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Patients with a gastric ulcer may experience pain worsening with eating, often described as a burning or dull ache. Other symptoms include belching, vomiting, weight loss, or poor appetite. Complications may include bleeding, perforation, and blockage of the stomach. Common causes include the bacteria Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs). H. pylori was first identified as causing peptic ulcers by Barry Marshall and Robin Warren of the University of Western Australia in the late 20th century, a discovery for which they were awarded the Nobel Prize in 2005. Other, less common causes include tobacco smoking, stress due to serious illness, Beh et’s disease, Zollinger-Ellison syndrome, Crohn’s disease, and liver cirrhosis[1]. Older people are more sensitive to the ulcer-causing effects of NSAIDs[1]. The diagnosis is typically suspected due to the presenting symptoms with confirmation by either endoscopy or barium swallow[1]. H. pylori can be diagnosed by testing the blood for antibodies, a urea breath test, testing the stool for signs of the bacteria, or a biopsy of the stomach[1]. Other conditions that produce similar symptoms, include stomach cancer, coronary heart disease, and inflammation of the stomach lining (gastritis) or gallbladder inflammation (cystitis) [1]. Treatment includes stopping smoking, stopping use of NSAIDs, reducing or preferably stopping alcohol consumption, and taking medications to decrease stomach acid[1]. Ulcers due to H. pylori are treated with a combination of medications, such as amoxicillin, clarithromycin, and a proton pump inhibitor (PPI). The medication used to decrease acid is usually either a PPI or an H2 blocker (histamine H2-receptor antagonists). Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful. Peptic ulcers are present in around 4% of the population.
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