Are you suffering from stomach ulcers? These are the most common causes

Hydrochloric acid is necessary for the processing of food in the stomach. A mucus-like, fatty layer called mucin protects the stomach lining from its acidic pH (1-2).

In addition to this, other protective factors are present.

If there is insufficient protection of the mucosa, stomach acid acts aggressively on it and disrupts it. The most common causes of ulcer disease include Helicobacter pylori.

But apart from this, we know other causes that may be responsible for the development of difficulties. In the following lines you will learn more about the risks and causes of this disease.

Gastric and duodenal ulcer disease

There are several factors involved in its occurrence.

The main cause is the disruption of the protective (defensive) factors of the mucosa. The mucosa of the digestive tract is affected by aggressive factors that damage it. Repeated inflammation of the mucosa subsequently causes erosions and ultimately ulcers.

Table showing factors for the development of ulcer disease

An ulcer can form wherever the low pH of the acid has a negative effect.

At first, this is superficial damage, so-called mucosal erosion.
Later, an ulcer can form in its place.

A peptic ulcer can occur in several places, such as a reflux ulcer of the oesophagus, a gastric ulcer, a duodenal ulcer or even in a place called Meckel's diverticulum.

Read more about peptic ulcer disease in the article gastric ulcers.

The main causes

Approximately 10% of the population will get an ulcer during their lifetime. The highest incidence is in middle age.

Several factors are involved in the development of ulcer disease.
Helicobacter pylori is cited as the primary cause.
Secondary causes may include ulcers caused by medication or stress.

In Clinical Gastroenterology (1988), Prof. Zdeněk Mařatka MD, DrSc. gives a division into acute ulcer and chronic ulcer. He classifies stress ulcers as acute and those caused by helicobacter as chronic.

In the past the rule was:
"No acid, no ulcer"
Nowadays it has changed to:
"No helicobacter, no ulcer"

Risk factors:

• Helicobacter pylori is responsible for the development of chronic gastritis and stomach cancer (50% of the population is infected after the age of 50, risk drops to 5% after treatment)
• Medications (NSAIDs, acetylsalicylic acid, corticosteroids)
• family history (family history of ulcer disease)
• smoking
• alcoholism
• age over 50 years
• diabetes mellitus (diabetes)
• blood group 0
• elevated pepsinogen I level
• other diseases (e.g. lung, blood vessel, liver)
• gastrinomas (Zollinger-Ellison syndrome)
• Poor lifestyle (spicy food, irregular eating, too hot food, strong coffee on an empty stomach, long-brewed teas, burnt food e.g. grilling irritates the stomach lining)
• inadequate socio-economic and hygienic conditions

The most common causes:

• Helicobacter pylori
• Medications such as NSAIDs, non-steroidal antirheumatic drugs, acetylsalicylic acid, corticosteroids
• Acute and prolonged stress
• genetic predisposition
• smoking
• alcohol
• increased production of the hormone gastrin (gastrinoma, Zollinger-Ellison syndrome)
• consequence of other diseases (liver disease, vascular disease, lung disease, diabetes)

Helicobacter pylori

Helicobacter pylori is a bacterium that colonises the stomach lining.

The prevalence of infection with this bacterium is estimated at 30-55% of the population. It is present in 85-95% of duodenal ulcers and approximately 65-80% of gastric ulcers.

It was discovered in 1982 and classified as a class 1 carcinogen by the World Health Organisation. In 2005, the Nobel Prize for Physiology and the discovery of the cause of gastric ulcers was awarded to Barry Marshall and Robin Warren of Australia.

It is thought to infect 50% of the population. Transmission is by the oral-oral route (mouth-to-mouth), either directly (kissing) or indirectly (contaminated food, cutlery).

Infection is most often acquired during childhood from the mother, but new infections also occur in adulthood (mainly in immunocompromised persons).

Helicobacter produces substances (proteases and phospholipases) that disrupt the protective mucus layer. In addition, they provoke an increased production of gastrin, which is responsible for the production of hydrochloric acid (HCl).

The bacteria contain an enzyme that interferes with the effectiveness of local immunity. This ability of the bacteria causes repeated local inflammation of the gastro-duodenal mucosa (stomach and duodenum), with ulcer formation as a consequence over time.

The occurrence of Helicobacter pylori is conditioned by:

• age (especially in the elderly)
• low socio-economic level
• higher in families with duodenal ulcer disease
• higher in Africans, in South Asia, Brazil, in the black race
• lower in developed countries

Use of non-steroidal antirheumatic drugs

Drugs such as NSAIDs, i.e. non-steroidal anti-inflammatory drugs (e.g. ibuprofen, diclofenac, used to relieve pain, mainly in muscles, joints and inflammatory diseases), cause lower prostaglandin production (in the stomach they act as a protective factor, reducing HCl secretion and vice versa).

The concomitant use of NSAIDs and blood thinners is a high risk factor for stomach problems.

Long-term and acute stress

Other important influences that are negative in the development of ulcer disease include stress. This can be long-term or acute.

Long-term poor psychological state is one of the risk factors and also one of the causes of ulcers.

Acute stress causes erosions and also ulcers. Most commonly in patients in shock, after trauma, after surgery, in sepsis. An ulcer caused as a result of burns is called a Curling's ulcer. After trauma or surgery it is referred to as a Cushing's ulcer.

Part of other diseases

Diseases of other systems are also involved in the development of ulcer disease, for example:

• cardiovascular diseases, which mainly affect the microcirculation at the level of the gastric mucosa
• chronic obstructive pulmonary disease, in which the incidence of ulcer disease is approximately 25%
• liver disease
• renal failure
• Chronic pancreatitis, with approximately 20 % presence of ulcer disease, mainly due to reduced production of pancreatic bicarbonate, which has a protective effect on the gastric mucosa

Lifestyle

We know that poor lifestyle has an impact on digestive disorders and also on the development of ulcer disease.

As you have already noticed, long-term stress is a negative factor. Getting enough sleep at night, on the other hand, has a preventive effect.

In the treatment of ulcer disease, physical and mental rest and sufficient sleep are the regimen. Diet is a prerequisite in the case of treatment.

Regular dietary intake, sufficient fibre content and limitation of spicy foods are necessary. Chilli, hot peppers, Hungarian peppers do not irritate the stomach mucosa.

Smoking and alcohol intake (especially concentrated) negatively affect the stomach lining and contribute to the formation of erosions and ulcers.

Coffee should not be drunk on an empty stomach. Food that is too hot is harmful to the stomach lining and food that is too cold is not suitable.

Complications

Nowadays, they are less common than in the past, thanks to effective conservative treatment. Sometimes an ulcer can be hidden, without symptoms (latent ulcer). In this case, its complications may be its first manifestation.

These include:

• Bleeding, which is manifested by vomiting blood (hematemesis) or black stools (melena).
• With intense or prolonged bleeding, anaemia and, in worse cases, haemorrhagic shock (confusion, disorientation, low blood pressure, rapid pulse, cold sweat, disturbances of consciousness, collapse) may occur.
• Perforation is the penetration of an ulcer through the wall of the digestive tract and exiting up into the abdominal cavity, this can result in peritonitis.
• Penetration is when an ulcer penetrates a nearby organ (liver, pancreas).
• Stenosis of the bulb of the duodenum is a narrowing of the initial part of the duodenum (the site with the most frequent occurrence of an ulcer) as a result of its scarring at the site of a chronic ulcer. An obstruction (obstruction, blockage of the passage) may occur at the site of the narrowing.

Table of risk factors for ulcer perforation

Symptoms of peptic ulcers

It is not a rule that the presence of an ulcer must cause any symptoms.

In its hidden form, a complication can be the first symptom. In case of the appearance of difficulties, it is good to seek a doctor. A specialist doctor is called a gastroenterologist. And with timely treatment, you can avoid later problems.

Symptoms that may occur in ulcer disease:

• pain in the upper abdomen (epigastrium) in the stomach area (burning, sharp, sometimes dull, depending on the location of the ulcer)
  • stomach ulcer hurts after eating (weight loss)
  • duodenal ulcer hurts an hour to an hour and a half after food intake, i.e. fasting (gaining weight), at night as a night hunger pain. In diabetics, the time extends to 4 hours (the reason is slower gastric emptying)
  • radiating pain under the left rib arch - a sign of a gastric ulcer
  • radiating pain under the right rib arch - a sign of a duodenal ulcer
• heartburn
• nausea, vomiting (vomitus)
• vomiting of blood (haematemesis)
• dark to black stool (melena) indicates bleeding from the upper parts of the digestive tract
• anaemia
• bloating, feeling of fullness
• fatigue, drowsiness, weakness
• lack of appetite, weight loss
• excessive salivation
• putrid-smelling stools

Prevention

Preventive measures should include diagnosing the presence of Helicobacter pylori, especially for long-term problems, and treating it.

Subsequently, the use of medications to protect the stomach lining in the case of NSAIDs and other aggressive drugs. Or their substitution with another non-aggressive type of drug. A general practitioner or gastroenterologist can advise on this.

Prolonged psychological stress or acute stress is also involved in the development of ulcer disease. Also work overload and lack of rest and sleep.

Therefore, we should also think about taking some rest and a healthy dose of night sleep.

More care should be taken by people with a positive family history of diseases such as helicobacter infection or ulcer disease.

When choosing a suitable condition, you need to think about the fibre content. If you have stomach problems, avoid spices.

Don't worry, they don't have a negative effect on the stomach lining.

Eating regularly is guaranteed to be healthier than one or two rich meals a day. Remember that eating too hot or too cold is not advisable.

Care should be taken by coffee drinkers. Too strong coffee in the morning on an empty stomach is the wrong way to start the day. When steeping teas, the recommended time should be observed. Too much sediment is released when steeping for too long, which subsequently irritates the stomach lining.

Smoking and alcohol should be limited and, in the case of pre-existing stomach disorders, completely avoided.