Stomach ulcers, also known as gastric ulcers, represent a common gastrointestinal condition that affects millions worldwide.
These ulcers are painful open sores that develop on the lining of the stomach due to an imbalance between the stomach's acid secretion and its protective mechanisms.
<h3>What Is a Stomach Ulcer?</h3>
A stomach ulcer is essentially a break in the stomach's mucosal lining that extends deeper than 5 millimeters and penetrates the muscularis mucosa layer. This breach results from damage to the protective barriers, including mucous, growth factors, and adequate blood flow, which normally shield the stomach from its highly acidic environment.
When these defenses weaken or are overwhelmed by harmful agents, erosion begins and progresses to ulceration. This condition causes pain, potential bleeding, and if untreated, can lead to severe complications.
<h3>Primary Causes: The Role of Helicobacter pylori and NSAIDs</h3>
The majority of stomach ulcers about 80 to 90%—are linked to the bacterium Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori is a spiral-shaped bacterium that colonizes the stomach lining, inducing chronic gastritis and disrupting the mucosal defenses.
Its presence triggers inflammatory responses and increases acid production by damaging the stomach's regulatory pathways. Infection is typically acquired in childhood, especially in crowded or low socioeconomic settings, and while not all infected individuals develop ulcers, certain bacterial factors such as the cagA gene enhance ulcer risk.
NSAIDs, commonly used medications for pain and inflammation, interfere with the stomach's ability to produce protective prostaglandins. Prostaglandins are essential for maintaining the integrity of the mucosal lining by promoting mucus and bicarbonate secretion and preserving blood flow.
By inhibiting these molecules, NSAIDs reduce the stomach's defenses, making it more susceptible to injury from gastric acid. People taking long-term or high doses of NSAIDs are at increased risk of developing ulcers, emphasizing the need for careful use and sometimes preventative medications like proton pump inhibitors.
<h3>Symptoms and Complications</h3>
Symptoms of stomach ulcers often include persistent burning or gnawing pain in the upper abdomen, which may worsen or lessen after eating. Other signs can involve belching, nausea, reduced appetite, and weight loss. Some individuals remain asymptomatic, particularly older.
Serious complications may arise if ulcers bleed or perforate, causing internal bleeding, vomiting of blood, or sudden severe abdominal pain that requires emergency care.
<h3>Diagnosis and Detection</h3>
Diagnosis is primarily through endoscopy (EGD), a procedure wherein a flexible tube equipped with a camera is introduced via the mouth to visually inspect the stomach lining and detect ulcers. During this test, biopsies can be taken to confirm the presence of H. pylori and rule out malignancies.
Non-invasive tests like urea breath testing and stool antigen assays also help identify H. pylori infection for targeted antibiotic treatment efforts.
<h3>Treatment Strategies</h3>
Treatment revolves around eradicating H. pylori infection, reducing stomach acid production, and protecting the stomach lining. Eradication usually involves a combination of antibiotics and acid-suppressing drugs like proton pump inhibitors (PPIs). Avoiding NSAIDs or using them cautiously with protective agents is crucial.
According to Nobel Prize–winning microbiologist Dr. Barry Marshall, who discovered the link between Helicobacter pylori and peptic ulcers, Every patient with a duodenal ulcer showed evidence of this bacterium, which we now know as H. pylori. Understanding its role has transformed the treatment of stomach ulcers and allowed physicians to target the underlying cause effectively.
In 1983, Barry Marshall deliberately infected himself with the bacterium and established his own stomach illness.
Stomach ulcers are open sores caused mainly by Helicobacter pylori infection and NSAID use, resulting from damage to the stomach's protective lining. Recognizing symptoms and obtaining timely diagnosis via endoscopy are essential for effective management. Modern treatments that combine antibacterial therapy with acid suppression, alongside lifestyle modifications, have substantially improved patient outcomes.
Knowledge of these facts helps demystify stomach ulcers, encouraging prompt medical attention and adherence to therapies that prevent serious complications.
