People generally head to the hospital to get healthier, but your body can still show signs of stress after you have been admitted. One common type of malady that affects particularly sick patients after being admitted to intensive care settings is the appearance of stress ulcers. 

What are Stress Ulcers?

The terminology around ulcers can be a bit confusing. Being under chronic psychological or physiological stress for long periods may contribute to the formation of some ulcers, but the term “stress ulcer” refers to a specific type of irritation to the lining of your gastrointestinal tract that appears quickly as a result of acute physiological stresses such as severe illness, infections, or head injuries.  

Unlike peptic ulcers, stress ulcers are a form of gastric ulcer that appears in people who have other underlying medical conditions such as systemic infections, organ failure, and head injuries. Peptic ulcers typically form gradually over time from H. pylori infections, chronic stress, or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Stress ulcers, by contrast, often form quickly in people who are placed on ventilators or who are admitted to intensive care units for serious medical conditions.

What are the Symptoms of Stress Ulcers?

Stress ulcer symptoms are not altogether different from those of peptic ulcers and many other gastric conditions. This can sometimes present a challenge, as a wide range of diseases and conditions can produce many common symptoms, including:

  • pain in the upper stomach
  • abdominal pain, with or without bloating
  • pain that varies based on food intake
  • feeling unusually full or bloated
  • symptoms of anemia, like pale skin and shortness of breath
  • nausea or vomiting

While these are concerning symptoms in their own right, some ulcers may bleed heavily, which can cause dangerous levels of blood loss in patients who are already suffering from other serious medical conditions. Symptoms of a heavily bleeding ulcer can include:

  • vomit that resembles coffee grounds or contains large amounts of blood
  • bloody stool
  • tarry, dark bowel movements
  • fainting or feeling light-headed

What Triggers Stomach Ulcers?

Stomach ulcers can be caused by a wide variety of triggers. Though your stomach is a naturally acidic environment, the continuous use of NSAIDs such as ibuprofen or naproxen, chronic psychological stress, and other factors can upset the chemical balance in your stomach and cause an increase in the amount of stomach acid your body produces. 

This increase in acidity can cause holes to form in the mucosal lining of your stomach and the upper portion of your small intestine known as the duodenum. One of the most common causes of stomach ulcers is an infection of the H. pylori bacterium, which can cause your stomach to secrete too much acid, eventually wearing holes in the lining of the stomach.

One bit of good news for lovers of spice is that recent research has shown that eating spicy food is not a significant contributor to the formation of ulcers. This is not to say, however, that eating certain foods won’t irritate an ulcer that already exists. If you have an ulcer and find that eating hot, spicy foods makes your symptoms worse, it is best to stick to a bland diet.

Can Stress and Anxiety Cause Stomach Ulcers?

There is still some debate over this in the medical community, but there is evidence to suggest chronic stress and anxiety can result in imbalances in hormone levels that can increase the acidity of your stomach. This increase in stomach acid can eventually lead to ulcerations in the lining of your stomach and duodenum. 

Stress and anxiety have also been linked to sleep disorders, which can further wear your body down and make it harder for tissues to repair themselves, further wearing away at your stomach lining. 

How are Ulcers Treated?

Treatment for stress ulcers is similar to that for other stomach and duodenal ulcers. Similar to the use of over-the-counter antacids to help treat occasional heartburn, the first goal of treatment is to lower the acidity of your stomach to allow inflamed tissues to begin healing. 

One of the first lines of treatment for stress ulcers are drugs such as proton pump inhibitors or histamine blockers designed to reduce the secretion of stomach acid. These drugs work on different chemical pathways, but both can help reduce the elevated amount of acid in your digestive tract that contributes to the development of ulcers. 

Though allowing your body to begin healing itself is part of the course of treatment, it is not the entire picture. Since stress ulcers are typically present in patients who are suffering from other serious illnesses, treating the underlying condition that caused your stress ulcers to appear will be necessary for your body to fully heal. 

How are Ulcers Diagnosed?

Blood tests and even breath tests for H. pylori infections can give your doctor a clue as to what is going on inside you, but to be sure nothing is missed in a diagnosis, a visual inspection is essential. Getting a look inside is typically done during an endoscopy, a procedure where a long, thin, flexible tube with a camera on the end is inserted through your mouth and down your esophagus. This camera allows your doctor to inspect the lining of your stomach and the upper portion of your small intestine. In some cases, the endoscope can be fitted with tools to retrieve tissue samples to check for stomach cancer. 

Anytime you experience prolonged gastrointestinal bleeding, you should seek medical attention immediately. Many other gastrointestinal conditions, including stomach and colon cancer, can cause blood to appear in your stool or in vomit. Other serious conditions such as Crohn’s disease can mimic many of the symptoms of ulcers, which makes getting a firm diagnosis from a gastroenterologist crucial to ensuring you are treating the underlying condition and not merely managing symptoms. 

Cancer is not the only concern for people suffering from stomach ulcers. Having a perforation in the lining of your stomach or esophagus is a significant risk factor for bacterial infections, bleeding, and shock.  The likelihood of developing stress ulcers increases for patients who need to be intubated, which can further complicate treatment for individuals suffering from acute coronavirus infections. The increased chance of complications from blood loss or possible infection can make placing patients on a respirator more dangerous. Stress ulcers are more common in people who have a history of gastric bleeding or peptic ulcers. For this reason, it is more important than ever to maintain good digestive health. At Cary Gastroenterology, we focus our expertise on the digestive tract to help provide the best possible outcomes for individuals suffering from problems with their gastrointestinal tract. If you have been experiencing the symptoms listed above, or are merely interested in being more proactive about your digestive health, request an appointment with us today.