What is a stomach ulcer?

A stomach ulcer arises when there is a break or loss of continuity of its lining known as epithelium. This definition also applies to ulcers that appear on the skin surface that are common and easily visible unlike stomach ulcers.

What causes ulcer?

There are numerous causes of stomach ulcers which can broadly be divided into benign (not cancerous) and malignant (cancerous ulcers). The most common benign cause of stomach ulcers is a combination of bacterial infection (H.pylori) and the acid conditions in the stomach. The stomach normally produces about 2.5 litres of fluid a day which contains a mixture of acid (hydrochloric acid) and enzymes or protein molecules that help to breakdown food particles.

It is therefore believed that excessive acid within the stomach can cause damage or ulceration in the absence of food in the stomach. This occurs in people with a poor diet or irregular eating habits such that the acid in the stomach can begin to cause early damage known as gastritis and progress to ulceration if untreated. Other health conditions such as inflammatory bowel disease such as crohns or anti-inflammatory drugs like ibuprofen or aspirin can also cause benign stomach ulcers.

Malignant or cancerous ulcers can also occur in the stomach. Its exact cause is unknown although there is good evidence that risk factors include smoking, obesity, chronic H.pylori infection, radiation, excessive salt intake or salty foods. It nonetheless remains a very serious condition that can result in death if not diagnosed early and effectively treated.

What are the symptoms of ulcer?

Common symptoms of stomach or gastric ulcer include, heartburn, weight loss, dull ache in the stomach, not wanting to eat because of stomach pain, nausea (feeling sickness) vomiting, bloating, heartburn ( burning sensation in the chest), feeling easily full, burping or acid reflux. Where these ulcers are untreated, they can progress and may result in life-threatening complications such as bleeding, obstruction/blockage of intestine or perforation of the stomach lining. This becomes an emergency and prompt medical/surgical intervention is required to save life.

Cancerous ulcers may present without symptoms or mimic the symptoms of benign ulcers. They can also result in catastrophic bleeding, perforation or blockage of bowel. Of concern is the fact that gastric ulcers, whether benign or malignant, may present without symptoms and are diagnosed as part of a routine screening programme. It is generally advised that anyone of any age with the aforementioned symptoms that fail to resolve within a four-week period, with or without treatment, should seek expert medical advice and consider an endoscopy or gastroscopy (examination of the stomach using a fibre-optic camera) allowing direct visualisation of the entire stomach and taking tissue samples or biopsies to make a definitive diagnosis. This procedure, when undertaken by expert gastrointestinal endoscopists, should be painless and takes less than 10 minutes to complete.

Endoscopy or gastroscopy can also be performed whilst patient receives a small amount of intravenous sedation for the extremely anxious patient. In some countries like Japan, where stomach cancer is very common and result in more than 50,000 deaths per annum, people above the age of 40 years are invited to undergo an endoscopy/gastroscopy in the hope of identifying early disease that is easily treatable and curable.

What food can a person eat when they have ulcer?

Most people with a stomach ulcer are able to tolerate a variety of foods with the exception of very spicy ones, drinks and fruits that have a high acid content, milk and milk products, chocolate, alcohol and caffeine which all tend to increase acid production and reflux (movement of acid from the stomach to the upper gullet). Cranberries produce special nutrients called flavonoids, which reduce the growth of H.pylori, the bacteria that can cause ulcers in the stomach. Other foods that are rich in flavonoids, like onions, garlic, celery and green tea, are also protective. Bananas produce a special coating of mucus in the stomach which can prevent ulceration and allow healing of established ulcers to take place.

Can fasting worsen stomach ulcer?

Absolutely, 100 per cent! If someone is fasting, that means the person is not eating and the acid produced by the stomach has nothing to digest other than to cause injury to the lining of the stomach. You are therefore likely to eventually develop an ulcer in the absence of food in the stomach. Ulcer development can go through early stages (mild, moderate and severe) known as gastritis. This is a form of inflammation of the lining of the stomach. If it is not treated, gastritis can progress to form a full-blown ulcer resulting in a break in the lining of the stomach.

Can stomach ulcer indicate that there is something worse going on in the body?

Yes of course! There are numerous ailments affecting the gastrointestinal tract that present as ulceration in the stomach such as crohns disease which is a form of inflammatory bowel disease. However, a non-healing stomach ulcer most certainly may indicate the presence or development of stomach cancer. Typically, stomach cancer frequently presents as an ulcer although occasionally, no ulcer is seen and there is marked scarring or shrinking of the stomach because the cancer is hidden beneath the stomach lining. It is therefore crucial that if you have symptoms of an ulcer as outlined above, you are suffering from weight loss and unable to keep any food or drink down, then you must see a doctor who should recommend an investigation known as gastrocopy.

This procedure enables direct examination of the stomach lining and is the most accurate way to make a diagnosis. The doctor or endoscopist is also able to take direct tissue samples (biopsies) from the ulcer for further examination in the laboratory to confirm the presence or indeed absence of a cancerous growth.

Can infants have stomach ulcer?

Yes, ulcers can occur in infants although it is rare. The symptoms to look out for as a parent are vomiting, feeling sick, presence of burning pain around the breastbone, loss of appetite and frequent burping or hiccups. They are treated in the same way as adults.

Can stomach ulcer be cured?

Of course, it can be cured. First of all, you need to understand the cause of the ulcer (is it benign or malignant) by undergoing gastroscopy. In Nigeria, the commonest cause of stomach ulcers is H.pylori infection which is benign and easily treatable by prescribing drugs that antagonise acid production and antibiotics to treat the bacterial infection. The best treatment is a combination of several antibiotic agents and drugs known as proton pump inhibitors that prevent acid production in the stomach. Your doctor will be able to prescribe the required therapy which involves a one-week course of antibiotics and a 6-12 weeks course of proton pump inhibitors.

On the other hand, treatment of malignant or cancerous ulcers will depend on the stage of the disease. If diagnosed early, then they are usually treatable by surgery alone, hence the need for early diagnosis. You are advised to have a gastroscopy if symptoms of an ulcer fail to resolve within three to four weeks.

It is therefore imperative that stomach cancer is diagnosed and treated before it has the chance to spread to the lymph glands (that are like police officers of the body, engulfing bad or cancerous cells) or other organs like the liver and lungs. At this point, surgery alone cannot cure the patient and further treatment with chemotherapy with or without radiotherapy may be necessary to control the disease. The important message to note here about stomach ulcers is that you must not ignore ulcer symptoms that fail to settle within a month despite taking simple antacid medications, avoiding spicy meals or things that are likely to make your symptoms worse. In such cases, you require a gastroscopy by a qualified gastroenterologist or gastrointestinal surgeon trained to recognise the normal from abnormal and institute appropriate intervention. It is right to ensure that the doctor performing this procedure has adequate training and experience. Enquire where they received their training and how many procedures they have performed.

It is not customary in Nigeria to question or interrogate your doctor, but I believe that patients should be adequately armed with information in order to give suitable consent. I would say that the doctor, who is able to calmly address your questions satisfactorily, without resorting to irritation or anger, is a good doctor.

How can it be prevented?

For the ulcers that are due to things like infection, – H.pylori – there isn’t much you can do to prevent it in that it is not known to be infectious. However, once diagnosed, it is easily eradicated with the drugs alluded to above. Beware that it is not uncommon for the infection or symptoms to return following eradication therapy. Measures one can take to minimise development of benign stomach ulcers include eating a health balanced diet at regular intervals of six to eight hours/day, reducing the length of time stomach acid makes contact with its lining. Consume foods rich in fibre and proteins. Avoid foods that irritate the stomach, stop smoking and ensure that intake of anti-inflammatory drugs like ibuprofen/neurofen and aspirin are taken with meals and not on empty stomach.

Unfortunately, there is no known single cause of stomach cancer and prevention relies on being vigilant in the detection of ulcer symptoms that fail to resolve within four weeks despite completion of H.pylori eradication therapy and anti-acid agents. In this scenario, one would require expert gastroscopy to examine the stomach lining. Alternatively, screening with gastroscopy is indicated in people with a family history of stomach/gullet cancer, aged above 45 years with new onset ulcer symptoms or have chronic recurrent symptoms. Screening allows the detection of early stage disease that is potentially curable with surgery alone without the need for chemotherapy or radiotherapy. Remember to seek medical advice if you are concerned.

Can stomach ulcer put a pregnant woman at serious risk?

Yes and it will depend on the type of ulcer. There are two main types – benign ulcer, as we have discussed and is easily treatable, although most doctors would tend to avoid a gastroscopy within the first trimester of pregnancy to minimise the risk of miscarriage or harm to the baby. A complicated benign ulcer – one that results in bleeding or perforation of the stomach lining – may require emergency intervention either with the gastroscopy to stop the bleeding endoscopically or an operation.

The second variety is a malignant or cancerous ulcer of the stomach that can occur anytime during pregnancy, although uncommon. This is a serious and challenging condition when encountered as treatment will depend on the stage of the disease and careful consideration needs to be given to the treatment options in the interest of the mother and unborn child.

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