What is a stomach ulcer?

A stomach ulcer, also called a gastric ulcer, is a raw area or open sore that develops in the lining of the stomach. The stomach's lining has a protective layer of cells that produce mucus. The mucus prevents the stomach from being injured by stomach acids and digestive juices. When this protective layer is damaged, an ulcer may occur.

How does it occur?

Stomach ulcers may develop from:

• decreased resistance of the lining of the stomach to gastric acids

• increased production of gastric acids

• bacteria called Helicobacter pylori (H. pylori).

Stomach ulcers are more likely to occur in people who:

• take anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen

• drink alcohol

• smoke tobacco

• feel stressed.

What are the symptoms?

Symptoms of stomach ulcer include:

• gnawing, burning, aching, or hunger-like pangs 45 to 60 minutes after a meal or, less often, before a meal

• pain that is relieved by eating food, taking antacids, or vomiting

• nausea and vomiting

• weight loss

• fatigue.

How is it diagnosed?

To diagnose a stomach ulcer, your doctor may order an x-ray of your upper gastrointestinal tract (an upper GI series). Your doctor may also order:

• blood tests to look for H. pylori bacteria

• tests of a sample of your bowel movement to check for blood (which might come from a bleeding ulcer)

• a blood test to check for anemia (which may be an indicator of internal bleeding)

• an endoscopy or gastroscopy, which usually allows the doctor to see the ulcer by inserting a slim, flexible lighted tube or telescope through your mouth to your stomach

• a biopsy, which is an exam under a microscope of a tissue sample taken from the lining of the stomach during the endoscopy.

How is it treated?

Your doctor may hospitalize you for the initial stage of treatment, if your symptoms are severe, or if you are having complications, such as bleeding.

Your doctor may prescribe:

• antacids (the liquid form is more effective than the tablet form)

• medication to decrease acid production

• antibiotics for H. pylori bacteria

• sucralfate, a medication that helps to form a protective barrier over the lining of your stomach.

Because antacids can have side effects after prolonged use, follow your doctor's instructions carefully, and report any problems promptly.

Reduce or stop your use of irritants such as tobacco, alcohol, caffeine and anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen. Smoking slows the healing of ulcers.

Learning to control emotional stress may help reduce the production of gastric acids during stressful circumstances.

How long will the effects last?

Stomach ulcers respond well to treatment but recur in many people. Complications of untreated ulcers, which may require surgery, can include:

• hemorrhage (massive bleeding)

• perforation (a hole through the stomach wall produced by an ulcer)

• obstruction (ulcer scarring that prevents passage of food).

Two to three percent of stomach ulcers become stomach cancer. It is important to report all continuing or recurrent symptoms to your doctor.

How can I take care of myself?

Follow your doctor's prescribed course of treatment. Keep your follow-up appointments. Also, you may want to make lifestyle changes such as:

• Avoid tobacco.

• Avoid alcohol.

• Avoid drugs such as aspirin, ibuprofen, and naproxen that cause stomach inflammation. (Ask your doctor if you can substitute acetaminophen.)

• Avoid strong tea, caffeinated and decaffeinated coffee, and colas.

• Eat balanced, nutritious meals. Several small meals may be better than two or three large ones.

• Learn how to manage stress

• Get plenty of rest.

• Exercise as recommended by your doctor.

• Seek professional help for dealing with events that cause anxiety.

If you continue having symptoms or your symptoms get worse, tell your doctor.

How can I help prevent stomach ulcers?

• Follow your doctor's treatment plan and keep your follow- up appointments.

• Change your lifestyle in ways that might help prevent ulcers.