Peptic ulcer (gastric ulcer)

21 October 2017

© Jupiter Images / iStockphoto

At a stomach ulcer (gastric ulcer) the stomach lining is damaged in one place. An ulcer is the most common gastrointestinal disease and occurs mostly when the gastric mucosa is not sufficiently protected against the aggressive gastric acid. Frequently, an infection with the bacterium Helicobacter pylori is the cause.

One in ten German suffering during his life at least once a stomach ulcer. This makes it one of the most common diseases of the stomach. Ill each year about 50 of every 100,000 people in it. Most sufferers are over 50 years old and have recurring stomach ulcers.

At a stomach ulcer (gastric ulcer) the stomach lining is damaged in one place. In the short form, physicians call it shortens just ulcer (From Latin. Ulcus = ulcer).

At a stomach ulcer deeper layers of the stomach wall are damaged. Stomach ulcers occur mainly in certain areas of the stomach, in the so-called lesser curvature and in antrum. This is the small inner curvature of the stomach or the area in front of the gastric outlet.

An even more common gastrointestinal disorder is the duodenal ulcer (duodenal ulcer), suffering from the year 150 of every 100,000 people.

The anatomy of the stomach © LifeArt image / 2001 / Lippncott Williams & Wilkins all rights rese

Construction of the stomach

A stomach ulcer (gastric ulcer) can be located very different symptoms to make noticable:

Frequently suppressed and hurts a stomach ulcer in the upper abdomen (called epigastric pain;. epigastric = the upper abdomen) Regulations. The pain due to an ulcer can ulcer radiate towards the sternum, lower abdomen or in the back.

Many of those affected the characteristic pain occurs then when they take food - or shortly thereafter. In others, the opposite is the case. Less often, patients complain of pain on an empty stomach (fasting pain), which typically occur at night. These are typical of patients with duodenal ulcer.

Upper body with highlighted stomach or gastric ulcer © iStock

The most common symptom of a peptic ulcer is pain in the upper abdomen.

People with a stomach ulcer also report occasional symptoms such as vomiting (for example, stomach ulcers near the pylorus) and the fact that they not tolerate certain foods. What foods these are, however, ulcer individually different for those affected with gastric.

Vomiting, intolerance of certain foods or even pain in food intake can cause many sufferers lose weight. If there is a result of stomach ulcers stomach bleeding, this either as vomiting blood (haematemesis) or as a black colored stools (tarry, melena) manifest itself through the admixed, digested blood.

Caused a stomach ulcer no symptoms, the doctor recognizes it usually only as an incidental finding in the context of other studies. People taking certain painkillers (NSAIDs such as aspirin), the stomach ulcer causes no symptoms in most cases.

A stomach ulcer (gastric ulcer) can different causes have: the body's own as well as external factors. common to all development mechanisms is an imbalance between aggressive and protective mechanisms of gastric mucosa.

The stomach lining that coats the entire interior stomach produces gastric juice. The cells of the gastric glands make the necessary for the digestive process secretions and enzymes (proteins, the biochemical processes support) and the stomach acid. Another product of the gastric mucosa is formed by the so-called accessory cells alkaline mucus, of the stomach from the corrosive stomach acid protects: it binds the hydrochloric acid of the gastric juice and prevents the stomach so in a self-digestion. Either endogenous as well as outer Factors can disturb this balance and lead to a stomach ulcer.

Facts about stomach ulcers

From a stomach ulcer occurs when the stomach lining is damaged at a particular location.

to develop a stomach ulcer The risk is increased in individuals with blood group 0th The reasons for this are unknown. Likewise, persons whose parents are ill already at a gastric ulcer or were at an increased risk of peptic ulcer. Women and men are affected about equally often the stomach ulcer.

Gastric mucosa with peptic ulcer © Jupiter Images / iStockphoto

Gastric mucosa with damage from gastric ulcer

People who ulcer an ulcer in the area of ​​gastric outlet (pylorus, so-called. Porter) who or which occurred simultaneously to a gastric and duodenal ulcer, often produce too much stomach acid.

Disturbed movements in the stomach (so-called. Peristaltikstörungen) are currently being discussed as essential gastric ulcer causes. A special role is played by the coordination of movement between the area in front of the gastric outlet (the so-called. Antrum) and the duodenum, which is directly adjacent to the stomach.

For those concerned with such a disturbed movement to solid food emptying only delayed from the stomach. At the same time already mixed with bile flow food increased from the duodenum back into the stomach. Thus, the gastric mucosa is exposed to bile acids. A stomach ulcer can occur.

Some people with peptic ulcer produce less epidermal growth factor. This is to a certain protein that promotes the repair of damage to the gastric mucosa and inhibits the production of stomach acid. Lack of growth factor that caused frequent stomach ulcers.

Among the rare endogenous factors that can cause an ulcer, including Zollinger-Ellison syndrome and hyperparathyroidism.

At the Zollinger-Ellison syndrome produces a tumor in the pancreas or duodenum, the hormone gastrin in excess. Gastrin in turn promotes an excessive acid production in the stomach and a duodenal ulcer may occur.

At a Hyperparathyroidism (Hyperparathyroidism), there is an oversupply of calcium. Calcium also stimulated cells, inter alia, that produce gastrin. This ultimately increases a parathyroid gland and the acid production in the stomach, which can lead to a gastric ulcer occurs.

A direct link between the consumption of nicotine and alcohol, and the formation of peptic ulcer (gastric ulcer) has not yet been clearly demonstrated. However it is known that smoking promotes the nocturnal production of stomach acid. Higher proof alcohol leads to superficial mucosal inflammation in the stomach. Both nicotine and alcohol are thus disturbing the balance between aggressive factors (stomach acid) and protective factors (healthy gastric mucosa) capable.

Infection with the bacterium Helicobacter pylori, a chronic gastritis (Gastritis) cause. Among the sequelae or complications include the development of gastric ulcers. In about 75 of 100 people with a gastric ulcer is found Helicobacter pylori in the stomach. On the other hand, these bacteria are often present even in people who have no stomach ulcers and show no corresponding symptoms.

For a gastric ulcer (gastric ulcer) and drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) may be the cause. They are used in inflammatory rheumatic diseases, but also for pain, fever, or generally in inflammation. NSAID painkillers such as acetylsalicylic acid damage the stomach lining and can thus lead to inflammation and ulcers.

Cortisone can also cause stomach ulcers in rare cases. At a Cortisone therapy However, the development of gastric ulcers depends on the duration or the amount ingested steroids.

Non-steroidal anti-inflammatory drugs alone increase to develop a stomach ulcer, by a factor of 4. If NSAIDs, however, combined with corticosteroids the risk, the risk increases to 15 times.

People who suffer from depression seem more likely to develop stomach ulcers. The same applies to people who are at increased professional or personal stress. Also acute stress and shock situations, such as serious accidents and major surgeries, probably among the causes of stomach ulcers. Therefore, these patients receive preventive medication usually.

For the diagnosis of the doctor first asked the patients in the study usually after his complaints which already receives indications of the disease. For further diagnosis of gastric ulcer the doctor scans the upper abdomen, which is usually painful for patients with a peptic ulcer. Added may still a blood test and, where appropriate, an ultrasound (sonography) in order to confirm the finding. Ultimately, however, only one gastroscopy secure the gastric ulcer diagnosis.

The crucial investigation at a stomach ulcer is the stomach (gastroscopy). With it, the doctor can make a direct view of the mucosa toss of the stomach and examine them in such detail. During the investigation, it also can be found for the tissue examination of several tissue samples (biopsies). A gastroscopy allows to distinguish between a gastritis, a stomach ulcer and gastric cancer. In addition, the physician determines on the basis of the tissue samples, whether the stomach with the bacterium Helicobacter pylori is populated.

be sober for a gastroscopy on the suspicion of a gastric ulcer, the patient must have therefore taken over a period of time no food and no drinks. To the gag reflex when introducing the endoscope to suppress by mouth, the doctor spraying the throat with a local anesthetic (e.g., lidocaine with a spray).

Graphic of a gastroscopy with endoscope © Jupiterimages / Hemera

Rigid: At a gastroscopy, the doctor pushes a flexible endoscope through the esophagus into the stomach.

An endoscope is a flexible, tube-like instrument with an integrated camera. If desired, the patient is given a sedative that puts him in a sleep-like state before the examination. If an ulcer is detected, the gastroscopy should be renewed within twelve weeks to check the success of therapy.

If a gastric ulcer is not fully healed under the chosen treatment, the doctor must take more tissue samples in order to clarify certain whether not yet stomach cancer is present.

For persons who refuse a gastroscopy or where an increased risk associated with the investigation, a X-ray of the stomach done with contrast. However, this study is not as meaningful as the gastroscopy because the doctor can examine the stomach lining is not directly and remove any tissue samples.

The treatment of stomach ulcers is primarily on the particular cause.

To treat an ulcer, it is advisable, at least temporarily, to avoid anything that damaged mucosa of the stomach and irritates and thus promotes the development of gastric ulcer. These include:

Medicines you should settle but only in consultation with your doctor!

Because of the acidic gastric juice plays an important role in the development of gastric ulcers, are employed especially those drugs for the treatment, which inhibit gastric acid production - so-called antacids. The reduced production of gastric acid to a reduction in pain, on the other hand, the gastric mucosa to recover.

Proton pump inhibitor (such as the active compounds omeprazole, pantoprazole, esomeprazole) inhibit acid production in the stomach.

In addition, so-called histamine-blocking agents may (also known as H2 blockers or H2 blockers) help. These include the active ingredients cimetidine or ranitidine. They block the histamine H2-receptor to the acid-producing stomach cells so they make no further hydrogen ions and not too much stomach acid can be formed.

(So-called. Antacids) and acid-binding agents can be used in a gastric ulcer during the therapy. Antacids neutralize stomach acid secreted.

When the stomach is severely cramped help drugs that stimulate the stomach movements (so-called. Prokinetic agents, such as metoclopramide (MCP) and domperidone).

If the bacterium Helicobacter pylori is the cause of an infection of the gastric mucosa, the treatment comprises a multi-day treatment with antibiotics, which kill the bacteria Helicobacter pylori. Doctors call this form of gastric ulcer therapy and eradication therapy. The patient must simultaneously (metronidazole alternative) and a proton pump inhibitor to take in exactly metered dose antibiotics amoxicillin and clarithromycin over a period of seven days. They kill the bacteria off, and the stomach ulcer can thus heal.

Close up of a stomach ulcer with Helicobacter pylori © iStock

In this ulcer trigger the bacteria Helicobacter pylori was (circle).

Under certain circumstances, for a gastric ulcer, a surgery useful or even essential - for example, when a stomach ulcer despite medication after several months does not heal. Even with complications such as bleeding, stomach narrowing, perforation or the suspicion of gastric cancer surgery is the appropriate form of therapy.

Depending on the need different methods are:

Bleeds gastric ulcer, the doctor can during a gastroscopy try to inject under the bleeding site with a drug. The injected drug constricts blood vessels and thus stops the bleeding from gastric ulcer. The doctor may also the source of bleeding with a so-called fibrin glue and the bleeding using a laser breastfeeding.

Massive bleeding that can not be controlled by means of a gastroscopy, can stop only after an open surgery often. Gastrointestinal perforations (. So-called perforations) also often make surgery necessary - sometimes it is possible to treat the perforation using a laparoscopy (laparoscopy) mesh and do not large abdominal incision (minimally invasive procedure).

Other risk factors for complications of a gastric ulcer are:

Another complication that can occur as a result of stomach ulcers, is the gastric constriction (Stenosis) by scarring. The stomach wall is concentrated or it shrinks, whereby a so-called hourglass arises.

In chronic gastric ulcer is also the risk of developing gastric cancer, increased by about three percent.

At a stomach ulcer the forecast is quite good without treatment, as it often heals by itself.

An effective drug therapy of gastric ulcer healing rate over 90 percent. Despite successful treatment often leads to a renewed stomach ulcer. Risk factors for this are:

Those who want to prevent a stomach ulcer (gastric ulcer), all food and drinks should omitting, that irritate the stomach and are not well tolerated. This applies, for example, very sharp and hot food as well as for hard alcohol and large amounts of coffee. Since the compatibility of most drinks and food is subject to strong fluctuations individually, it is important that sufferers try out with a gastric ulcer themselves what and what quantities get them.

Anyone suffering from a stress-related stomach ulcer, should try to reduce stress. Here, for example, relaxation exercises may be useful. Because smoking also damage the stomach lining, it makes sense to do without it to prevent gastric ulcer. Who regularly stomach damaging drugs occupies (non-steroidal anti-inflammatory drugs such as aspirin), it should settle where appropriate after consultation with the doctor and discuss what alternatives there are. In one caused by the germ Helicobacter pylori peptic ulcer of the excitation needs to be combated with medication. Otherwise the ulcer may occur again.

If these suggestions fail, a preventive taking special medication (antacids, proton pump inhibitors) is also conceivable. antacids can be preventive sense for people who need to be treated for rheumatic joint diseases with non-steroidal anti-inflammatory drugs (NSAIDs).

If an ulcer recurs, despite all precautionary measures have been taken to a surgery (stomach partial removal) may be advisable. This is true even if the person concerned because of side effects should stop taking drugs. However, may occur after such an operation, in some cases re stomach ulcers.


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