Stomach Ulcer: Description:
A stomach or gastric ulcer is a break in the tissue lining the stomach. The term ‘peptic ulcer’ refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion.
A stomach ulcer (also called a peptic ulcer) is a small erosion (hole) in the gastrointestinal tract. The most common type, duodenal, occurs in the first 12 inches of small intestine beyond the stomach. This ulcer is not contagious or cancerous. Duodenal ulcers are almost always benign, while stomach ulcers may become malignant.
Stomach ulcer disease is common, affecting millions of Americans yearly. The size of a stomach ulcer can range between 1/8 of an inch to 3/4 of an inch.
Stomach ulcer, symptoms:
The symptoms of a stomach ulcer can include:
1. Abdominal pain just below the ribcage.
4. Loss of appetite.
6. Weight loss.
7. Altered blood present in the vomit or in the bowel motions (occasionally).
8. Symptoms of anemia, such as light-headedness.
The major symptom of an ulcer is a burning or gnawing feeling in the stomach area that lasts between 30 minutes and 3 hours. This pain is often interpreted as heartburn, indigestion or hunger. The pain usually occurs in the upper abdomen, but sometimes it may occur below the breastbone. In some individuals the pain occurs immediately after eating. In other individuals, the pain may not occur until hours after eating. The pain frequently awakens the person at night. Weeks of pain may be followed by weeks of not having pain. Pain can be relieved by drinking milk, eating, resting, or taking antacids. Appetite and weight loss are other symptoms. Persons with duodenal ulcers may experience weight gain because the person eats more to ease discomfort. Recurrent vomiting, black stool, blood in the stool and anemia are other symptoms.
Stomach ulcer, Treatment:
The treatment involves a combination of medications to kill the H. pylori bacteria (if present), reduce acid levels, and protect the GI tract. This strategy allows your ulcer to heal and reduces the chance it will come back.
Take all of your medications exactly as prescribed.
Medications may include one or more of the following:
Acid blockers (such as cimetidine, ranitidine, or famotidine) Antibiotics to kill H. pylori Bismuth to help protect the lining and kill the bacteria, medications that protect the tissue lining (such as sucralfate), Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) If you have an ulcer without an H. pylori infection, your doctor will likely prescribe a proton pump inhibitor for 8 weeks. You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.
If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.
Stomach ulcer, Causes and Risk factors:
Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in your stomach. But for a variety of different reasons, the protective process can stop working correctly, and the lining breaks down. The results in inflammation (gastritis) or an ulcer.
Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through is called a perforation. A perforation is a medical emergency.
The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have such bacteria in their stomach do not develop an ulcer.
The following also raise your risk for peptic ulcers:
Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), smoking cigarettes or using tobacco, if you have a family history of ulcers or the blood type O, you are more likely to get a duodenal ulcer.
A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas that releases high levels of a hormone, which causes an increase in stomach acid.
Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home. However, a very ill patient who is on a breathing machine is at risk for so-called “stress ulceration.”
To diagnose an stomach ulcer include
Esophagogastroduodenoscopy (EGD): It is a special test performed by a gastroenterologist in which a thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. During an EGD, the doctor may take a biopsy from the wall of your stomach to test for H. pylori. Upper GI is a series of x-rays taken after you drink a thick substance called barium
Your doctor may also order these tests hemoglobin blood test to check for anemia Stool guaiac to test for blood.
Endoscopy – A thin flexible tube is threaded down the esophagus into the stomach under light anesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer.
Barium Meal – A chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable.
Biopsy – a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found.
C14 breath test – To check for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon (C14) and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women.
Medicine and medications:
Medications used in patients with peptic ulcer disease (PUD) reduce gastric acidity and serve to eradicate H pylori infection. PPIs, which work at the final common pathway for gastric acid secretion, are the most potent acid inhibitors.
Histamine H2-receptor antagonists: Receptors for histamine are located on the acid-producing parietal cells. Blocking histamine action suppresses gastric acid secretion.
Ranitidine (Zantac): H2 antagonist studied most often in children. H2 antagonists competitively inhibit histamine at H2 receptors of gastric parietal cells, lowering gastric acid secretion. Course of therapy tried for 8 wks, by which time most ulcers heal. Because H2 antagonists have no antibacterial effect, symptoms caused by H pylori infection may persist or recur. Pediatric preparations are syr 15 mg/mL; tab 75, 150, or 300 mg; and effervescent granules 150 mg.
PPI: PPIs are more potent acid inhibitors than H2-receptor antagonists. This class of drugs blocks gastric acid secretion at the proton pump (i.e., hydrogen/potassium adenosine triphosphatase [H+/K+ ATPase] of the gastric parietal cell), which is the final common pathway of secretion. PPIs are recommended as a part of the drug regimen for symptomatic H pylori infection. PPI therapy alone does not eradicate H pylori infection, but it does have bacteriostatic activity against H pylori.
Omeprazole (Prilosec, Zegerid): Used in PUD, alone or in combination with antimicrobials to eradicate H pylori, inhibits gastric acid secretion. Ulcers may heal more rapidly than with H2 antagonists
Antacids: These agents neutralize gastric acid and may be of benefit in children with PUD. Medication compliance may be a problem because of the requirement for frequent dosing.
Aluminum and magnesium hydroxide (Mylanta, Maalox): Neutralizes gastric acids, raises stomach pH, and helps to provide pain relief. Antacids may be used in multidrug regimens to eradicate H pylori.
Mylanta: Each 5 mL contains 200 mg AlOH, 200 mg MgOH, and 20 mg simethicone.
Maalox: Each 5 mL contains 225 mg AlOH and 200 mg MgOH.
Mylanta or Maalox chewable tabs: 200 mg AlOH and MgOH.
Antibiotics, macrolide: Multidrug regimens have been studied in the eradication of H pylori infection. All regimens contain 1-2 antimicrobials and agents that neutralize acid or inhibit acid secretion.
Sucralfate (Carafate): Forms viscous adhesive substance that protects GI lining against pepsin, peptic acid, and bile salts. For short-term management of ulcers. Available as tabs or oral susp 1g/10 mL.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.