What are the signs of an ulcer

Stomach ulcer

Brief overview

  • What is a stomach ulcer? deep wound in the stomach lining; Men and women are affected about equally often.
  • Causes: Infection with the stomach germ Helicobacter pylori, disturbed gastric emptying, disturbed gastric acid production, certain medications, genetic predisposition, unfavorable lifestyle habits (stress, alcohol, etc.)
  • Symptoms: Pain in the upper abdomen, nausea, feeling of fullness, loss of appetite, possibly tarry stools, anemia (anemia)
  • Possible complications: Bleeding from the ulcer, gastric perforation with peritonitis
  • Examination: Doctor-patient discussion (anamnesis), physical examination, blood test, ultrasound, gastroscopy, breath test
  • Therapy: medication; surgical intervention in the event of complications
  • Forecast: good with early treatment and a stomach-friendly lifestyle

Gastric ulcer: symptoms

Stomach ulcers are one of the most common gastrointestinal diseases. Only that occurs more often Duodenal ulcer (medical duodenal ulcer).

Both gastric and duodenal ulcers typically cause pressing or burning pain in the upper abdomen (Epigastrium = between costal arch and navel). The symptoms often arise in connection with eating or drinking. However, people with a duodenal ulcer often experience pain on an empty stomach (fasting pain) and at night. On the other hand, an increase in pain shortly after eating is a typical gastric ulcer sign.

Furthermore you can Loss of appetite, Bloating, Nausea and vomiting as Weight loss indicate a stomach ulcer. Some people also develop signs of as a result of a bleeding stomach ulcer Anemia (Anemia).

Some stomach ulcers do not cause any discomfort at all. They are then often only discovered by chance during an examination or only become noticeable when there are complications.

Stomach cancer can rarely cause symptoms similar to gastric ulcer. A gastroscopy then provides clarity, in which a tissue sample is taken (biopsy) and examined in terms of tissue (histological).

Gastric ulcer: complications

On the one hand, certain pain relievers and anti-inflammatories such as acetylsalicylic acid (ASA), ibuprofen or diclofenac can cause stomach ulcers. On the other hand, if taken regularly, they can suppress the pain stimulus so that those affected do not notice the typical gastric ulcer symptoms. As a result, (severe) complications can develop unnoticed.

The most common complication of gastric ulcer (and duodenal ulcer) is one Bleeding from the ulcer. A possible sign of this is a pitch black discolored stool (tarry stool). The black color occurs when the blood from the ulcer is broken down by the acidic gastric juice.

Sometimes the ulcer bleeds so little that the stool won't discolor. The persistent blood loss is reflected in a reduced hemoglobin level in the blood.

If a stomach ulcer bleeds profusely, the person may even vomit the blood (vomiting blood or hematemesis). This is life-threatening and must be treated immediately by a doctor!

A stomach ulcer rarely breaks through the stomach wall into the abdominal cavity. Through this hole, digested food and acid can get into the abdominal cavity and a Peritonitis (Peritonitis). Those affected then feel massive pain all over the abdomen (peritonism) and get a fever.

A gastric ulcer breakthrough is an emergency that needs to be treated as soon as possible!

Gastric ulcer: causes and risk factors

Psychological factors: "With so much stress you will develop a stomach ulcer sooner or later" - such warnings are heard more often. In fact, stress at work or at home seems to increase the risk of developing a stomach ulcer. This is presumably because the body produces excessive stomach acid when stress is sustained, while making less protective mucus.

Even acute stressful or shock situations as well as depression seem to favor the development of gastric ulcers. However, there is a high probability that they are not the sole triggers. Rather, they only have an ulcer-inducing effect in combination with other risk factors.

Too much stomach acid: A stomach ulcer occurs when the aggressive stomach acid and the protective factors of the stomach lining (for example mucus and acid-neutralizing salts) are in imbalance. If the acid is too strong or the protective factors are too weak, the mucous membrane is damaged and a stomach ulcer can develop. Such an imbalance first inflames the stomach lining (gastritis). If the inflammation persists for a long time or keeps coming back, a stomach ulcer can develop over time.

Disturbed processes in the stomach: Disturbed stomach movements are also suspected of being able to trigger a gastric ulcer. If the stomach empties with a delay and at the same time more bile acid flows back into the stomach, this can promote the development of a gastric ulcer. An increased tendency to ulcer can also be observed in people who only produce reduced amounts of the protein that repairs the gastric mucosa.

Colonization with Helicobacter plyori: This bacterium, which does not mind aggressive stomach acid, is the main cause of gastric ulcer. The bacterium can be detected in 75 percent of all patients with a gastric ulcer and in up to 99 percent of all patients with a duodenal ulcer. The stomach germ is not solely responsible for an ulcer. Ulcers can only develop in combination with other risk factors. These risk factors include taking certain medications and poor lifestyle and eating habits (see the following points).

Taking certain medications: People who regularly take pain relievers and anti-inflammatory drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs or NSAIDs) are particularly prone to developing a stomach ulcer. These include active ingredients such as acetylsalicylic acid (ASA), ibuprofen and diclofenac. The combination of cortisone (glucocorticoids) and non-steroidal anti-inflammatory drugs is particularly problematic.

Unfavorable diet and lifestyle habits: Smoking, alcohol and coffee increase stomach acid production and thus increase the risk of a stomach ulcer. Certain foods (e.g. spicy foods) can also irritate the stomach lining. What is tolerated varies greatly from person to person.

Genetic predisposition: Stomach ulcers are more common in some families. This suggests that genetic factors are involved in ulcer formation.

Other causes: Stomach ulcers can very rarely be caused by metabolic diseases such as an overactive parathyroid gland (hyperparathyroidism) or a tumor disease (gastrinoma; Zollinger-Ellison syndrome). Stomach ulcers can also develop after major operations, accidents or burns. Since various "stress reactions" take place in the body in these situations, such a stomach ulcer is also known as a stress ulcer. In addition, people over the age of 65 and those with blood group 0 are more prone to stomach ulcers. In addition, people who have had such an ulcer can easily form a new one.

Gastric ulcer: treatment and prevention

How doctors treat a stomach ulcer depends largely on the cause. A particularly important role is whether the stomach germ Helicobacter pylori has been detected in the patient's stomach. If this is the case, the doctor primarily relies on gastric ulcer therapy Antibiotics one to clear the infection. To do this, the person concerned takes two different antibiotics (clarithromycin and amoxicillin or metronidazole) every day for seven days. In addition, the doctor will give an acid-reducing drug (for example a so-called "Proton pump inhibitors") Prescribe. As "stomach protection", they inhibit the production of stomach acid so that the attacked mucous membrane can recover.

Helicobacter treatment with antibiotics is known as "Helicobacter pylori eradication therapy". It works in more than 90 percent of people with a stomach or duodenal ulcer. In rare cases, however, the gastric ulcer pathogens are resistant to one of the antibiotics. Then effective gastric ulcer therapy is more difficult.

If the Helicobacter pylori bacterium cannot be detected, antibiotics are not used, only acid-reducing drugs, especially “proton pump inhibitors”. Therapy is symptomatic. That means, it only alleviates the discomfort. Without the damaging effects of gastric acid, the gastric ulcer normally heals on its own. In addition, however, it must be ensured that the person concerned completely avoids stomach-irritating substances and foods (alcohol, coffee, nicotine) until the gastric ulcer has healed.

In addition to proton pump inhibitors, H2 antihistamines and antacids also have an acid-reducing effect. Here you can read more about the effect and application of these groups of active ingredients in gastric ulcer treatment:

Gastric ulcer treatment: gastroscopy

After completing the drug treatment of the gastric ulcer, a gastroscopy is performed within about six to eight weeks. This checks whether the ulcer has really healed completely.

A gastroscopy can also be performed to treat complications: If the ulcer is bleeding, the doctor can inject a special protein glue (fibrin glue) into the wound as part of the gastroscopy to stop the bleeding.

Gastric ulcer treatment: surgery

Stomach ulcers are rarely operated on today. For example, if you have a very stubborn ulcer, it can make sense to remove part of the stomach. As a rule, the vagus nerve (nervus vagus) is also severed (vagotomy) in order to reduce gastric acid production.

Surgery may also be necessary if there are complications from a gastric ulcer. A gastric perforation, for example, always has to be treated surgically.

Gastric ulcer: examinations and diagnosis

The right person to contact if you suspect a stomach or duodenal ulcer is a specialist in internal medicine and gastroenterology. Affected people can first go to their family doctor. He can then initiate further examinations if necessary.


First, the doctor will talk to the patient in detail to collect his or her medical history. Possible questions are:

  • Where exactly do you have a stomach ache?
  • Does eating and drinking make the pain worse or worse?
  • Do you drink alcohol? When Yes, how much?
  • Do you smoke? When Yes, how much?
  • Do you drink coffee? When Yes, how much?
  • Do you have a lot of stress right now?
  • Do you take over-the-counter pain relievers such as acetylsalicylic acid (ASA), ibuprofen, or diclofenac?
  • Are you taking any other medication?
  • Have you or a family member had a stomach ulcer or duodenal ulcer?
  • Have you ever had a gastroscopy? If so, when?
  • Do you have any pre-existing or underlying illnesses?

Physical examination

After the interview, the doctor will examine the patient briefly, if necessary. In doing so, he carefully feels his stomach. This gives him an impression of how severe the pain is. In addition, when palpating, there may be a defensive tension: This means that the abdominal muscles involuntarily tense due to the pain. For the doctor, this is a sign that he must immediately initiate further examinations and appropriate treatment.

Blood tests

If a stomach ulcer is suspected, the patient's blood will also be tested. If there is a bleeding stomach ulcer, the continuous loss of blood may be reflected in anemia. Typically, the hemoglobin value (Hb) is then lowered.

Various blood values ​​can also show whether there is inflammation in the body (number of white blood cells, CRP, etc.). This is possible, for example, with a stomach ulcer that has broken through the stomach wall.


An ultrasound scan of the abdomen can help rule out other possible causes of the abdominal pain. The pain can also originate from other abdominal organs such as the liver or the gallbladder. In order to be able to assess the condition of the stomach and duodenum more precisely, a gastroscopy is necessary.


The gastroscopy is used to confirm the diagnosis of "gastric ulcer". A flexible hose with a light source and small optics installed at the front end helps with this. This endoscope is carefully advanced over the mouth and esophagus into the stomach and down to the duodenum. In this way, the doctor can directly examine any changes in the mucous membrane.

Tissue extraction

During the gastroscopy, the doctor can use the endoscope to take tissue samples (biopsies) from suspicious areas of the mucous membrane. They are examined microscopically in the laboratory. In this way it can be determined whether the changes in the mucous membrane are actually a gastric ulcer and not gastric cancer. In addition, a colonization with the stomach germ Helicobacter pylori can be detected on the basis of the tissue samples.

13C breath test

Another way to detect Helicobacter pylori infection is to do a special breath test. The patient drinks a special solution with labeled 13C-urea. If Helicobacter bacteria live in the stomach, they break down the urea. As a result, carbon dioxide labeled with 13C can be found in the exhaled air.

Read more about the examinations

Find out here which examinations can be useful for this disease:

Gastric ulcer: disease course and prognosis

If you consistently treat a gastric ulcer early with medication and maintain a stomach-friendly lifestyle, the ulcer will usually heal easily and without complications. Part of a stomach-friendly lifestyle is to avoid alcohol, nicotine and caffeine as completely as possible, not to consume food that is irritating to the stomach (because it is very hot or spicy) and to avoid stress as far as possible.

If complications such as bleeding or a rupture of the stomach wall occur, healing usually takes significantly longer.

Gastric ulcer: prevention

There are many things you can do yourself to prevent stomach ulcers. This is especially important if you have ever had a stomach ulcer.

Pay attention to your diet, for example: Avoid very hot and spicy foods as they irritate the stomach lining. For the same reason, you should be careful with alcohol and coffee - in some people the stomach reacts irritably to even small amounts of the stimulants, in which case it is advisable to do without it completely. Other people can take at least the occasional glass of wine or a cup of coffee quite well.

To prevent stomach ulcers, you should also avoid stress whenever possible. Make sure you have regular relaxation phases in everyday life, for example in the form of walks, gardening, meditation or yoga. Try out what is best for calming you down.

Some people need to regularly take drugs that damage the stomach and a Stomach ulcer cause. Then you should talk to the attending physician whether it is possible to reduce the dose or switch to a better-tolerated preparation.

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