Steve Wright, a former Radio 2 DJ, died from a ruptured stomach ulcer at the age of 69, the BBC recently revealed. Although Wright died in February, the cause of death has only just been made known.
Author
Adam Taylor
Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University
But what causes stomach ulcers and how can they be prevented?
Two causes
There are two main causes of stomach ulcers. One is H pylori, a species of bacteria that isn't killed by stomach acid. In fact, it thrives in an acidic environment.
In the stomach, it moves through the protective layers of mucus that line the stomach and produces an enzyme called urease that damages the stomach lining.
The second cause is drugs called non-steroidal anti-inflammatories, or NSAIDs. Possibly the most well-know NSAID is ibuprofen.
Ibuprofen reduces the production of hormone-like substances called prostaglandins, which help heal tissue damage and injury. But it doesn't just do this at the source of the pain - it acts on the whole body, including the stomach.
In the stomach prostaglandins reduce acid secretion and stimulate mucus production. This means that when people take NSAIDs they reduce the production of protective prostaglandins, which in turn increases acid production and decreases the production of substances that protect the gastric lining.
Contrary to popular belief, stress and spicy foods don't cause stomach ulcers, but they can make them worse.
How do ulcers form?
Initial damage to the stomach lining appears as irritation, known as gastritis. If this progresses, the innermost lining can erode. Without treatment, larger sores (ulcers) appear in the gastric lining, eroding down into the underlying submucosa and underlying muscular layer.
Ulcers can range from 3mm to several centimetres in diameter. If treatment isn't sought for a long enough period the erosion can tear all the way through the layers of the stomach, out into the cavity around the abdominal organs.
If this occurs, the stomach contents, including all the microbes within it, can leak into the abdominal cavity and cause a significant infection called peritonitis. This can swiftly progress to sepsis, which can rapidly lead to death.
Ruptured ulcers are associated with up to 30% mortality rate, and this can rise as high as 50% with increasing age. Even those who make it to the hospital and have surgery are at an increased risk of death.
Before perforation, the patient may notice dark (black) poo which smells foul and has a tar-like consistency, this is a classical symptom of a bleeding ulcer called melena. The dark colour of the faeces is caused by the digestive breakdown of the blood in the intestines.
Who gets ulcers?
Ulcers can affect anyone, but they are more common in men and in older adults. Studies show that up to 78% of people over 65 may have a stomach ulcer.
Smoking, taking antidepressants, especially if taking NSAIDs, too, consuming large quantities of alcohol over a prolonged period (because alcohol damages the stomach lining) and stomach injury all increase the risk too.
In older adults, there is an increased risk of dying from ulcers because the symptoms aren't always typical, and managing ulcers can become difficult because of side-effects and drug interactions with other medications.
How they're treated
Not all stomach ulcers have symptoms, but when they do cause symptoms they usually include heartburn or reflux, burping, nausea and abdominal pain.
A doctor can usually make a diagnosis based on symptoms alone, but the gold standard for diagnosis is gastroscopy, where a small camera on a tube is inserted into the mouth and swallowed enabling the doctor to see the internal lining of the stomach.
Treatment is often aimed at reducing stomach acid to allow the lining to repair. Two types of drugs are taken to promote this: H2 receptors, such as famotidine, or proton pump inhibitors, such as omeprazole or lansoprazole.
People who have an ulcer that was caused by NSAIDs may need to take one of these drugs in the long term to prevent a relapse.
Ulcers in the stomach are usually easily treatable once the cause is identified and can prevent more serious complications, such as cancer, particularly where H pylori is the cause. So if you have any of the symptoms listed above, do see your GP as soon as you can.
Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
