Stomach ulcers are a common digestive disease. If treatment is delayed, they can increase the risk of gastric cancer. Therefore, it is important to understand the full picture of stomach ulcers—recognizing their causes, symptoms, and prevention strategies—to fully protect digestive health.
Frequent Bloating Could Be a Stomach Ulcer? Severe Cases May Lead to Gastric Cancer?
Stomach ulcers primarily involve damage to the gastric mucosa (stomach lining), forming an ulcer. Common symptoms include upper abdominal pain, nausea, and vomiting. If treatment is delayed, severe complications can include gastric bleeding, perforation, and an increased risk of stomach cancer.
What Causes Stomach Ulcers?
There are two main causes of stomach ulcers: Helicobacter pylori infection and excessive or improper use of medications (primarily nonsteroidal anti-inflammatory drugs, NSAIDs).
- H. pylori Infection: About 70-75% of stomach ulcers are associated with H. pylori. This bacterium damages the protective layer of the gastric mucosa, stimulating gastric acid to erode the stomach wall, and can even lead to gastric cancer or lymphoma. H. pylori is a very common bacterium, infecting an estimated 30-50% of the global population.
- Excessive or Improper Use of Medications: Long-term use of NSAIDs such as ibuprofen and aspirin inhibits the gastric mucosa's repair function, weakens its self-protection ability, and increases ulcer risk.
Additionally, irregular eating habits can disrupt the rhythm of gastric acid secretion, causing excessive acid production on an empty stomach that directly erodes the gastric mucosa, leading to ulcer formation over time.
Lifestyle factors such as excessive stress, smoking, and heavy alcohol consumption can also weaken the stomach's defense mechanisms. Stress stimulates gastric acid secretion, while smoking and alcohol directly damage the gastric mucosa.
What Are the Symptoms of a Stomach Ulcer?
- Upper Abdominal Pain: The pain is typically located at the base of the sternum (breastbone). It can be persistent or intermittent with a burning sensation. Some patients experience increased pain on an empty stomach, which may temporarily improve after eating. However, others find that eating worsens the pain, as food entering the stomach stimulates acid secretion, further eroding the ulcer site.
- Accompanied by Bloating and Indigestion: Gastric emptying slows down, preventing food from moving into the intestines and causing a feeling of fullness and discomfort, possibly even nausea or vomiting. Persistent stomach discomfort can also lead to loss of appetite and weight loss.
- Heartburn (Acid Reflux): Excessive stomach acid production overwhelms the stomach's ability to neutralize it, leading to acid reflux into the esophagus. However, note that patients with GERD also experience heartburn; if in doubt, consult a doctor promptly.
If a stomach ulcer is left untreated, the most severe complications include gastric bleeding (massive bleeding can lead to shock and be life-threatening). The ulcer can also perforate the stomach wall, causing acute peritonitis. Furthermore, long-term, recurrent stomach ulcers have a certain probability of becoming cancerous, developing into gastric cancer, posing a major health threat.
What is the Difference Between a Stomach Ulcer and GERD (Acid Reflux)?
Some people confuse stomach ulcers with GERD, but they are fundamentally different conditions. A stomach ulcer is a localized defect in the gastric mucosa, forming an open sore, with pain typically located in the central upper abdomen. GERD is the backward flow of stomach contents into the esophagus, causing mucosal irritation and inflammation, with typical symptoms of heartburn and acid regurgitation.
Simply put, stomach ulcers involve structural damage to the stomach wall tissue, while GERD is a functional issue caused by the backflow of gastric contents. If upper abdominal pain is closely related to eating, it tends to indicate a stomach ulcer. If a burning sensation is centered behind the sternum and accompanied by acid regurgitation, it tends to indicate GERD. However, symptoms can overlap. If in doubt, seek early medical confirmation.
How is a Stomach Ulcer Diagnosed and Treated?
Generally, treatment for stomach ulcers primarily relies on medication, and most patients heal within a few months. Common medications include:
- Proton Pump Inhibitors (PPIs): Effectively inhibit gastric acid secretion, promoting ulcer healing.
- Antacids: Neutralize existing stomach acid, providing rapid pain relief.
- H. pylori Eradication Therapy: If H. pylori infection is detected, triple therapy (two antibiotics plus a PPI) or quadruple therapy is typically used to eradicate the bacteria.
- Mucosal Protective Agents: Protect the gastric lining and promote repair.
In certain special circumstances, such as massive bleeding unresponsive to medication, acute perforation, cicatricial gastric outlet obstruction (pyloric stenosis), or suspicion/confirmation of gastric cancer, surgical treatment or vagotomy may be necessary.
What Should Stomach Ulcer Patients Pay Attention to in Daily Life?
Patients need to make multiple lifestyle adjustments to promote ulcer healing and prevent recurrence:
- Maintain regular eating habits; avoid overeating or prolonged fasting.
- Choose easily digestible, low-irritation foods.
- Quit smoking and alcohol; both tobacco and alcohol components aggravate damage to the gastric mucosa.
- Properly manage stress, get adequate sleep, and engage in moderate exercise to help improve gastric health.
How to Prevent Stomach Ulcers?
- Dietary Adjustments: Maintain regular eating patterns; avoid overeating or prolonged fasting. Reduce intake of irritating foods such as spicy, fried, overly sour, or overly sweet items. Avoid excessive consumption of coffee, strong tea, carbonated drinks, and alcohol.
- Quit Smoking and Alcohol: Smoking weakens the gastric mucosal defense and increases acid secretion. Alcohol directly irritates the gastric mucosa.
- Use Medications Cautiously: Avoid long-term or excessive use of NSAIDs. If necessary, use them under medical guidance, and consider concurrent use of gastric protective agents. For chronic pain, consider pain relievers with less gastric irritation.
- Manage Stress: Stress increases gastric acid secretion. Relieve stress through exercise, meditation, yoga, etc. Get adequate sleep and avoid excessive fatigue.
- Prevent H. pylori Infection: Pay attention to food hygiene. Use serving chopsticks when dining with others to avoid cross-infection. If a family member is diagnosed with H. pylori, arrange testing and treatment early to prevent further spread.
- Regular Gastroscopy (Upper Endoscopy): Regular endoscopic examinations help detect stomach ulcers and any changes early, monitor treatment effectiveness, and prevent severe complications. Especially for those with symptoms or in high-risk groups, active screening is essential to protect gastric health.
Author: Dr. Sze Yuen-zhan, Specialist in Gastroenterology and Hepatology
