It’s happening again. You finished lunch a little while ago and that painful burning sensation in your stomach is back. You pop a Tums and wait for relief, but you know that it won’t last and your heartburn will probably start up again soon. You start to feel queasy and hope you don’t need to run to the bathroom. Why does this keep happening after every meal? You might have a stomach ulcer. There are more than half a million new cases of stomach ulcers every year, and around 25 million Americans will get an ulcer at some point during their lives, according to the Centers for Disease Control and Prevention (CDC). This health issue is relatively common, but the good news is that ulcers have a high likelihood of being permanently cured. So how do you know if your stomach pain is caused by an ulcer? HealthyWay asked Will Bulsiewicz, MD, MSCI, the board-certified practicing gastroenterologist behind the popular gut health Instagram account @theguthealthmd, to bust the common misconceptions about stomach ulcers. (Hint: Spicy food doesn’t cause them!) He also shared expert advice on diagnosing, treating, and preventing the disease. Here’s what you should know about stomach ulcers.
Understanding the Condition
There are many myths and misconceptions that swirl around when people talk about stomach ulcers. So let’s set the record straight, starting with the name. “The term ‘stomach ulcer’ is something that people use liberally to refer to a peptic ulcer, which occurs in the stomach or in the first part of the small intestine, known as the duodenum,” says Bulsiewicz. “A peptic ulcer is basically a breakdown of the lining in the small intestine or stomach due to a disruption in the natural balance between inflammation and the barrier to inflammation that exists in the body.” In other words, it’s a sore or hole in the lining of the stomach or the first part of the small intestine. Ouch! So what causes stomach ulcers? You’ve probably heard that spicy food can burn holes in your stomach lining or that a stressful lifestyle contributes stomach ulcers, but that’s not entirely true. “It does make for an interesting story, though,” explains Bulsiewicz. “After the Germans bombed England in World War II, they found that the rate of stomach ulcers rose substantially, so that’s where the myth that stress causes stomach ulcers comes from. While there’s some truth to the concept of a stress ulcer (they’re common in patients who are critically ill with organ failure), it’s generally caused by a bacterial infection.” That’s right—rather than a few months of heightened stress causing stomach issues, the Helicobacter pylori bacterium (commonly known as H. pylori) is actually responsible for around 90 percent of ulcers. “Many people will carry H. pylori without showing any symptoms. There are theories that exist that we have evolved to have this bacteria and it’s protective, but it also disrupts defense mechanisms in the stomach and therefore causes ulcers in stomach or the first part of the small intestine,” says Bulsiewicz. As for other causes of stomach ulcers, the main culprit can be found right in your own medicine cabinet: non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen. (Note: Acetaminophen, or Tylenol, is not an NSAID.) “Long-term use of NSAIDs can break down the natural defense mechanisms in the stomach and small intestine and cause direct harm, wearing away the lining,” says Bulsiewicz. “I don’t love these medicines, because when someone’s having severe gastrointestinal bleeding, it’s often because they’ve been using too much of these medicines to treat arthritis and things like that.” Stomach ulcers can also be caused by Zollinger–Ellison syndrome, a rare condition that causes the body to produce too much acid. Zollinger–Ellison syndrome occurs in only about 1 in every 1 million people and is more common among men between the ages of 30 and 50, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Your doctor can run tests to determine if you have Zollinger–Ellison syndrome.
Signs You Might Have a Stomach Ulcer
Everyone suffers from the occasional stomachache—it’s no fun, but it usually passes after a couple hours without cause for alarm. But what if the pain is recurring? Could it be an ulcer? What do stomach ulcers feel like? “The classic indicator is pain in the upper part of the stomach in your midline, but not quite in the chest. It’s the epigastric area,” says Bulsiewicz. The doctor goes on to explain that mealtime can influence when you feel the worst. “If it’s a stomach ulcer, the pain happens right after eating. If the ulcer is in the small intestine, it will hurt two or three hours after a meal,” he added. However, pain isn’t the only sign of a problem. Other stomach ulcer symptoms include nausea, getting full too quickly (a condition known as “early satiety”), and anemia. Abnormal vomit and stools, such as if they’re bloody or look like coffee grounds, can also be big warning signs. “If you have severe abdominal pain or any of the other symptoms, you should go see your doctor,” warns Bulsiewicz. “Don’t wait until it worsens to ask what’s going on.” Delaying treatment for a stomach ulcer could lead to potentially serious complications. “It might erode all the way through the lining of your stomach or intestine and create a perforation. You’ll develop peritonitis and there’s be a sudden onset of severe abdominal pain. It’s also possible to develop an obstruction, where the ulcer causes a deformation of the tube, or lumen, of the intestine and food can’t get through,” says Bulsiewicz. If you suspect you might have a stomach ulcer or another gastrointestinal issue, get in touch with your physician as soon as possible. Early treatment can help you avoid painful complications down the road.
How to Get a Diagnosis
When it comes to any health issue, reading about symptoms on the internet should be used strictly for gathering background information. Only a medical professional can say for sure whether you have a stomach ulcer. Generally, your doctor will start by checking for an H. pylori infection, which might indicate a stomach ulcer. They can look for the bacteria through a stool, blood, or breath test. You may also need to undergo an upper endoscopy, one of the best ways to diagnose a stomach ulcer, says Bulsiewicz. You’ll receive anesthesia, then the gastroenterologist will slip an endoscope (a thin, flexible tube with a light, camera, and tools to collect tissue for a biopsy) down your throat to look for sores. “Once I’ve diagnosed it as an ulcer, I can administer a treatment during the procedure if medically appropriate. The endoscopy is the most direct test. It presents the least likelihood of missing an ulcer and it offers opportunity for treatment,” he says. While used less frequently, a barium swallow can also help determine whether you have a stomach ulcer. This test involves swallowing a liquid with barium sulfate, which will coat the upper part of your gastrointestinal tract. Then the doctor will take a series of X-rays to watch the contrast and potentially spot an ulcer. Your doctor will provide a recommendation on the best way to diagnose a stomach ulcer in your body.
Treating the Problem
Once your doctor confirms you have a stomach ulcer, he or she can begin making recommendations for treatment. The good news is that most stomach ulcer treatments are short and will help you feel better fast. Stomach ulcers are relatively common and easily cured with the right medical interventions. “If you have H. pylori, the classic treatment is called a triple therapy. It’s a combination of two antibiotics—usually amoxicillin and clarithromycin—and a proton-pump inhibitor (or PPI), such as Prevacid, Nexium, and Prilosec, to reduce stomach acid,” says Bulsiewicz. “You’ll start to feel better in a few days unless you have a severe ulcer.” Some doctors may treat a stomach ulcer with a histamine-2 (H2) receptor antagonist, rather than a PPI, to help your body cut down on acid production. The exact combination of drugs, dosage, and duration of treatment will depend on your medical history and the severity of your stomach ulcer. As with almost every drug, stomach ulcer treatments such as PPIs do come with the risk of side effects. However, Bulsiewicz says that PPIs are safe and effective for the treatment of stomach ulcers. “Many of the studies people have seen reported in the news about PPIs and their risks are overblown. In general, we believe these medicines are very safe. While there are risks, taking the medicine for 4 to 8 weeks is going to be completely safe for most people,” he says. Your doctor may also provide recommendations for treating stomach ulcers with natural remedies in addition to medical preventions. For example, Bulsiewicz says that in addition to a PPI, he’s used fiber and probiotics to treat ulcers. This approach fosters gut health and may help prevent future stomach ulcers. “Fiber, probiotics, and possibly fermented foods: These are things I believe in. What’s cool is that most things that contain fiber also have prebiotics, the food found in plants that feeds our gut microbiome and helps our body work the way it’s supposed to,” Bulsiewicz says. Garlic and licorice root may potentially help heal stomach ulcers, but more research is required before they can be relied on as a natural treatment, adds Bulsiewicz.
Soothe with food.
What you put in your body can have a big influence on how you feel when you have a stomach ulcer. Bulsiewicz recommends eating a high-fiber diet (as long as you don’t have an obstruction) and limiting consumption of spicy and acidic foods. “They can aggravate an ulcer. You should also avoid processed foods, which may impair healing of the ulcer,” he says. It’s a good idea to lay off alcohol and smoking when you’re treating a stomach ulcer, Bulsiewicz cautions. So what are the best foods to eat when you have a stomach ulcer? Stick with fresh, low-acid fruits and vegetables and lean meats. They’ll give your body the essential nutrients it needs during a time of healing. You may also consider eating homemade sauerkraut, which contains beneficial bacteria for your gut.
Stomach Ulcers and Pregnancy
During pregnancy, there are always heightened concerns about the impact health woes will have on the mother and the baby. “Pregnancy may actually be protective when it comes to peptic ulcers, because increased progesterone levels from pregnancy lower stomach acid output and create more protective mucus. Nonetheless, ulcers can still happen and are more likely in those who smoke or who have a prior history of ulcer disease,” says Bulsiewicz, adding that if you think you might have a stomach ulcer while you’re pregnant, your doctor can perform an endoscopy—ideally during the second trimester—to make a diagnosis. “There are safe medication options that could be used to treat the ulcer, such as the H2 receptor antagonists,” says Bulsiewicz. Your doctor is the best source of information for diagnosis and treatment of a stomach ulcer during pregnancy.
Preventing Stomach Ulcers
Perhaps you’ve figured out that something else was the cause of your stomach pain (ate one slice too many at a pizza party? We don’t judge!), but now that you’ve read about stomach ulcers, you’re worried about getting one. How can you prevent it from happening to you? “Be cautious with your use of NSAIDs. That’s what I see as the dominant controllable factor,” says Bulsiewicz. He also recommends moderating the amount of alcohol you drink, quitting smoking, and eating a clean, healthy diet. “Maximizing your consumption of fruits and vegetables and really doing your best to not consume processed foods is to everyone’s benefit,” says Bulsiewicz. If you’re worried about getting a stomach ulcer, talk to your doctor so you can work together to decide the best way to check for an H. pylori infection and prevent gastrointestinal issues.