Stomach ulcer

Stomach Ulcer (Gastric Ulcer)

Definition
A stomach ulcer is an open sore in the lining of the stomach caused by the breakdown of its protective mucosal barrier, allowing gastric acid and digestive enzymes to damage underlying tissue. It is a type of peptic ulcer disease, which also includes duodenal ulcers.

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Causes

• Helicobacter pylori infection (most common)

• Long-term use of NSAIDs (e.g., ibuprofen, naproxen, aspirin)

• Excess stomach acid production (Zollinger–Ellison syndrome, rare)

• Smoking and excessive alcohol intake

• Severe stress (critical illness, major surgery)

• Corticosteroid use (especially with NSAIDs)

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Risk Factors

• Age over 50

• Previous ulcer history

• Chronic NSAID use

• Family history of peptic ulcer disease

• Smoking

• Alcohol overuse

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Pathophysiology

• The stomach lining normally produces mucus and bicarbonate to protect against acid

• H. pylori damages epithelial cells, reduces mucosal protection, and triggers inflammation

• NSAIDs inhibit cyclooxygenase (COX) enzymes, reducing protective prostaglandins

• Acid and pepsin further erode the lining, forming an ulcer

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Clinical Features

• Burning or gnawing pain in the upper abdomen, often worsens with eating in gastric ulcers

• Nausea or vomiting

• Loss of appetite, weight loss

• Bloating or belching

• In severe cases: hematemesis (vomiting blood), melena (black stools)

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Diagnosis

• Endoscopy: gold standard for diagnosis and to exclude malignancy

• H. pylori testing: urea breath test, stool antigen, biopsy urease test

• Full blood count (anaemia)

• Fecal occult blood test

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Treatment

General Measures

• Stop NSAIDs if possible

• Avoid smoking and alcohol

• Eat smaller, frequent meals; avoid irritant foods

Medications

• H. pylori eradication (triple therapy for 7–14 days):

  • Omeprazole 20 mg twice daily (or equivalent PPI)

  • Clarithromycin 500 mg twice daily

  • Amoxicillin 1 g twice daily (or metronidazole 400 mg twice daily if penicillin-allergic)

• Acid suppression (if not H. pylori or after eradication):

  • Omeprazole 20–40 mg once daily (or other PPI) for 4–8 weeks

• Alternative acid suppression: H2 receptor antagonists (e.g., ranitidine 150 mg twice daily, less commonly used now)

• Mucosal protectants: sucralfate 1 g four times daily, misoprostol (especially in NSAID-related ulcers)

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Complications

• Gastrointestinal bleeding

• Perforation (acute abdomen)

• Gastric outlet obstruction

• Increased risk of gastric cancer (especially with chronic H. pylori infection)

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Quick-Reference Clinical Chart — Stomach Ulcer

Feature	Details
Definition	Open sore in stomach lining due to acid and pepsin damage
Causes	H. pylori infection, NSAIDs, excess acid, smoking, alcohol
Symptoms	Burning epigastric pain, nausea, weight loss, bloating
Risk factors	Age >50, NSAID use, H. pylori, smoking, alcohol
First-line treatment	H. pylori eradication (PPI + clarithromycin + amoxicillin × 7–14 days)
Drug therapy (adult dose)	Omeprazole 20 mg BD + Clarithromycin 500 mg BD + Amoxicillin 1 g BD (or metronidazole 400 mg BD if allergic)
Adjuncts	Stop NSAIDs, avoid alcohol, dietary modifications
Investigations	Endoscopy, H. pylori testing, blood count
Prognosis	Excellent with treatment; recurrence if risk factors persist