Asymptomatic stomach ulcers are becoming a "silent killer," and experts urge high-risk groups to undergo screening proactively.
For decades, the common image of a stomach ulcer was that of an executive clutching his stomach after a stressful business lunch. Today, medicine has corrected this misconception: ulcers are not caused by stress or spicy food, but primarily by bacteria and commonly used painkillers. However, a dangerous reality remains-many ulcers, especially drug-induced ones, are often asymptomatic and pose a serious threat to public health.
Gastrointestinal ulcers, or peptic ulcer disease (PUD), were once shrouded in mystery, with stress and spicy food being widely believed as the causes. Today, they are well understood, and the disease is treatable. Peptic ulcers-open ulcers in the stomach (gastric ulcers) and upper duodenum (duodenal ulcers)-are far from rare but pose a significant global health burden, despite modern medicine's efforts to reduce their incidence.
Understanding the typical warning signs and risk factors for these occult ulcers is a crucial first step in prevention and timely treatment. Two major contributing factors are outlined below:
1. Persistent Bacteria: Helicobacter pylori
The most common cause of peptic ulcers is chronic infection with Helicobacter pylori (H. pylori). This spiral-shaped bacterium is present in the gastric mucosa of approximately two-thirds of the world's population and is usually asymptomatic. However, in some infected individuals, it triggers a chronic inflammatory response called gastritis.
Helicobacter pylori lives under the protective layer of the gastric mucosa, shielded from the highly acidic environment. It causes damage in several ways: it produces urease, which converts urea into ammonia, neutralizing surrounding stomach acid and making the environment more suitable for its survival. It directly irritates the gastric mucosa and triggers inflammation. This inflammation makes the gastric mucosa more susceptible to damage from its own digestive juices.
This infection is believed to be primarily transmitted through person-to-person contact, especially the fecal-oral or oral route, and through contaminated food or water. Although its prevalence is declining in developed countries due to improved sanitation, it remains a significant public health issue globally.
2. The Painkiller Paradox: Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are the second leading cause of peptic ulcers, especially in developed countries, where their overuse is a major contributing factor. One reason for the declining Helicobacter pylori infection rate is the frequent use of NSAIDs. These drugs include common over-the-counter medications such as aspirin, ibuprofen, and naproxen sodium. They promote the formation of a protective mucus layer and a bicarbonate layer, helping maintain an adequate blood supply to the gastric mucosa and thus promoting cell repair. However, they weaken the gastric mucosal barrier, rendering it more susceptible to erosion by gastric acid and pepsin. Long-term or high-dose use significantly increases the risk of ulcers, especially in older people and those with a history of ulcers.
How to Recognize Stomach Ulcer Symptoms and Latent Ulcers in Everyday Life
A typical warning sign is that stomach pain is not just "indigestion."
The most common and characteristic symptom of peptic ulcers is dull, burning, or throbbing pain in the upper abdomen, especially the area between the sternum and the navel. This discomfort is often described as hunger or severe heartburn, and its unique pain pattern helps distinguish it from other digestive problems.
1. Timing of Pain Onset: A Key Clue
The timing of pain relative to mealtime is key to distinguishing between the two main types of ulcers.
The most common is a duodenal ulcer, which causes pain that usually worsens when the stomach is empty. The pain may occur 2 to 3 hours after eating or wake you up at night. Crucially, eating or taking antacids usually relieves the pain because food buffers stomach acid. The second most common is a gastric ulcer, whose pain may worsen shortly after eating because the act of eating stimulates the stomach to release more acid, immediately irritating the ulcer. Eating usually does not relieve the pain, or it may recur quickly.
2. Stomach Symptoms Aren't Just Burning Pain
Besides the primary abdominal pain, peptic ulcers can disrupt the digestive process in other ways and manifest as more common symptoms in daily life, such as bloating and a feeling of fullness, nausea and vomiting, heartburn and unexplained weight loss due to indigestion, and loss of appetite, often caused by eating exacerbating the pain or persistent nausea, leading to significant, involuntary weight loss.
The most worrying type is the occult ulcer. Most people only seek medical attention when they experience heartburn, such as with stomach protectants or during research on newer drugs like BPC-157. Still, occult ulcers often go unnoticed in daily life, which is the most concerning aspect of peptic ulcers. These ulcers do not cause obvious pain or discomfort.
Medical experts emphasize that the following four high-risk groups should be highly vigilant and proactively consult a doctor for relevant screening:
1. People who frequently take nonsteroidal anti-inflammatory drugs (NSAIDs): If you take low-dose aspirin to protect your cardiovascular system, or frequently (daily or almost daily) take over-the-counter NSAIDs to relieve chronic pain (such as arthritis, migraines).
2. Older adults (65 years and older): Aging increases the risk of ulcer formation and often reduces pain response, making ulcers more likely to be asymptomatic.
3. Individuals infected with Helicobacter pylori: Helicobacter pylori is the most common ulcer pathogen worldwide. Although many infected individuals are asymptomatic, a routine **breath or stool test** can confirm the diagnosis. Even without symptoms, eradicating Helicobacter pylori is an important preventative measure.
4. Individuals with chronic diseases: Patients with serious illnesses (such as liver disease).
"Simply focusing on a burning sensation in the stomach is far from enough," the expert added. "For high-risk groups, proactive testing and prevention are the best strategies to block this common but potentially life-threatening condition. The public is advised to pay attention to persistent indigestion signals and seek medical attention promptly, especially if you belong to any of the high-risk groups mentioned above (particularly those who take nonsteroidal anti-inflammatory drugs (NSAIDs) long-term). Here's a brief explanation of gastric mucosal protectants: these medications do not directly inhibit stomach acid but work by forming a protective layer on the gastric mucosa and promoting mucosal repair; they are often used in combination with acid-suppressing drugs. Studies have found that BPC-157 is beneficial for gastric ulcers, fistulas, and inflammatory diseases. BPC-157 has anti-ulcer properties, can scavenge free radicals, and promotes wound and fistula healing.