Skipping meals causes stomach ulcers

Gastric ulcer (gastric ulcer)

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Written by Wiebke Posmyk • Medical editor
Checked by Dr. med. Elisabeth Schönenberg • Gastroenterologist

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The gastric ulcer (Ulcus ventriculi) is one of the most common gastrointestinal diseases. It occurs when the stomach wall is not adequately protected from the aggressive stomach acid. The bacterium Helicobacter pylori often plays a role in this. What are the typical symptoms of a stomach ulcer?

One in ten Germans will suffer from a stomach ulcer at least once in their lifetime. It is estimated that around 50 out of 100,000 people get the disease every year.

In the case of a gastric ulcer (gastric ulcer), the lining of the stomach is so damaged in one place that aggressive stomach acid causes a wound in the stomach wall. Doctors speak of an ulcer (from lat.ulcer = Ulcer). Duodenal ulcer (ulcus duodeni), which affects about 150 out of 100,000 people every year, is even more common than gastric ulcer.

Video: Six tips for a stomach-friendly diet


The stomach lining protects the stomach

The gastric mucosa lines the entire interior of the stomach. Without it, the stomach wall would be defenseless against the aggressive stomach acid.

Glands within the stomach lining produce around two to three liters of gastric juice every day. This is made up of different substances. For one thing, it contains stomach acid. It renders most pathogens harmless and contributes to the digestive process. On the other hand, the gastric juice contains the secretions and enzymes (proteins that support biochemical processes) necessary for the digestive process.

Another product of the gastric mucosa are the mucous substances (mucins) formed by the so-called secondary cells. They protect the stomach wall from stomach acid: They bind the hydrochloric acid in the gastric juice and thus prevent the stomach from digesting itself.

If the balance between stomach acid and the protection against self-digestion is disturbed, a stomach ulcer can develop.

Gastric ulcer: symptoms

A gastric ulcer (ulcus ventriculi) can be associated with different symptoms. Typical complaints are:

A stomach ulcer in the upper abdomen often presses and hurts (so-called epigastric pain; epigastric = affecting the upper abdomen). The pain can radiate towards the sternum, lower abdomen or even into the back.

Many sufferers feel the characteristic pain while eating - or shortly afterwards. The pain can also be felt independently of meals. Pain on an empty stomach (fasting pain), which is typically noticeable at night, is more of a sign of a duodenal ulcer.

However, complaints such as stomach pain, bloating or nausea can have many causes and are not proof that it is an ulcer. Similar symptoms can arise, for example, with an irritable stomach (functional dyspepsia). It is important that the complaints are clarified by a doctor. In the case of an irritable stomach, for example, a gastroscopy does not reveal any abnormal findings, while a gastric ulcer is clearly visible.

People with a stomach ulcer occasionally report that they cannot tolerate certain foods. Which foods are is very different from one individual to another.

A stomach ulcer can cause stomach bleeding. Possible signs of gastric bleeding are vomiting of blood (hematemesis) or black stools (tarry stools, melena).

A stomach ulcer is not always noticeable

Some people have no symptoms for a long time. In particular, people who take certain pain relievers (non-steroidal anti-inflammatory drugs such as acetylsalicylic acid) sometimes have little to no symptoms. This also applies to serious comorbidities, which are then in the foreground. Then the gastric ulcer is usually only recognized as an incidental finding in the context of other examinations or if a sudden gastric bleeding occurs.

When to the doctor

Definitely see a doctor if you do

  • notice dark colored stools or vomit blood and / or
  • feeling tired and exhausted and very pale and / or
  • have inadvertently lost a lot of weight and / or
  • have acute severe symptoms and / or
  • permanently or repeatedly suffer from symptoms such as epigastric cramps, fullness, nausea or vomiting.

Gastric ulcer: causes & risk factors

A gastric ulcer (gastric ulcer) can have various causes. Several factors favor that stomach acid and germs can attack the walls of the stomach.

Common to all development mechanisms is a disturbed balance between the aggressive and protective mechanisms of the gastric mucosa. An excess of stomach acid on the one hand and impaired mucosal production on the other hand play a role here.

The most common gastric ulcer triggers are:

  • an infection with the bacterium Helicobacter pylori
  • the long-term use of certain medications, especially pain relievers from the group of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Smoke
  • Protein deficiency

Peptic ulcer due to infection with Helicobacter pylori

In Germany around 35 out of 100 adults are infected with the bacterium Helicobacter pylori infected. Many people are likely to be infected with it in childhood, and infection or re-infection in adulthood is extremely rare.

However, an infection does not necessarily have to be associated with symptoms: many people carry the bacterium without developing a stomach ulcer. Solves for someHelicobacter pylori However, a chronic inflammation of the gastric mucosa (gastritis), which in turn favors a gastric ulcer and in particular a duodenal ulcer.

About 75 out of 100 people have a gastric ulcerHelicobacter pylori detectable in the stomach.

Gastric ulcer caused by NSAIDs and other drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) pain relievers can cause stomach ulcers. This is especially true if they are taken over a long period of time. Non-steroidal anti-inflammatory drugs inhibit an enzyme that converts fatty acids from cellular metabolism into prostaglandins. Prostaglandins are hormones that inhibit the release of acid and thus protect the stomach lining.

NSAIDs are used for inflammatory rheumatic diseases, but also for pain or fever. Active substances from the group of NSAIDs include, for example, acetylsalicylic acid, ibuprofen or diclofenac.

Long-term use of NSAIDs increases the risk of gastric ulcer by a factor of 4. Do not take NSAID painkillers on your own for a long period of time. Discuss with your doctor whether and for how long these drugs are suitable for you.

Preparations with cortisone (glucocorticoids) also increase the likelihood of gastric ulcer, especially in combination with NSAIDs: If NSAIDs are combined with cortisone preparations, the risk of gastric ulcer increases by a factor of 15.

Other drugs that can favor a stomach ulcer include:

Facts about stomach ulcers

One speaks of a stomach ulcer if the Gastric mucosa damaged in one place.

At first only that upper layer of mucous membrane affected. Over time, however, can also deeper layers of the stomach wall be harmed.

Infection with the bacterium is one of the main causes Helicobacter pylori and long-term use of certain medications, in particular non-steroidal anti-inflammatory drugs (NSAIDs).

In Germany, about 50 out of 100,000 People a stomach ulcer.

The majority of those affected are older than 50 years.

People with the Blood group 0 have an increased risk of developing a stomach ulcer.

AlsoStress,nicotine and alcohol are possible triggers.

Possible symptoms are Pain and Feeling of pressure in the upper abdomen. Other typical complaints are Loss of appetite, nausea and if necessary Vomit.

However, a stomach ulcer does not always cause the typical symptoms. For people who certain pain relievers the cause, stomach ulcers mostly remain complete symptomless.

By Scan of the upper abdomen, the doctor already receives initial information about the disease.

The main method of diagnosing a stomach ulcer is that Gastroscopy. During this examination, the doctor pushes a flexible tube over the mouth and esophagus into the stomach.

If you have a stomach ulcer, you should be everyone substances harmful to the stomach (e.g. coffee, alcohol, nicotine, painkillers). Important: Only stop taking medication after consulting your doctor.

Further therapy depends on the respective causes. Drugs are often used that inhibit gastric acid production - so-called Acid blockers.

Should be the causative agent Helicobacter pylori The doctor will additionally be the cause of a stomach ulcerAntibiotics Prescribe (amoxicillin with clarithromycin or with) that kill the baterium.

Only if a stomach ulcer does not heal after several months despite medication or if complications occur, it may be one surgery necessary.

If you want to prevent a new stomach ulcer, you should omit all food and drinks that cause the Irritate stomach. This includes very spicy food as well as high-percentage alcohol and large quantities of coffee.

Stress ulcer: stomach ulcer caused by physical stress

Physical stress reactions can promote gastric ulcer. Such reactions arise mainly during intensive medical treatment, for example after

Video: how stomach ulcers develop


Other causes and risk factors

Nicotine and alcohol can disturb the balance between aggressive (stomach acid) and protective factors (healthy stomach lining). Persistent psychological stress can also increase the risk of developing a stomach ulcer.

People with blood group 0 are more likely to develop a stomach ulcer than others. The reasons for this are not yet known. Likewise, people whose parents are or have already had gastric ulcer have an increased risk of gastric ulcer.

Rare diseases can also trigger a gastric ulcer:

  • In Zollinger-Ellison syndrome, a tumor in the pancreas or duodenum produces large amounts of the hormone gastrin. Gastrin increases the production of acid in the stomach, which promotes the development of a gastric ulcer.
  • If the parathyroid gland is overactive (hyperparathyroidism), the calcium level in the body is increased. Calcium stimulates, among other things, cells that produce gastrin.
  • Certain infections can also result in a stomach ulcer, for example with cytomegaly or herpes simplex viruses.

Gastric ulcer: treatment

Acid blockers are usually used to treat gastric ulcers (gastric ulcer). Whether further medication is necessary depends primarily on whether the doctor has detected the bacterium Helicobacter pylori has proven. It is also important that the patient spares his stomach.

Inhibiting acid production with drugs

Acid blockers very effectively inhibit the production of stomach acid. This allows the stomach lining to recover. In addition, the pain is relieved.

The doctor usually prescribes so-called proton pump inhibitors with active ingredients such as omeprazole, pantoprazole or lansoprazole. Proton pump inhibitors are considered the drug of choice for all gastric ulcers. The patient takes these drugs for several weeks.

As an alternative to proton pump inhibitors, the doctor can, in exceptional cases, also prescribe histamine receptor blockers (also called H2 blockers or H2 receptor blockers). These include, for example, the active ingredients cimetidine or ranitidine. These drugs block histamine H.2-Receptor on the acid-producing stomach cells. Acid-binding agents (so-called antacids) are recommended less frequently. Antacids with active ingredients such as magaldrate, hydrotalcite, carbaldrate or algeldrat neutralize the gastric acid secreted.

In the case of movement disorders of the stomach, drugs that stimulate stomach movements (so-called prokinetics, e.g. metoclopramide (MCP) and domperidone) help.

For Helicobacter pylori infestation: eradication therapy with medication

When the bacteriumHelicobacter pylori caused the stomach ulcer, antibiotic therapy for several days is necessary. The goal is the bacteriumHelicobacter pylori kill. Doctors speak of eradication therapy (lat. eradicare = tear out, erase).

In eradication therapy, the patient must simultaneously take various antibiotics in combination with a proton pump inhibitor in precisely defined doses.

Triple therapy: combination of three active ingredients

A triple therapy consisting of three active ingredients is recommended as a standard:

Alternative: quadruple therapy with four active ingredients

The antibiotic clarithromycin does not help for some people because the pathogens have become resistant to it. This can be the case, for example, if a patient has previously been treated with this antibiotic. If there is a high risk that clarithromycin will probably not work or if the triple therapy has not worked sufficiently, the doctor will suggest a so-called quadruple therapy. It consists of four active ingredients:

  • a proton pump inhibitor
  • Bismuth,
  • the antibiotic metronidazole and
  • the antibiotic tetracycline.

If the quadruple therapy was unsuccessful, other medications are also available.

People with Helicobacter pylori Are infected but do not have a stomach or duodenal ulcer do not necessarily need to be treated with antibiotics. In the case of purely functional complaints without ulcers and simultaneous detection of Helicobacter, only 10 out of 100 of those affected benefit from antibiotic therapy, which can sometimes have side effects.

Take it easy on your stomach: you can do it yourself

Anyone who has a stomach ulcer should at least temporarily avoid anything that damages and irritates the lining of the stomach. These include, for example:

It can also be helpful to eat many small meals instead of a few large servings.

If you take drugs that attack the stomach (e.g. so-called non-steroidal anti-inflammatory drugs), you should avoid them if possible. However, check with your doctor before stopping it.

When is an operation necessary?

In rare cases, surgery is useful or even unavoidable in the case of a gastric ulcer. Surgery is particularly an option

  • Complications, e.g. bleeding, narrowing of the stomach, gastric perforation
  • Suspected stomach cancer
  • a stomach ulcer that does not resolve despite conservative treatment

Gastric ulcer: diagnosis

Symptoms such as upper abdominal pain, bloating or nausea can indicate a gastric ulcer (gastric ulcer). But they can also have many other causes. For example, to find out if a stomach ulcer is behind the symptoms, the doctor will want to know

  • which complaints the patient has exactly,
  • since when the complaints have existed,
  • whether the patient is taking certain medications or
  • whether the patient has ever had a stomach ulcer.

The doctor then palpates the upper abdomen, which is usually painful for patients with a stomach ulcer. Whether the patient with the bacterium Helicobacter pylori is infected can be found out with a breath test, blood test, or stool test. On the basis of the blood values, the doctor can also determine whether there is possibly a disease that favors a stomach ulcer (e.g. Zollinger-Ellison syndrome).

In order to be able to diagnose a stomach ulcer with certainty, a gastroscopy is necessary in any case. It gives the doctor a direct view of the lining of the stomach.

Gastroscopy

The most important examination for a gastric ulcer is a gastroscopy. The doctor inserts an endoscope through the mouth and into the stomach. An endoscope is a flexible, tube-like instrument with an integrated camera.

During the examination, the doctor can take several tissue samples (biopsies) for the histological examination. A gastroscopy makes it possible to differentiate between gastric ulcer and gastric cancer. In addition, the doctor can use the tissue samples to determine whether the stomach is colonized with the bacterium Helicobacter pylori.

For a gastroscopy, the patient must be sober, so he must not have consumed any food or drinks. He should also not smoke at least 12 hours beforehand.In order to suppress the gag stimulus when inserting the endoscope through the mouth, the doctor sprays the mucous membrane of the throat with a local anesthetic (e.g. with a lidocaine spray). It is also possible to administer a short anesthetic. The examination usually takes about 10 minutes.

If the doctor has discovered a stomach ulcer, the gastroscopy should be repeated after a few weeks to check the success of the therapy. If the ulcer has not healed completely, the doctor will need to take additional tissue samples to determine whether the stomach cancer is not present. Duodenal ulcers usually do not require endoscopic follow-up.

Gastric ulcer: course & complications

A gastric ulcer (gastric ulcer) heals itself in many cases without special treatment. However, there is then a high risk that another ulcer will form again after a short time. Therefore, if you suspect a stomach ulcer, you should always consult a doctor. Appropriate drug therapy reduces the risk of a relapse and the ulcer heals much faster.

A gastric ulcer caused by Helicobacter pylori regresses in 9 out of 10 cases with drug treatment.

Complications

Possible complications of a gastric ulcer (Ulcus ventriculi) include above all

  • Bleeding and
  • a breakthrough of the ulcer through the stomach wall (gastric perforation).

Bleeding

A stomach ulcer can cause bleeding. Possible signs are:

  • Vomiting blood (called hematemesis)
  • black-colored stool (so-called tar stool, also called melena)
  • Anemia with symptoms such as shortness of breath during exertion, tiredness / fatigue or paleness

Anyone who has such symptoms should have them clarified quickly by a doctor.

Gastric Rupture: A Medical Emergency

If the stomach ulcer extends into deep layers of the stomach wall, there is a risk that the stomach wall will break (so-called gastric perforation). The contents of the stomach can get into the abdominal cavity. Then there is a risk of inflammation of the peritoneum (peritonitis).

Signs of a stomach rupture can be very severe, sharp pain in the upper abdomen. A gastric rupture is life threatening and must be treated immediately. You should therefore always call an emergency doctor if you suspect it (112).

Other possible complications of a stomach ulcer include:

  • Gastric penetration: The ulcer can penetrate into the pancreas, which is noticeable in back pain. Sometimes pancreatitis develops due to penetration.
  • Constriction of the stomach: If a stomach ulcer heals in the area of ​​the stomach outlet, a scarred constriction can form (so-called stenosis). The stomach wall is narrowed.
  • Stomach cancer: A long-lasting (chronic) gastric ulcer increases the risk of gastric cancer.

Gastric ulcer: prevention

Anyone who has already had a gastric ulcer (gastric ulcer) can minimize the risk of a relapse:

  • Avoid all food and drinks that irritate the stomach and that are not well tolerated. This applies, for example, to very spicy and hot food as well as to high-percentage alcohol and large quantities of coffee.
  • Try to reduce stress, for example with relaxation exercises.
  • Because smoking attacks the stomach lining, it makes sense to avoid it.
  • Anyone who regularly takes gastric-damaging medication (non-steroidal anti-inflammatory drugs such as acetylsalicylic acid) should discontinue them after consulting their doctor and discuss the alternatives.

In some cases it can be useful to take an acid blocker as a preventive measure. This is an option, for example, for people who have to be treated with non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic joint diseases. Important: Talk to your doctor beforehand before using an acid blocker.

Herold, G .: Internal Medicine. Self-published, Cologne 2021

Online information from the Pschyrembel: www.pschyrembel.de (accessed: March 18, 2021)

Gastric and duodenal ulcers. Online information from the Institute for Quality and Efficiency in Health Care (IQWiG): www.gesundheitsinformation.de (as of June 13, 2018)

Guideline of the German Society for Digestive and Metabolic Diseases: Helicobacter pylori and gastroduodenal ulcer disease. AWMF guidelines register No. 021/001 (as of February 2016)

Baenkler, H .: Short textbook internal medicine. Thieme, Stuttgart 2015

additional Information

ICD-10 Diagnostic Key:

You can find the appropriate ICD-10 code for "gastric ulcer (gastric ulcer)" here:


Last content check:18.03.2021
Last change: 18.03.2021