Gastric Ulcer

Food passes down the oesophagus (gullet) into the stomach. The stomach makes acid which is not essential, but helps to digest food. After being mixed in the stomach, food passes into the duodenum (the first part of the small intestine). In the duodenum and the rest of the small intestine, food mixes with enzymes (chemicals). The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food which is absorbed into the body.

• Peptic inflammation is inflammation caused by stomach acid. Inflammation may be in the stomach, the duodenum (as acid flows in with food), or the lower oesophagus (if acid splashes up to cause 'reflux oesophagitis').
• A peptic ulcer is an ulcer caused by stomach acid. An ulcer is where the lining of the gut is damaged and the underlying tissue is exposed. If you could see inside your gut, an ulcer looks like a small, red crater on the inside lining of the gut.
• A stomach ulcer is one type of peptic ulcer. A stomach ulcer is sometimes called a gastric ulcer. (The most common type of peptic ulcer is a duodenal ulcer.)

The rest of this leaflet deals only with stomach ulcers. See separate leaflets called 'Duodenal Ulcer', and 'Acid Reflux and Oesophagitis'.

Duodenal Ulcer

Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.

Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Esophageal ulcers that occur inside the hollow tube (esophagus) that carries food from your throat to your stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

Symptoms

Pain is the most common symptom

Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:

• Be felt anywhere from your navel up to your breastbone
• Be worse when your stomach is empty
• Flare at night
• Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication
• Disappear and then return for a few days or weeks

Symptoms

Less often, ulcers may cause severe signs or symptoms such as:

• The vomiting of blood — which may appear red or black
• Dark blood in stools or stools that are black or tarry
• Nausea or vomiting
• Unexplained weight loss
• Appetite changes

Causes

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the esophagus, stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Common causes include:

• A bacterium. Helicobacter pylori bacteria commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems, but it can cause inflammation of the stomach's inner layer, producing an ulcer.
• It's not clear how H. pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.
• Regular use of certain pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, Anaprox, others), ketoprofen and others.
• Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.

Risk factors

You may have an increased risk of peptic ulcers if you:

• Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.

Surgery for cancer of the stomach

Surgery is rarely needed to treat peptic ulcers. Very effective medicine treatments are available to help heal ulcers. Treatment of a Helicobacter pylori (H. pylori) infection prevents most ulcers from coming back.

• Ulcers that do not heal (intractable peptic ulcers) after extensive medicine therapy and self-care.
• Life-threatening complications of an ulcer, such as severe bleeding, perforation, or obstruction.

Surgery Choices

When surgery is done to treat an ulcer, it usually involves one or more of the following:

• Cutting one or more of the nerves to the stomach (vagotomy).
• Widening the opening of the bottom of the stomach (pyloroplasty).
• Removing part of the stomach (partial gastrectomy).

What is fundoplication?

Fundoplication is the standard surgical method for treating gastro-esophageal reflux disease (GERD). GERD causes inflammation, pain (heartburn), and other serious complications (such as scarring and stricture) of the esophagus. GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to reflux of acid. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most of the time, this muscle is contracted (constricted, or tight), which closes off the esophagus from the stomach. In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately. Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.

What happens during fundoplication?

During the fundoplication procedure, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, wrapped, and sutured (sewn) around the lower end of the esophagus and the lower esophageal sphincter. (The gathering and suturing of one tissue to another is called plication.) This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux.