The term gastric relates to the stomach. A gastric ulcer is an open lesion on the mucous membrane layer of the stomach that penetrates into the muscle. The stomach is a muscular, sac-like portion of the digestive track between the esophagus and duodenum. The ulcers are often on the lesser curvature of the stomach.

Traditionally, the cause of peptic ulcer was thought to be acid hypersecretion. It is now thought that bacterium Heliobacter (H) pylori is the major factor in the production of peptic ulcers. Nonsteroidal anti-inflammatory drugs (NSAID) may promote gastric ulcer through topical and systemic effects.

Manifestations of the condition are related to the site of the ulcer and age of the patient. Older individuals present either few or no symptoms. The foremost symptom is pain in the epigastrium that is relieved by antacids or food. Only one-half of the patients display this characteristic; some patients experience more pain when eating. Because of scarring and edema, pyloric ulcers tend to give symptoms of obstruction with bloating, nausea, and vomiting.

The patient history is significant in diagnosis and stomach cancer needs to be ruled out. The most important tool used is the endoscope. This device can be used for biopsy, can diagnose H. pylori, and can detect esophagitis, gastric ulcers and esophageal ulcers. Barium x-ray is another useful test performed.

Previously, the focus of treatment was neutralizing gastric acidity. Currently, the shift is to eradicate H. pylori with antibiotic treatment. More than one agent must be used in this infection. Histamine-blocking drugs are needed in the regimen to eradicate H. pylori along with proton pump inhibitors. Antacids will provide relief of symptoms, promote healing, and help to reduce ulcer recurrence. Restriction of alcohol and smoking are important aspects of ulcer healing. Milk does not aid healing, and, as a food that causes gastric distress by increasing gastric secretions, it should be avoided. Current drug therapy has significantly decreased the number of persons requiring surgery. Those who require surgery have an obstruction, perforation or hemorrhage.

After surgical resections of the stomach, thirty percent of patients have symptoms that are significant. Some of these include weight loss; dumping syndrome; poor digestion; anemia; vomiting of bile; diarrhea; and recurrence of the ulcer. Dumping syndrome consists of palpitations, lightheadedness and decreases in blood pressure after eating a meal high in carbohydrates. Limitation of simple sugar-containing liquids and solids (sweets), elimination of liquids at mealtime, and frequent small meals are measures used to ally symptoms of the syndrome.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

• If the Veteran is a former prisoner of war and was interned or detained for not less that 30 days, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

Notes

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CFR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.114.  [38 CFR 4.113]

• Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach or duodenum in comparison with those at an anastomotic stoma are sufficiently recognized as to warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that the findings adequately identify the particular location.” [38 CFR 4.110]