Gastric ulcer: what it is, causes, symptoms, complications, diagnosis and treatment

Gastric ulcer: what it is, causes, symptoms, complications, diagnosis and treatment

A gastric ulcer is a small lesion that develops within the stomach wall. In medicine we speak of peptic ulcer when it concerns the upper digestive tract and includes, in addition to the stomach, also the duodenum (duodenal ulcers).

In practice, when the ulcer affects only the stomach it is called gastric ulcer, while if it affects only the first part of the intestine it is called duodenal ulcer.

The symptoms of gastric ulcer are pain in the abdominal area and a burning sensation in the stomach that start with an empty stomach (between meals or during the night), improve temporarily after eating and can last from a few minutes to several hours.

The cause of peptic ulcer is mainly a bacterial infection, specifically Helicobacter pylori. But also the prolonged use of anti-inflammatory drugs such as aspirin or the abuse of smoking and alcohol.

According to data, around 4 million people suffer from peptic ulcer every year. In particular, gastric ulcer mainly affects after the age of 60, while the duodenal ulcer affects younger subjects.

Gastric ulcer: what is it

In medicine we speak of peptic ulcer, meaning a deep lesion affecting the inner lining of the stomach (gastric ulcer) or the duodenum, i.e. the first part of the small intestine connected to the stomach (duodenal ulcer). If the erosion is superficial, however, we speak of erosive gastritis or duodenitis and not of ulcer.

Among the functions of the stomach, there is that of producing gastric juices, which are acidic and therefore corrosive, but necessary to digest food and eliminate pathogens. The stomach mucosa is therefore protected from the acidity of the juices and by a special membrane that covers it.

Specifically, it is composed of three layers: epithelium, lamina and muscularis mucosae. The epithelium is made up of cells that produce mucus and bicarbonate and which protect the mucosa from corrosion by digestive juices.

When this balance is altered, the “exposed” area of ​​the mucosa becomes the target for digestion of gastric juice. This lesion is precisely the gastric ulcer.

Gastric or peptic ulcer?

Peptic ulcer is a deep lesion, which forms a small cavity in the mucous membrane of the stomach, or of the pylorus (opening between the stomach and duodenum), of the duodenum (first section of the small intestine) or of the esophagus.

Based on the location of the lesion, it is defined as gastric, then stomach, duodenal and esophageal ulcers. It mainly affects the gastrointestinal mucosa since it is a tissue sensitive to the action of gastric juices.

Gastric juices

Normally, the body produces acidic juices in order to digest food and eliminate any microbes. Since acids are very corrosive, cells in the stomach release mucus that protects the lining.

The mucus, rich in bicarbonate, maintains the pH at a higher, alkaline value than that of gastric acid.

Thus, under normal conditions, the inner lining of the stomach tolerates acids and proves to be an impenetrable barrier to them. The epithelial cells of the organ participate in the defense with a rapid turnover which also allows the simultaneous repair of any injuries.

However, when, for various reasons, the production of acids increases and that of mucus decreases, the mucosal barrier is altered.

So the wound results from an imbalance between aggressors, including bacteria and gastro-harmful substances, and defenders, such as good blood flow. The walls of the stomach are thus damaged and excavated, with loss of substance, until the formation of the ulcer.

Gastric ulcer: symptoms

Symptoms of gastric ulcer are above all pain in the pit of the stomach, which can be both diurnal and nocturnal. However, the presence of a gastric or duodenal ulcer is not always associated with symptoms. In fact, about 75% of people affected by peptic ulcers do not show any symptoms or feel a sense of fullness in the stomach, difficulty digesting and nausea. However, anemia may occur due to blood loss from the injury.

Especially in the initial stages, therefore, the symptoms can be non-specific such as nausea, vomiting, lack of appetite and belching. In other cases, some complications appear immediately such as haemorrhage, perforation, penetration into adjacent organs, narrowing (stenosis). It is changes in pain characteristics that often indicate complications. For example:

  • Pain that becomes constant, that does not improve with food and antacids, that radiates posteriorly, may be an expression of pancreatic penetration.
  • Pain that is accentuated after a meal, and accompanied by vomiting, may indicate a narrowing (pyloric stenosis).

Sudden and generalized abdominal pain may indicate a perforation of the bowel in the abdominal cavity. In this case, you should notify your doctor immediately.

Burns and cramps

The ulcer causes burning sensation and epigastric pain, or in the upper and central part of the abdomen. The pain, which is strongest in the early hours of the night, can be stabbing, burning, dull and intense.

Resembling a cramp, heavy pressure, or a sense of emptiness, canker pain can also spread to the back. Ingestion of food sometimes relieves symptoms temporarily and sometimes exacerbates them, particularly in ulcers along the lesser curvature.

The pain sometimes appears half an hour after a meal or at most within 2-5 hours, combined with a sense of fullness and belching. In addition, ulcers often cause loss of appetite, resulting in weight loss and malnutrition.

Finally, erosion is accompanied by a feeling of general malaise and local weight, with poor digestion (dyspepsia).

Nausea, vomiting and black stools

In some cases, the disease causes tissue swelling, or edema, up to the small intestine. Edema makes it so difficult for food to pass from the stomach to the duodenum that it is blocked.

Consequently, after meals, the subject with intestinal obstruction experiences meteorism, nausea and vomiting.

Also, the ulcer may bleed resulting in vomiting of blood and black stools. If the bleeding is continuous, symptoms of anemia may also occur, with asthenia, weakness and dizziness.

Diagnosis and exams

The first choice test for the diagnosis of gastric or duodenal ulcer is gastroscopy (esophago-gastro-duodenoscopy – EGDS), a test to inspect the upper digestive tract.

The procedure involves introducing a probe into the stomach and duodenum, equipped with a small camera, which is introduced through the nose or mouth. During the examination it is also possible to perform a test to detect the possible presence of Helicobacter pylori which is carried out on a piece of tissue taken from the stomach.

In the case of a stomach ulcer, a biopsy is also performed to rule out the presence of stomach cancer which, in some cases, can “look like” an ulcer.

Biopsy and radiological examination

With the biopsy, not only the histological examination is performed, but the Helicobacter pylori can be searched for. The “upper digestive tract barium study,” or contrast radiography, is done with a barium-labelled meal. The fluorescent substance inserted into the meal is intercepted by X-rays.

Based on the speed of the passage of the contrast medium, it is possible to measure the gastric emptying time and other parameters. Instead, the radiological examination helps define the severity and size of the ulcer.

Finally, blood and stool tests and the urea breath test are prescribed in case of suspicion of a Helicobacter pylori infection.

Causes of gastric or peptic ulcer

What causes gastric ulcer? In healthy people, the mucous membranes of the stomach and duodenum, as we have seen, are protected by a series of barriers. Any circumstance which alters this protection (smoking, alcohol, anti-inflammatory drugs, Helicobacter pylori infection) or which increases the production of gastric juices favors the appearance of the ulcer.

Often, the cause, as we have seen, is an infection caused by a bacterium, Helicobacter pylori, or by the prolonged intake of other non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin.

But cigarette smoke or alcohol can also irritate and corrode the mucous membrane and increase the amount of gastric acid produced, as can stress or foods that are too spicy. Certainly these are factors that individually do not cause a stomach ulcer but can favor it, exacerbate it and hinder the healing process.


There are many factors that can alter the protective lining, increase gastric acidity and hinder mucosal repair. Among these, numerous incorrect dietary and lifestyle behaviors influence the appearance and progression of the ulcer.

Cigarette smoking slows gastric emptying, reduces bicarbonate production, and increases reflux from the duodenum to the stomach. Thus, smokers are more prone to ulcers than non-smokers and their wounds heal more slowly.

Alcohol abuse is also one of the most incisive reasons for the appearance of erosion since it reduces the amount of bicarbonate in the mucus.

Similarly, an excess of coffee or nerve substances, including chocolate, stimulates gastric secretion and is irritating. However, the abundant intake of fatty foods also causes the stomach to empty over a longer period of time, exposing it to the effects of hyperacidity.

In case of gastritis, inflammation of the mucous membrane, the ulcer occurs more easily and shows the same changes in the lining. In fact, gastritis, which always precedes erosion, is characterized by a lower emission of bicarbonate in the mucus.


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