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Gastric Ulcer

Stomach Ulcer

Gastric ulcers are defects in the gastric mucosa that extend through the muscularis mucosa. Epigastric pain which occurs after meals is the most common symptom of gastric ulcers.


Presentation

Abdominal pain is the most common symptom of gastric ulcer. The pain subsides with antacid drugs. In addition, the following are some of the other symptoms:

  • Bloating
  • Feeling of fullness after meals
  • Retching
  • Abdominal pain that usually gets worse after meals.

In more severe cases, individuals with gastric ulcer may experience the following:

  • A sudden and sharp pain in the stomach that gets worse
  • Vomiting blood
  • Passing blood in stools

Such signs could signal ulcer bleeding and individuals should receive quick medical attention.

Weight Loss
  • We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months.[ncbi.nlm.nih.gov]
  • An 81-year-old man presented with epigastric pain and weight loss for one month. He had a past history of pulmonary tuberculosis, 10 years ago.[ncbi.nlm.nih.gov]
  • We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome.[ncbi.nlm.nih.gov]
  • If you have excess weight and are prone to gastric ulcers, this becomes an additional reason to seek professional help with weight-loss.[obesityaction.org]
  • loss , and reduction in alcohol consumption .[teachmesurgery.com]
Vomiting
  • A 61-year-old male had osmotic demyelination syndrome caused by rapid correction of gastric ulcer bleeding and vomiting related hyponatraemia with normal saline. It is rare to see severe hyponatraemia caused by gastric ulcer bleeding and vomiting.[ncbi.nlm.nih.gov]
  • For example, the irritation of the ulcer may cause vomiting, sometimes with blood in the vomit. Vomited blood may be dark red, but may also be black.[livestrong.com]
  • A 59-year-old woman died in the Emergency Department following a 2-day period of mild abdominal pain, vomiting, and diarrhea.[ncbi.nlm.nih.gov]
Nausea
  • We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome.[ncbi.nlm.nih.gov]
  • Symptoms that occur less often: Nausea or vomiting Unexplained weight loss Appetite changes Vomiting of blood – appear red or black Diagnosis and treatment options Test and diagnosis Blood test Breathe test Stool antigen test Barium upper gastrointestinal[nuh.com.sg]
  • The ulcer may also cause varying levels of nausea, with your teen feeling like he is going to vomit, even if nothing comes up.[livestrong.com]
  • Other less common symptoms include: indigestion (heartburn) loss of appetite vomiting feeling full and bloated, or belching not being able to tolerate fatty foods nausea.[healthdirect.gov.au]
  • Side effects of medications used to treat stomach ulcers can include: nausea dizziness headaches diarrhea abdominal pain These side effects are typically temporary.[healthline.com]
Abdominal Pain
  • The purpose of this article is to report on the evaluation of vague abdominal pain and anemia in the deployed military environment resulting in the diagnosis of a giant gastric ulcer.[ncbi.nlm.nih.gov]
  • We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months.[ncbi.nlm.nih.gov]
  • An 83-year-old woman presented to the emergency department with sudden onset of severe abdominal pain. She had a background of ulcerative colitis managed surgically at the age of 18 years with panproctocolectomy and permanent ileostomy.[ncbi.nlm.nih.gov]
  • We report a case of 48 year old male, a non-smoker but chronic substance abuser, who presented with abdominal pain, mainly epigastric with radiation to the back.[ncbi.nlm.nih.gov]
  • A 30-year-old woman, presenting with diffuse abdominal pain and free pneumoperitoneum, was submitted to transumbilical single-access laparoscopy.[ncbi.nlm.nih.gov]
Loss of Appetite
  • Other less common symptoms include: indigestion (heartburn) loss of appetite vomiting feeling full and bloated, or belching not being able to tolerate fatty foods nausea.[healthdirect.gov.au]
  • Symptoms may include: Gnawing pain: May awaken you from sleep May change when you eat May last for a few minutes or several hours Feels like unusually strong hunger pangs May be relieved by taking antacids Nausea Vomiting Loss of appetite Bloating Burping[health.cvs.com]
  • Symptoms may include: A burning pain or dull ache in the belly that: Comes and goes May start soon after eating or 2 to 3 hours later Comes in the middle of the night when your stomach is empty May get better when you eat something Loss of appetite Bloating[summitmedicalgroup.com]
  • If present, they can include: abdominal pain just below the ribcage indigestion nausea loss of appetite vomiting weight loss bright or altered blood present in vomit or bowel motions symptoms of anaemia, such as light-headedness shock due to blood loss[betterhealth.vic.gov.au]
  • Loss of appetite and weight loss. Bloating or nausea after eating. Vomiting. Vomiting blood or material that looks like coffee grounds. Passing black stools that look like tar, or stools that contain dark red blood.[uwhealth.org]
Melena
  • The melena and CMV antigenemia was improved with ganciclovir; however the patient died from worsening of hepatic failure.[ncbi.nlm.nih.gov]
  • The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer.[ncbi.nlm.nih.gov]
  • Author information 1 General Internal Medicine, Ohta-Nishinouchi Hospital, Japan. gim-hoshino@ohta.hp.or.jp Abstract A 67-year-old woman presented with melena and general weakness.[ncbi.nlm.nih.gov]
  • The patient visited our hospital due to melena and dizziness. The patient showed a huge ulcer and an exposed vessel in the posterior wall of the gastric high body during endoscopy.[ncbi.nlm.nih.gov]
  • We report the case of a 67 year old male who presented with a nine year history of a gastric ulcer with symptoms of hematemesis and melena.[ncbi.nlm.nih.gov]

Workup

Diagnosis of gastric ulcer is made based on the symptoms experienced by the individual. If the symptoms point towards development of ulcers in the stomach then the following procedures are done to confirm the diagnosis:

  • Endoscopy: With the help of endoscopy, inflammation and ulcers in the stomach can be detected.
  • Breath test, blood test or stool test is done to look for the presence of H. pylori bacteria
  • Gastric acid assays using basal acid output (BAO) and maximal aid output as parameters may be a helpful predictor of gastric ulcer propensity in patients [5].
  • Biopsy is also done to confirm the condition. Small samples of the tissues are analyzed for signs of cancer.
Gastric Lesion
  • Pathology showed marked infiltration of IgG4-positive plasma cells in the gastric lesions, which led us to suspect IgG4-related sclerosing disease.[ncbi.nlm.nih.gov]
  • A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence.[ncbi.nlm.nih.gov]
  • The lesion extended into the pancreas, where histological lesions and gastric lesions were also observed.[ncbi.nlm.nih.gov]
  • The gastric lesion was significantly ameliorated in the EVD group compared with that in the model group.[ncbi.nlm.nih.gov]
  • Rats were orally treated with vehicle, lansoprazole (30 mg/kg) or pogostone (10, 20 and 40 mg/kg) and subsequently exposed to acute gastric lesions induced by indomethacin.[ncbi.nlm.nih.gov]

Treatment

Treatment is geared towards managing the symptoms by suppressing the excessive production of acid and eradicating the infection if the ulcer has occurred due to bacterial infection. The following methods are employed to treat gastric ulcers:

  • Medications: Medications such as antibiotics are administered if bacteria are the source of infection. In addition, acid suppressing medications are also given to suppress the acid produced in the stomach. Therefore, a proper course of antibiotic along with acid suppressing medications (triple therapy) is given to treat gastric ulcers [6].
  • Surgery is usually the last resort. It is done only when complications develop and medications are of no help. In cases of ulcer bleeding and perforation, surgical intervention is carried out.

Prognosis

The prognosis of the condition is very favorable if timely treatment is initiated. Failure to diagnose the condition and appropriately treat it can pave way for complications to set in.

Acute gastric perforation due to gastric ulceration carries a mortality rate of up to 30% [4]. In severe cases, the ulcers can bleed and cause other secondary complications. It is necessary that ulcers be promptly treated to avoid the condition from taking a severe form.

Complications

Complications of gastric ulcer include the following:

  • Perforation: Untreated ulcers can even penetrate the wall of the stomach. Such a kind of development causes the food and acid to leak into the abdominal cavity leading to severe pain. Perforation as a result of ulcers is a medical emergency requiring prompt intervention.
  • Bleeding: Ulcers that are left untreated for long can cause them to bleed giving rise to life threatening complications. Symptoms of bleeding ulcers include passing of blood in stools and vomiting blood.
  • Gastric obstruction: In this condition, ulcers block the passage of the food through the digestive tract.

Etiology

Infections by Helicobacter pylori (H. pylori) are known to trigger the development of sores in the stomach. Majority of individuals develop such bacterial infections at least once in their lifetime. Appropriate antibiotic drugs are necessary to treat the infection; otherwise the infection would persist for the rest of their life.

Various drugs such as  non–steroidal anti-inflammatory drugs (NSAIDs) can also lead to gastric ulcers [1]. In addition, the disorder is also known to occur as a secondary condition to other medical illnesses such as Crohn disease and stomach cancer.

Diuretic medications like spironolactone has been found to cause gastric ulcers and gastric bleeding in patients taking long term maintenance with spironolactone [2].

Epidemiology

Gastric ulcer is a common condition affecting about 1 in every 10 individuals in England. It has also been estimated that infections are the major cause of gastric ulcers that account for every 8 in 10 cases [3].

Sex distribution
Age distribution

Pathophysiology

Bacterial infections and certain class of medications are known to trigger the development of gastric ulcers. When the bacteria H. pylori gains entry into the human system, it causes inflammation of the lining of the stomach. Inflammation in turn damages the mucosal barrier causing some amount of acid to be released. This acid gives rise to open sores on the stomach lining. In similar fashion, some over the counter drugs taken for common ailments can also lead to release of acid causing open sores to develop on the lining.

Prevention

Development of gastric ulcers can be prevented by following certain simple practices:

  • Washing hands frequently to avoid infections.
  • Certain medications such as NSAIDs and anti-inflammatory drugs can cause gastric ulcers; use of such medications should be limited. For those who need to continue their NSAIDs therapy, a maintenance of a daily proton pump inhibitor may prevent recurrence of gastric ulcer [7].
  • Avoiding use of high spicy foods that can worsen the already existing ulcers.
  • The active control of H. pylori infection in the stomach and intestine with triple therapy has a cure rate of 85-90% in gastric ulcer cases [8].
  • Patients diagnosed with gastric ulcer or duodenal ulcer triggered by H. pylori may experience relapse with continued smoking [9]. Although, smoking has already been proven to be directly harmful to the gastroduodenal mucosa [10].

Summary

Gastric ulcers, also commonly known as stomach ulcers, are characterized by development of open sores in the mucosal lining of the stomach. It is a common condition affecting millions of individuals across the globe.

Bacterial infection is the major cause of gastric ulcer. An appropriate treatment regime with antibiotics is successful in treating such a condition. Certain preventive measures can also be taken to keep bacterial infections at bay.

Patient Information

Definition

Gastric ulcers are characterized by development of open sores in the lining of the stomach. It is a common condition affecting several individuals across the globe. Infections and certain class of drugs cause inflammation of the stomach lining which in turn disrupts the mucosal cells. As a result of this, acid is released by the cells giving rise to development of open sores.

Cause

Infections by bacteria known as Helicobacter pylori is one of the major causes of gastric ulcer. In addition, medications such as anti-inflammatory drugs and NSAIDs are also known to trigger development of ulcers.

Symptoms

Symptoms of gastric ulcer include abdominal pain, bloating, retching and feeling of fullness after meals. In addition, more serious symptoms include passing of blood in stools, vomiting blood and sharp and sudden pain in the abdomen that persists for long duration.

Diagnosis

Diagnosis of gastric ulcer is done through endoscopy that makes use of a flexible tube inserted through the mouth to study the presence of inflammation and ulcers in the stomach. In addition, blood test is also required to detect the presence of bacteria in the body. 

Treatment

Treatment includes administration of medications such as antibiotics and acid suppressing drugs. Surgery is employed only when the condition turns severe and medications do not seem to work.

References

Article

  1. Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP. Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients. Aliment Pharmacol Ther. Nov 2010; 32(10):1240-8.
  2. Gulmez SE, Lassen AT, Aalykke C, Dall M, Andries A, Andersen BS, et al. Spironolactone use and the risk of upper gastrointestinal bleeding: a population-based case-control study. Br J Clin Pharmacol. Aug 2008; 66(2):294-9.
  3. Cai S, García Rodríguez LA, Massó-González EL, Hernández-Díaz S. Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005. Aliment Pharmacol Ther. Nov 15 2009; 30(10):1039-48.
  4. Svanes C, Lie RT, Svanes K, Lie SA, Søreide O. Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg. Aug 1994; 220(2):168-75.
  5. Schubert ML, Peura DA. Control of gastric acid secretion in health and disease. Gastroenterology. Jun 2008; 134(7):1842-60.
  6. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. Aug 2007; 102(8):1808-25.
  7. Lai KC, Lam SK, Chu KM, Hui WM, Kwok KF, Wong BC, et al. Lansoprazole reduces ulcer relapse after eradication of Helicobacter pylori in nonsteroidal anti-inflammatory drug users--a randomized trial. Aliment Pharmacol Ther. Oct 15 2003; 18(8):829-36.
  8. Javid G, Zargar SA, U-Saif R, Khan BA, Yatoo GN, Shah AH, et al. Comparison of p.o. or i.v. proton pump inhibitors on 72-h intragastric pH in bleeding peptic ulcer. J Gastroenterol Hepatol. Jul 2009; 24(7):1236-43.
  9. Sonnenberg A, Müller-Lissner SA, Vogel E, Schmid P, Gonvers JJ, Peter P, et al. Predictors of duodenal ulcer healing and relapse. Gastroenterology. Dec 1981; 81(6):1061-7
  10. Koivisto TT, Voutilainen ME, Färkkilä MA. Effect of smoking on gastric histology in Helicobacter pylori-positive gastritis. Scand J Gastroenterol. 2008; 43(10):1177-83.

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Last updated: 2018-06-22 11:58