A stomach ulcer causes pain in the stomach area or pain in the upper abdomen, and a burning sensation behind the breastbone may also occur. In cases of stomach pain, testing should be carried out to determine whether there is inflammation of the stomach lining. Stomach complaints may indicate a bacterial infection, but a food allergy or the use of painkillers can also cause stomach pain.
Stomach ulcer – a bacterial infection
In more than 10% of people with stomach complaints, the bacterium Helicobacter pylori is found in the stool. This bacterium is contagious; Helicobacter pylori can be transmitted through contaminated hands, contaminated food or water.
Complaints that may indicate a stomach ulcer are a burning, gnawing sensation in the stomach area or behind the breastbone. The pain may radiate to the back, between the shoulder blades or to the neck. Nausea and a bloated feeling in the abdomen are also common. The pain occurs especially when you are hungry and decreases after eating or taking an acid-suppressing medicine. Men have an increased risk of a stomach ulcer, as do people who smoke cigarettes.
Infection with Helicobacter pylori, which causes stomach ulcers, is more common among immigrant populations and increases after the age of 45.
Stomach complaints
The stomach wall and oesophagus may be irritated without a bacterial infection. The cause may be:
A hernia of the diaphragm.
Inflammation of the oesophagus, oesophagitis; this may be caused by irritation from stomach acid.
Food allergies and coeliac disease can cause stomach complaints, including stomach ulcers.
Blastocystis hominis often causes nausea.
Reflux
When eating, food is swallowed and passes through the oesophagus into the stomach. At the level of the diaphragm, the oesophagus transitions into the stomach, where a valve closes off the stomach. With reflux, food flows back from the stomach into the oesophagus. If this happens frequently, symptoms can develop because the lining of the oesophagus becomes irritated.
Reflux can also cause a burning, gnawing sensation behind the breastbone or swallowing problems, with pain radiating to the back, between the shoulder blades or to the neck.
Sometimes stomach acid reaches the throat and mouth; this is called regurgitation. The rising acid can irritate the mucous membrane and cause coughing. It can also cause a bloated abdomen, diarrhoea and flatulence.
Reflux symptoms increase when fatty meals are eaten frequently, during pregnancy and in people who are overweight.
- Inflammation of the oesophagus can lead to scarring and narrowing. Abnormal cells, a metaplasia (Barnett), may also develop. These cells can develop into cancer cells.
- In people with gluten intolerance, eating bread can often cause stomach or reflux complaints.
Testing
The Helicobacter test can distinguish between a stomach ulcer and reflux.
- Stool testing is a very reliable way to detect Helicobacter pylori.
- Small amounts of bleeding can occur with a stomach ulcer. The blood passes from the stomach into the intestines and eventually ends up in the stool. This can be detected with the occult blood test.
- When acid-suppressing medicines are used, digestion decreases. This can reduce fat absorption and increase the fat content of the stool.
Because reduced fat absorption is often associated with low levels of fat-soluble vitamins such as vitamin D3, it is advisable to have the vitamin D3 level in the blood measured.
Nausea
Nausea can occur with bacterial infections, allergies and intestinal parasites. A gallbladder disorder can also cause nausea. A digestion test can detect reduced fat absorption. This is often accompanied by a bloated abdomen, flatulence and abnormal bowel movements.
Intestinal parasites
Infection with intestinal parasites can cause nausea. This occurs especially with infection by Blastocystis hominis. In that case, a very bloated abdomen and flatulence are common.
Gluten intolerance
Stomach complaints and reflux are more common with gluten intolerance (coeliac disease). If eating bread makes the complaints worse, it is advisable to request the gluten intolerance test. Stomach complaints can be caused by food allergy.
Irritation caused by painkillers
The use of painkillers such as diclofenac can irritate the mucous membrane and cause inflammation of the stomach. Testing does not detect Helicobacter pylori. However, inflammatory markers such as calprotectin can be tested; this substance is often elevated with chronic use of painkillers.
Complaints caused by a stomach ulcer or reflux are:
- stomach pain, heartburn
- increase in complaints on an empty stomach
- certain foods cause irritation
- nausea and belching
- distended or bloated abdomen
- irritated throat, tickly cough
- a characteristic feature is that symptoms decrease when acid-suppressing medicines are used
