Stomach ulcers: new therapies and practical advice for recovery

Do you experience pain, burning or bloating in your stomach after meals? Many people experience similar symptoms and often just shrug it off, saying „I must have eaten something bad”. However, these signs could also indicate a stomach ulcer, a condition that needs to be taken seriously. The good news is that, thanks to modern medicine, there are now a number of effective treatment options that can not only alleviate symptoms but also promote a full recovery.

In this article, we explain in detail what exactly a peptic ulcer is, what factors cause it and how to recognise its symptoms. We also cover diagnostic methods, traditional and the latest innovative therapies. Our aim is to provide you with all the information you need to face this condition with confidence and preparation, and to understand that with the right specialist help, such as Endomedix Gastroenterology Centre recovery is possible and achievable.

What is a stomach ulcer and why does it develop?

A peptic ulcer (Latin: ulcus ventriculi) is a wound-like lesion that develops on the mucous membrane lining the inner wall of the stomach. Normally, the acidic environment of the stomach helps digest food, while a thick layer of mucus protects the stomach wall from the corrosive effects of acid. If this protective mechanism is weakened for some reason, or if acid production becomes excessive, the acid begins to damage the mucous membrane, leading to ulceration.

Main causes and risk factors:

• _Helicobacter pylori_ infection: This bacterium may be responsible for a significant proportion of stomach ulcer cases, up to 60%. _H. pylori_ is able to survive in the acidic environment of the stomach and causes inflammation, which weakens the protective lining of the mucosa.
• Taking non-steroidal anti-inflammatory drugs (NSAIDs): Commonly used painkillers and anti-inflammatory drugs such as aspirin, ibuprofen or diclofenac can increase the risk of developing an ulcer by a factor of four if taken regularly or in high doses. These drugs inhibit the production of prostaglandins, which play an important role in protecting the stomach lining.
• Smoking: Smoking not only increases acid production, but also reduces the blood supply to the stomach, which slows down mucosal regeneration and ulcer healing.
• Excessive alcohol consumption: Regular, large amounts of alcohol irritate and damage the stomach lining, contributing to ulcer formation.
• Stress: Although rarely a cause of ulcers on its own, chronic stress can contribute to increased acid production and weaken the body's defences, exacerbating existing problems.

What symptoms can indicate a stomach ulcer?

Stomach ulcer symptoms can be varied and are not always clear. The most common complaint is a dull, burning or cramping pain in the stomach area, in the abdomen.

• Pain after meals: Stomach ulcers are characterised by pain that gets worse after eating, as food stimulates acid production.
• Pain at night: Unlike duodenal ulcers (where eating relieves the pain), stomach ulcer pain does not necessarily occur at night, but it can.
• Bloating and a feeling of fullness: Many patients complain of an unpleasant feeling of fullness and bloating, even after small meals.
• Nausea, vomiting: Nausea is also a common symptom, and in more severe cases vomiting may occur.
• Loss of appetite and weight loss: Fear of pain can reduce appetite, leading to involuntary weight loss.

It is important to know that some patients, especially those with ulcers caused by NSAIDs, may be asymptomatic until a serious complication such as bleeding or perforation of the stomach wall occurs.

Making the diagnosis: what can you expect from the tests?

If you suspect a stomach ulcer based on your symptoms, you should consult a specialist gastroenterologist for an accurate diagnosis. Don't be afraid to have tests, they are essential to start the right treatment.

The most important diagnostic procedure is gastroscopy (gastroscopy). Although many people fear it, this test is now a routine procedure and can be performed under general anaesthesia with minimal discomfort. It involves a thin, flexible tube (endoscope) being passed through the mouth into the stomach, with a small camera at the end.

Why is a gastroscopy essential?

• Accurate diagnosis: The camera allows the doctor to see the mucous membrane directly and assess the size, location and condition of the ulcer.
• _H. pylori_ test: The test can include a biopsy of the stomach to detect the presence of _Helicobacter pylori_.
• Exclusion of malignancy: All gastric ulcers must be histologically sampled to rule out the possibility of cancer. This is not a routine procedure for duodenal ulcers.
• Immediate intervention: If the ulcer is actively bleeding, immediate haemostasis may be performed during the endoscopic examination.

Traditional and modern treatment options

The aim of stomach ulcer treatment is threefold: to relieve pain, to help the ulcer heal and to prevent recurrence. Therapy is always personalised and depends on the cause of the ulcer.

Reducing acid production: the cornerstone of therapy

Treatment is based on medicines that inhibit acid production. The most effective of these are proton pump inhibitors (PPIs). These medicines are extremely effective in reducing the production of stomach acid, giving the mucous membrane the time it needs to heal. Treatment usually takes 4-8 weeks. Less effective but also used are H2-receptor antagonists.

Eradication of _Helicobacter pylori_ (eradication)

If tests confirm _H. pylori_ infection, it is essential to eradicate the bacterium. This usually involves a 10-14 day course of combined medication consisting of a proton pump inhibitor and two types of antibiotics. It is very important that you follow the course of treatment exactly as prescribed by your doctor and for the length of time prescribed, even if your symptoms have already started to subside. The success of the treatment is usually checked weeks later.

New therapeutic methods for stubborn and bleeding ulcers

Although most ulcers respond well to medication, there are stubborn, hard-to-heal or bleeding cases that require specialised intervention. Modern gastroenterology has also made significant advances in this area.

• Advanced endoscopic haemostasis: Bleeding ulcers are now treated endoscopically. In addition to traditional injection (epinephrine), thermal (electrocoagulation) and mechanical (clips) methods, new, more effective tools have been developed.

- Hemospray: This is a special powdered anti-coagulant that can be sprayed directly onto the bleeding surface through the endoscope. In contact with the blood, the powder forms a gel-like layer that mechanically seals the bleeding. It is particularly effective for diffuse, large surface bleeding.

- Over-the-scope clip (OTSC) or „bear trap”: This is a large clip placed on the end of the endoscope that can hold the base of the ulcer and surrounding tissue together, so that it can mechanically seal off bleeding from even the larger blood vessels. It is used for large ulcers larger than 2 cm or deep ulcers where conventional clips would no longer be sufficient.

• Potassium-competitive acid blockers (P-CAB): Although less widely used in Hungary, these are a new generation of medicines with a faster and stronger antacid effect than PPIs. They have the advantage that their effect is not dependent on food intake and they provide more stable acid inhibition 24 hours a day. In the future, they could play an important role in the treatment of stubborn ulcers that are difficult to heal.
• Treatment of refractory ulcers: If the ulcer does not heal after 12 weeks of appropriate medication, it is called a refractory ulcer. In such cases, the cause of the failure (e.g. hidden NSAID use, smoking, undiagnosed cancer) should be investigated carefully in addition to increasing the dose of medication (e.g. double dose PPI).

Lifestyle advice and prevention

In addition to medication, lifestyle changes are also key to recovery and prevention of relapse.

• Stop smoking: It's one of the most important steps you can take to keep your stomach healthy.
• Avoid alcohol: Abstain from alcohol completely during treatment.
• Be careful with painkillers: If possible, avoid the use of NSAIDs. If you must take them (e.g. because of a rheumatological condition), consult your doctor, who may prescribe an anti-acid (PPI).
• Dietary advice: Although a strict diet is not necessary, it is advisable to avoid excessively spicy, fatty, indigestible foods, carbonated drinks and strong coffee, especially during the symptomatic period. Eat more often and in smaller portions.
• Stress management: Look for relaxation techniques (yoga, meditation, breathing exercises) that can help relieve stress.

When should you see a doctor immediately?

Some symptoms may indicate a serious complication that requires immediate medical intervention:

• Sudden, severe, knife-like pain in the abdomen: It may indicate perforation of the stomach wall.
• Vomit: Vomit can be anything from fresh, red blood to coffee grounds-like dark debris.
• Pitch stool: Black, tarry, foul-smelling stools indicate digested blood.
• Dizziness, weakness, feeling faint: There may be signs of large amounts of blood loss.

If you experience any of these, don't delay, call an ambulance or go to the nearest emergency department immediately!

The road to recovery: expert help for lasting results

Peptic ulcer is a serious but in most cases easily treatable disease. The key is accurate diagnosis and personalised, consistent therapy, which requires close cooperation with a specialist gastroenterologist. After recovery, usually 6-8 weeks later, a follow-up gastroscopy is necessary to monitor the healing process and to definitively rule out malignant lesions.

Don't let pain and discomfort control your life! Take the first step towards recovery. Visit Endomedix Gastroenterology Centre experienced specialists are at your disposal with modern diagnostic tools and the latest therapeutic procedures to help you regain your digestive health and a pain-free daily life.