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Complete Guide To Stomach Ulcers

Peptic ulcers can also be described as stomach ulcers. They are sores that develop in the walls of the esophagus’s lower portion or different areas of your small intestine or stomach. 

An ‘esophageal ulcer’ is a peptic ulcer present in the esophagus, while an ulcer of your stomach, is known as ‘gastric ulcer’. When an ulcer affects the duodenum, which is the first portion of the small intestine, it is referred to as a duodenal ulcer. The above mentioned are the types of peptic ulcers.

INTRODUCTION

When you eat, your stomach creates stomach acid, which is a highly acidic digestive juice. The stomach acids help break down food and pass it into your duodenum for additional digestion and succeeding absorption into the bloodstream.

Acids are corrosive. Thus a coating of mucus coats the lining of your stomach and duodenum to protect your organs from stomach acid’s damaging effects. Stomach acid can infiltrate into the stomach or duodenal lining. When the protective mucus layer breaks down, causing an ulcer.

Peptic ulcers are present in around 4% of the population; peptic ulcers may result in complications such as perforation, internal bleeding, and blockage of the stomach. Bleeding occurs in as many as 15% of people with the condition.

Risk factors associated with the conditions are smoking, drinking too much alcohol, upper abdominal radiotherapy, liver cirrhosis, Crohn’s disease. Peptic ulcers are not caused by hot food or stress, but they might aggravate symptoms.

To make a diagnosis, the doctor may take a medical history and perform a physical examination. The doctor will check for bloating in the belly and pain to know for certain if there is an ulcer. 

The doctor may perform an upper endoscopy. A doctor inserts an elongated tubing with a camera down the throat and into the stomach. The camera reaches the small intestine to check your digestive tract and look for an ulcer.

If an ulcer is detected, the small tissue is removed for examination in the laboratory. An upper gastrointestinal series, also called a barium swallow, may also be carried out. For this procedure, you will be required to drink a thick liquid called barium, and this liquid will coat your digestive tracts and make it possible for the doctor to view and treat your ulcer. The doctor may recommend a breath stool or blood test to determine if the h pylori bacteria are present in your stomach. This is done because the bacteria is a cause of the peptic ulcer.

CAUSES OF STOMACH ULCER

Peptic ulcers occur when the acidic juices erode the inner surface of the digestive tract. The cell of the stomach lining secretes the mucus film coating the digestive tract that normally protects against acid. An increase in the amount of acid or a decrease in the amount of mucus can create a painful open sore; the major causes are:

Helicobacter pylori or H pylori

Most peptic ulcers are caused by the bacteria “Helicobacter Pylori” also known as H pylori. A bacteria that lives in the mucus layer covers and protects the stomach and small intestine tissues. This bacteria often causes no problem. However, it can increase acid production, break down the protective mucus layer, and irritate the digestive tract in some people, producing an ulcer. 

The bacteria are usually transmitted from one person to another by close contact, such as kissing an infected person. It can also be transmitted with unclean food and water. Once inside your body, the bacterial lodge in the mucous layer of your stomach or duodenum.

Use of NSAIDs

Frequent use of certain pain relievers such as aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs, also known as (NSAIDs).  These medicines impair your stomach’s and duodenum’s capacity to defend themselves against the effects of stomach acid.

Another type of pain meds like acetaminophen, will not lead to peptic ulcers.

SYMPTOMS OF STOMACH ULCER

It’s crucial to remember that about 20% of people with peptic ulcer disease have no symptoms. About 20% of the patients who do have ulcers actually don’t experience any symptoms. So that’s very important to note, but if patients do have signs and symptoms of peptic ulcer disease, these are some of the signs and symptoms:

Dyspepsia

This is the most important one to note. Dyspepsia can be thought of as indigestion, pain, or discomfort in the epigastric area. The epigastric area is the area in the central upper area of your abdomen, above your belly button. 

It can be described as an annoying and burning sensation. The onset of the discomfort or pain differs depending on the type of ulcer. 

In gastric ulcers, epigastric pain or discomfort occurs within 15 to 30 minutes of eating. This makes sense if you have eaten, you have food and gastric acids within the stomach, and this can cause irritation of the gastric ulcer, usually occurring within 15 to 30 minutes of eating. It can be worsened or exacerbated by eating.

So when you’re eating and your stomach becomes full, you pyloric sphincter, an area that closes to hold the stomach contents within the stomach to allow digestion of those gastric contents, and there’s a release of stomach acids, and all of these things can irritate those gastric ulcers. So eating can worsen gastric ulcers. 

In duodenal Ulcers,  the epigastric pain or discomfort later occurs with duodenal ulcers; it often occurs within one to three hours after eating. So, for a time, the pyloric sphincter closes, keeping that gastric contents within the stomach.

The pyloric sphincter will slowly open and release some gastric contents from the stomach after a certain time. When the gastric content is released, it can irritate those duodenal ulcers. This is why we see duodenal ulcers having epigastric pain or discomfort approximately 1 to 3 hours after eating, so it occurs later than gastric ulcers, and it also makes sense that this is improved with eating and antacids. 

Heartburn

Ulcers can cause issues with gastric emptying, and reflux of acid into the esophagus can lead to heartburn.

Bloating

Patients may have issues with bloating or belching, and this often occurs after eating.

Nausea and Vomiting

This is usually due to irritation of cancer, and it occurs secondarily to epigastric pain. It is uncommon.

Abdominal Fullness

Irritation of the ulcer may give a sensation of fullness.

Early Satiety

Becoming full very and quickly than anticipated.

Other symptoms  due to complications include:

  • Melena: Black, tarry stool with a distinctive smell caused by a bleeding ulcer. It is black because the blood is digested.
  • Hematochezia: Red, bloody stool caused by a bleeding ulcer, it is quick rapid bleeding, so it is not digested.
  • Weight Loss: This occurs in gastric ulcers where patients try to stop eating to suppress the pain.
  • Weight gain: This occurs in duodenal ulcers where patients try to eat a lot to suppress the pain.
  • Recurrent Vomiting.

MEDICATION FOR STOMACH ULCER

To treat your peptic ulcer, your doctor may prescribe one or a combination of medicines, depending on the cause of the ulcer.

Antibiotics

If H pylori caused your ulcer, you would take antibiotics to kill the bacteria.

Stop or Limit the use of NSAIDs

If you have an ulcer caused by nonsteroidal anti-inflammatory drugs, you will be advised by your doctor to discontinue or reduce your usage of these medications.

Proton Pump Inhibitor (PPI)

If you have a gastric ulcer, a proton pump inhibitor, generally known as a PPI, may be prescribed to reduce acid production in your stomach.

H2 Blocker for Duodenal Ulcer

To limit the quantity of acid secreted in your stomach, you may be given histamine, a type 2 receptor antagonist, often known as an H2 blocker, if you have a duodenal ulcer. In addition, until the ulcer heals, your doctor may prescribe drugs to cover and preserve the lining of your stomach and duodenum. These include:

  • Misoprostol 
  • Sucralfate and 
  • Bismuth subsalicylate is commonly known as Pepto-Bismol.

SURGERIES AVAILABLE FOR STOMACH ULCER 

If an ulcer does not heal with medicine, surgery may be required, as well as surgery if an ulcer heals but returns after treatment. An ulcer that bleeds may necessitate surgery. You may need surgery to heal the damage if your ulcer breaks through or perforates the wall of your stomach or duodenum

Some ulcers prevent food from moving out of the stomach. If you have one of these or more than one of these issues, your doctor may consider one of the following three surgical treatments:

  • A Pyloroplasty,
  • An Antrectomy or,
  • A Vagotomy.

Your surgeon will cut a portion of your vagus nerve during a vagotomy. The vagus nerve is the nerve that your brain uses to signal your stomach to release acid. Once the nerve has been cut, your stomach will leak less stomach acid.

 The lowest region of your stomach, known as the antrum, is removed during an antrectomy. Your stomach is signaled to release acid by the antrum, and if it is gone, your stomach produces less stomach acid.

If an ulcer is preventing food from leaving your stomach, your surgeon may conduct a pyloroplasty. During this operation, your surgeon will expand the pylorus, the entrance between your stomach and duodenum, allowing food to flow more freely. 

You should avoid alcohol and cigarettes while your ulcer heals since they can hinder the healing process and make your ulcer worse. Your doctor may do an endoscopy, which is a technique that looks inside your upper digestive tract to see if your ulcer has healed a few weeks following treatment.

LIFESTYLE CHANGES FOR STOMACH ULCER

The majority of peptic ulcers heal within 4 to 6 weeks of starting treatment. Don’t stop taking the medicines you have been prescribed. Even if symptoms go away quickly, certain lifestyle changes to e adopted may include:

Diet and Lifestyle

Peptic Ulcer Disease patients should have a well-balanced diet. Eating more frequently or increasing the amount of milk and dairy products you consume will not help. These alterations may even result in an increase in stomach acid.

Stay away from foods and drinks that may cause discomfort or trigger the disease. These may include coffee, alcohol, fatty foods, caffeinated soda, chocolate, and spicy foods. Avoid eating late at night especially, snacks. Other things that can be done to ease symptoms and help healing  include:

Quit smoking and eating tobacco

Tobacco will retard the healing process of an ulcer and increase the probability of its recurrence.

Stress Reduction

Try to reduce your stress level and learn ways to manage stress better. Avoid drugs such as ibuprofen (Advil, Motrin), aspirin, or naproxen (Aleve, Naprosyn). Use acetaminophen (Tylenol) for pain relief. Use all medicines with enough water.

Follow-up

It is important to have follow-up checkups with the doctor to know how your ulcer is doing. If the ulcer occurred in your stomach, you might want to get an upper endoscopy after treatment. This is to ensure that the wound has healed and that there are no symptoms of malignancy. 

Follow-up testing will be required to ensure that the H pylori bacteria have been eradicated. Retesting should be done at least two weeks after the end of therapy. Before that time, test results may not be accurate.

UNTREATED & LONG TERM CONSEQUENCES

It is expected that 1 in 50 patients who have a stomach ulcer caused by an NSAID may suffer a complication. Black or bloody stools, bloody vomit that looks like coffee grounds, and sudden, acute pain that won’t go away are often symptoms of complicated peptic cancer. Complications may include the following:

  • Perforation: It rarely occurs as it affects about 1 in 350 people with a stomach ulcer.  The annual incidence of ulcer perforation is 4 to 14 cases per 100,000 individuals. Treatment is by performing vagotomy.
  • Bleeding: Internal bleeding may occur. If a peptic ulcer is left unattended, it may be a minor one that leads to anemia or a major loss which may require a blood transfusion. Black or bloody stools are symptoms of complications.

Other complications include:

  • Malignization by peptic ulcer
  • Obstruction by peptic ulcer 
  • Peptic ulcer surgical complications

UPCOMING TREATMENTS/MEDICATION

H+/K+ ATPase inhibitor omeprazole

When given at a dose of 30mg per day, it will heal 80% of duodenal ulcers in two weeks and 97% of duodenal ulcers in four weeks. Gastric ulcers are healed at a rate of 80% at four weeks and 95% at eight weeks. This is a significant improvement compared to existing ones. This regime produces 24-hour anacidity.

Several H2-antagonists can also produce anacidity and have the potential to produce similar healing rates. Unfortunately, all of these ‘super inhibitors’ have been withdrawn from clinical trials for the same reason (at the time of writing, trials of omeprazole are restricted to certain countries). 

Dysplasia or malignancy has been observed in the stomachs of rats given large doses for long periods of time. So that even if such a drug were passed for human use, it would, in practice, be difficult to market. Certain improvements are still being carried out on this medication.

CONCLUSION

Peptic ulcers are referred to as ulcerations that occur along the Gastrointestinal tract. They occur in about 4% of the population. The types include Gastric ulcer, duodenal ulcer, and esophageal ulcer. Most ulcers that are caused by H pylori are treatable and preventable. Other causes are excessive use of NSAIDs.

Symptoms include pain, bloating, belching, vomiting, bloody stools, weight loss, weight gain, among others. Medications that can be used are: antibiotics, limiting the use of NSAIDs, H2 blockers, and Proton Pump inhibitors (PPI).

Surgeries for ulcers that can be performed for ulcers that don’t heal with medications are Vagotomy, Antrectomy, or Pyloroplasty.

Lifestyle changes might involve quitting smoking, reduction of stress, and regular visit to the doctor. 

External Links

NEWS MEDICAL LIFE SCIENCES, LIVING WITH PEPTIC ULCER DISEASE BY.YOLANDA SMITH

https://www.news-medical.net/health/Living-with-Peptic-Ulcer-Disease.aspx

MAYO CLINIC. PEPTIC ULCER

https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

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