Ventricular ulcer (stomach ulcer): overview

Ventricular ulcer is a gastric mucosal defect caused primarily by Helicobacter pylori and the use of NSAIDs. Diagnostically, an esophagogastroduodenoscopy is performed and bleeding and perforations are treated directly. Helicobacter eradication and PPIs are important for treatment and prophylaxis.

What is a ventricular ulcer?

A ventricular ulcer is a defect in the gastric mucosa with a diameter of at least 5 mm that extends beyond the lamina muscularis mucosae. Erosions are smaller defects in which the lamina muscularis mucosae remains intact.

Why is this important?

Approximately 5-10% of the population will suffer from a ventricular ulcer in their lifetime and the annual incidence is 0.1 to 0.3%. In recent decades, the incidence has fallen sharply in high-income countries, which is due to improved treatment.

Epidemiology of ventricular ulcer

The lifetime prevalence of ventricular ulcer in the general population is approximately 5-10% and the incidence is 0.1 to 0.3% per year. In recent decades, the incidence has fallen sharply, especially in high-income countries. The declining figures can be explained by the increasing use of proton pump inhibitors (PPI) and more restrictive use of non-steroidal anti-inflammatory drugs (NSAIDs).

What causes a ventricular ulcer?

The main causes are an infection with Helicobacter pylori (HP) and the use of non-steroidal anti-inflammatory drugs (NSAIDs). HP infections and NSAIDs increase the risk of a ventricular ulcer by a factor of five to fifteen. However, other factors such as smoking, alcohol and stress also play a role.

How does a ventricular ulcer develop?

An imbalance between aggressive (e.g. stomach acid) and protective factors (e.g. mucus production) leads to damage to the stomach lining. HP infections increase acid production, while NSAIDs reduce mucus production.

What are the symptoms?

Typical symptoms are epigastric pain and signs of bleeding such as anemia, hematemesis (vomiting of blood), melena (tarry stools) and hematochezia (blood in the stool). The symptoms can be alleviated with antacids.

How is a ventricular ulcer diagnosed?

The most important diagnostic method is oesophago-gastro-duodenoscopy (OGD), in which tissue samples are taken to detect HP and rule out other diseases.

How is a ventricular ulcer treated?

The treatment depends on the cause. In the case of HP-positive ulcers, eradication therapy with antibiotics and proton pump inhibitors (PPIs) is carried out. NSAID-induced ulcers require discontinuation of the NSAID and administration of PPIs.

What are the possible complications?

Bleeding, perforation and gastric outlet stenosis can occur. Peptic ulcers are the most common cause of upper gastrointestinal bleeding.

What is the prognosis?

Most peptic ulcers heal after six to eight weeks of PPI therapy. However, infection with HP increases the risk of gastric cancer.

How can ventricular ulcers be prevented?

Avoid favorable factors such as NSAIDs, smoking and alcohol. HP eradication therapy can reduce the risk. Stress ulcer prophylaxis can be considered in critically ill patients.