A gastric ulcer is a loss of tissue in the lining of the stomach that is deeper than an erosion. At gastroscopy it usually appears as a sore with clearly defined edges.
Most gastric ulcers are benign and heal with appropriate treatment. But the cause of a gastric ulcer should be looked into, and it should be assessed with a biopsy where needed.
What causes a gastric ulcer?
Among the most important causes are:
- Helicobacter pylori (H. pylori) infection
- Aspirin and NSAID painkillers
- Smoking
- Some medicines and conditions that disturb the protective mechanisms of the stomach lining
More rarely, Crohn’s disease, some infections and tumours can also lead to ulcer-like lesions.
How common is gastric ulcer?
Peptic ulcer disease has become less common than in earlier years as H. pylori infection has declined and its treatment has become widespread. By contrast, the use of aspirin and NSAIDs remains an important cause, particularly at older ages.
The likelihood of a person developing a peptic ulcer over their lifetime varies with the population and their risk factors, but is reported at roughly 5–10%.
What symptoms can a gastric ulcer cause?
Some patients have no symptoms at all. Others may have:
- Pain or burning in the upper abdomen
- Indigestion
- Nausea
- Early fullness
- Loss of appetite
If the ulcer bleeds, vomiting blood or black, tarry stools can appear.
Are an erosion and an ulcer the same thing?
No.
- An erosion → is more superficial damage to the lining.
- An ulcer → is a deeper loss of tissue that goes beyond the mucosal layer.
So “erosion” and “ulcer” should not be used to mean the same thing on an endoscopy report.
Is a gastric ulcer cancer?
No. Most gastric ulcers are not cancer.
But some stomach cancers can look like an ulcer at endoscopy. So a gastric ulcer — particularly one that looks suspicious — should not be taken as “benign” from its appearance alone.
This is one of the important reasons a biopsy is taken from a gastric ulcer. It is a significant difference from duodenal ulcer.
Why is a biopsy taken?
When a gastric ulcer is seen at gastroscopy, biopsies may be taken from the edges of the ulcer and, where needed, from its base in suitable cases. A biopsy may be done to:
- Assess whether the ulcer has benign or malignant features
- Look for H. pylori
- Rule out other conditions
A biopsy being taken does not mean the patient has cancer. On the contrary, it is a procedure done in order to assess the nature of the ulcer reliably.
What is done if H. pylori is present?
If H. pylori is found, eradication treatment is given with appropriate antibiotic combinations. Confirming after treatment that the bacterium really has been eliminated matters.
Treating H. pylori successfully substantially reduces the risk of the ulcer coming back.
How is it treated?
Treatment is planned according to the cause of the ulcer. Approaches generally include:
- Acid-suppressing medicines such as proton pump inhibitors (PPIs)
- Eradication treatment if H. pylori is present
- Reviewing the use of NSAIDs and aspirin
- Stopping smoking
Do not stop a blood thinner on your own
Aspirin or blood-thinning medicines given for heart or vascular disease should not be stopped without speaking to your doctor.
How long does a gastric ulcer take to heal?
Most benign gastric ulcers heal within weeks with appropriate treatment. The healing time can vary with the size of the ulcer, its cause, H. pylori status, the medicines being taken and the person’s other conditions.
So the pain going away does not on its own show that the ulcer has healed completely.
Is a follow-up endoscopy needed?
A follow-up gastroscopy can matter with a gastric ulcer, particularly where:
- Adequate biopsies could not be taken at the first endoscopy
- The ulcer looks large or suspicious
- The pathology result is uncertain
- Symptoms are continuing
- It is necessary to show that the ulcer has healed
In practice a review at around 6–8 weeks is often planned to assess healing; but the interval should be decided according to the patient and the findings at the first endoscopy.
What complications can a gastric ulcer cause?
- Bleeding Is one of the most common important complications.
- Perforation The ulcer can go right through the stomach wall and cause a hole.
- Obstruction Ulcers near the stomach outlet in particular can cause swelling or narrowing that makes it harder for the stomach to empty.
These complications may need urgent treatment.
When is urgent assessment needed?
Medical assessment is needed without delay
Vomiting blood · vomiting that looks like coffee grounds · black, tarry stools · sudden, very severe abdominal pain · a rigid abdomen · fainting or marked weakness · persistent vomiting.
Remember
- A gastric ulcer Is mostly benign.
- H. pylori Is one of the important causes.
- Aspirin and NSAIDs Are important risk factors.
- A biopsy Matters in gastric ulcer.
- Bleeding Is an important complication.
- A follow-up endoscopy Is needed in some patients to show that the ulcer has healed.
- A gastric ulcer is not stomach cancer But because some stomach cancers can look like an ulcer, the necessary assessment should be carried out.
This is not enough to make a diagnosis
When a gastric ulcer is found at endoscopy, the ulcer’s size and appearance, the biopsy result, H. pylori status, the medicines you take and your symptoms all have to be weighed together.
Sources
- Prof. Ali Tüzün İnce, MD