



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