Linda Crampton is a writer and former teacher with a first-class honors degree in biology. She writes about the scientific basis of disease.
What Is a Stomach Ulcer?
A stomach ulcer is a sore on the inside of the stomach. The majority of stomach ulcers are caused by a bacterium named Helicobacter pylori, or H. pylori. Most of the remaining cases are caused by excessive use of medications called nonsteroidal anti-inflammatory drugs, or NSAIDs. Aspirin, ibuprofen, and naproxen are examples of NSAIDs. Excess stomach acid and stress don't cause ulcers, but they may make existing ones more painful.
Stomach ulcers can be very painful, especially when acid has been released into the stomach cavity to help food digestion. They can be treated, but the treatment may need to be taken for several weeks in order to be completely effective. While an ulcer is healing, it's important to treat it gently. An irritated ulcer can make life miserable.
Specific self-care steps should reduce pain from a stomach ulcer while waiting for the medically-prescribed treatments to work. A nutritious diet that includes certain foods, the elimination of foods that trigger pain, a healthy lifestyle, and stress reduction should all help to relieve the pain.
The information in this article is given for general interest. Anyone with unexplained stomach pain or questions about relieving the pain should visit a doctor for a diagnosis, treatment, and advice. Self-help techniques can be very useful for dealing with a stomach ulcer but are not a substitute for medical attention.
Stomach, Gastric, and Peptic Ulcers
Stomach ulcers are sometimes called gastric ulcers. The term "peptic ulcer" is also used, but this term refers to either a stomach ulcer or a duodenal one. The duodenum is the first part of the small intestine and is a common site of ulcer formation.
Often, pain from a stomach ulcer is worse soon after eating as acid production increases in the stomach. Pain from the dudodenal version may be worse two to three hours after eating when the food has left the stomach and entered the duodenum.
Occasionally, a peptic ulcer develops in the lining of the esophagus. In this location, it's also known as an esophageal ulcer. The esophagus is the tube that travels from the throat to the stomach. A muscle called the lower esophageal sphincter normally prevents stomach contents from entering the esophagus. Sometimes the sphincter doesn't close the passageway properly, however, allowing material to move from the stomach into the esophagus. Irritants entering the esophagus from the mouth can also cause esophageal ulcers.
What Causes a Stomach Ulcer?
The stomach lining is protected from damage by a layer of mucus. This mucus prevents the hydrochloric acid and digestive enzymes in the stomach cavity from irritating the stomach lining. The acid is required for protein digestion to take place. It also kills bacteria that have entered the stomach.
Helicobacter pylori hides in the mucus layer covering the stomach lining and is protected from an attack by acid and enzymes. In some people, the bacterium is present but causes no problems. In others, the presence of the bacterium leads to a weakened mucus layer, inflammation, and an ulcer.
Aspirin, ibuprofen, naproxen, and other nonsteroidal anti-inflammatory drugs can also cause ulcers when taken at a high dose for a long time. They reduce the production of protective mucus in the stomach. In addition, they may irritate the stomach lining and make it bleed. If a doctor has prescribed one of the medications, a patient shouldn't stop taking the drug without their physician's advice.
Possible Medical Treatments
It's important that someone with stomach pain visits a doctor to find the cause of the problem. A variety of medications are available to treat a stomach ulcer. The doctor will prescribe a suitable treatment regimen based on the cause of the problem.
If the person has a Helicobacter pylori infection, a specific antibiotic may be prescribed. Other drugs may be prescribed to reduce acid production in the stomach or to neutralize acid that has already been produced. A drug to protect the lining of the stomach may also be prescribed. All of the medications should be taken as recommended. The self-care tips that I include below are meant to accompany the medical treatment. They don't replace them.
Follow a Healthy Diet to Help Relieve Pain
Following a healthy diet will help to strengthen the immune system, which may aid the healing of a stomach ulcer. Some healthy foods may directly fight an ulcer and help to relieve the pain that it causes.
Vegetable, legumes or pulses (beans, lentils and peas), fruits, and whole grains are generally recommended as the main components of a good diet. Plant foods are rich in beneficial nutrients. Cabbage and other cruciferous vegetables such as broccoli, Brussels sprouts, cauliflower, and kale may be especially useful in treating an ulcer. Cranberries and cranberry juice may fight Helicobacter pylori. Cranberry juice often contains lots of sweetener, however.
Foods from plants are high in fibre, which has been shown to reduce the risk of peptic ulcer development. Both soluble and insoluble fibre are important in the diet, but soluble fibre seems to be the most useful type with respect to peptic ulcers. Foods rich in soluble fibre include oats, barley, beans, peas, and lentils.
Healthy fats include the omega-3 fatty acids in oily fish and the monounsaturated fatty acids in olive oil. Lean protein is also an important component of the diet. Extra virgin olive oil and unsweetened yogurt containing live probiotics (good bacteria) are both excellent foods. There is some evidence that they are helpful for an ulcer, but they should probably be eaten in small to moderate quantities. An excessive amount of fat or protein may be irritating for some patients.
Some foods may trigger stomach pain in people with ulcers. What causes pain in one patient may not hurt another patient, however. It's important that a person doesn't eliminate or restrict the ingestion of a healthy food unless they're sure that it makes their pain worse.
Avoid Food and Drinks That Increase Pain
You may not need to eliminate the following foods and drinks from your diet. Some people find that they irritate stomach ulcers, however. If this is the case for you, you might want to avoid them until your ulcer has healed. Some possible causes of ulcer irritation include:
- foods that are high in fat
- spicy foods
- acids from citrus fruits (such as oranges, lemons, limes, and grapefruit)
- beverages with a high caffeine level, such as coffee
- carbonated beverages
- decaffeinated coffee
A patient might want to keep a food diary and record any pain that results after eating the food. This may make it easier to choose an appropriate diet. If someone knows that a food irritates their stomach even when they don't have an ulcer, it would probably be a good idea to at least temporarily eliminate it from their diet.
Try Eating Small Servings of Some Foods
Try eating red meat and other very high-protein foods in small servings. When protein is eaten, hydrochloric acid is released into the stomach cavity to convert pepsinogen into pepsin, the enzyme that digests the protein. Protein is an important nutrient and needs to be part of the diet. Foods that are concentrated sources of protein require a larger amount of acid for digestion than foods containing a smaller amount, however.
People with a stomach ulcer are often advised to eat small or moderately sized meals instead of large ones. When a smaller meal is eaten, less stomach acid should be produced. In addition, a very large meal can stretch the stomach and make an ulcer more painful. Patients are also frequently advised to avoid eating close to bedtime in order to reduce acid secretion during the night.
Smoking seems to increase the chance of a stomach ulcer developing and slow or prevent the healing of one that is already present. It increases the amount of stomach acid that is produced and decreases the amount of sodium bicarbonate made in the small intestine. The bicarbonate neutralizes the acid that enters the intestine from the stomach, so when less bicarbonate is present there is more acid to irritate an ulcer in the intestine.
Though quitting smoking may sound like a sensible idea, the process may be difficult, especially when a person already has a stomach ulcer. Quitting smoking may be a major undertaking at a time when a person is already stressed by the presence of an ulcer. A doctor's advice should be sought in this situation.
Be Careful With Medications
Take your prescribed medication at the correct time and don't miss any doses in order to heal your ulcer. If you want to take any over-the-counter pain relievers or antacids, discuss whether this is advisable with your doctor and also ask which medications are best. Acetaminophen (paracetamol) may be appropriate as a pain reliever, since it isn't an NSAID. Since NSAIDs can stimulate ulcer development under certain conditions, taking one when an ulcer already exists might cause the problem to get worse. Concerns exist about the excessive use of acetaminophen, however. These should be investigated.
If you have an ulcer, remember to tell your doctor about all the medications that you take without his or her knowledge, including herbal medicines and supplements. Some medications can irritate ulcers, and some can interact with prescribed medicines. This problem applies to certain herbal medicines as well as pharmaceutical ones.