What is it?
Stomach (“peptic”) ulcers are localised areas of damage to the lining of the stomach that resemble small craters. While ulcers are most commonly found in the stomach they also frequently occur in the duodenum (start of the small bowel) .
What causes it?
(i) A long-term infection with the ‘Helicobacter pylori’ bacteria can cause widespread damage, or inflammation, to the lining of the stomach. This damage can progress over time to form an ulcer. This was an Australian discovery in which Dr. Barry Marshall and Dr. Robin Warren from Perth first showed that H. pylori causes ulcers. They won the Nobel Prize for Medicine in 2005 in recognition of this discovery.
(ii) The second most common cause of stomach ulcers is overuse of anti-inflammatory medications. These medications (eg. aspirin, ibuprofen, naproxen, diclofenac) have the unwanted side effect of impairing the way the stomach protects itself against gastric acid
Additional risk factors for ulcers include: older age, using steroid medication, , blood-thinning medications, smoking, autoimmune diseases, viral infections and having another chronic health condition.
What are the symptoms?
While stomach ulcers can cause symptoms they are also frequently ‘asymptomatic’ meaning that a person may not be aware they have an ulcer. When symptoms are present they usually include upper abdominal pain / discomfort, nausea or vomiting, loss of appetite and loss of weight.
The most serious complications of ulcers are:
(ii) Perforation (a hole in the stomach)
How do you diagnose?
Stomach ulcers are best diagnosed during a gastroscopy. During the procedure tiny accessories can be passed down the camera’s operating channel to take biopsies of the stomach and/or treat the ulcer if required.
What are the treatments?
Stomach ulcers that have not caused bleeding or a perforation can be successfully treated by:
(i) removing the underlying cause i.e. stopping anti-inflammatory medications or treating helicobacter pylori infection
(ii) taking an ‘acid suppressing’ medication for 4-8 weeks which allows the lining of the stomach to heal without further damage. Dietary changes can also enhance the healing process and help minimize the need for medication in the long-term.
It is important that a follow up gastroscopy be performed to check that a stomach ulcer has healed completely and that there is not an alternative factor contributing to the ulcer.
Bleeding ulcers can be treated with a variety of techniques including: lasers (Argon), clips, endoscopic sutures, pro-coagulant powders, local adrenaline injections, and/or gold probe thermal therapy.
For patients who require long term aspirin or another anti-inflammatory medication an ‘acid suppressing’ medication is sometimes co-prescribed to prevent further ulcers.