Gastric ulcer or peptic ulcer is an inflammatory disease in which comes to profound impairment of the stomach lining. We talk about gastric ulcer when the defect affects mucosa, submucosal tissue and the muscle layer of stomach. It is necessary to distinguish peptic ulcer from mere superficial mucosal defect, so-called erosion.
Causation of gastric ulcer
Gastric ulcers are caused by action of hydrochloric acid on the gastric mucosa. Mucosa is normally protected by mucus, i.e. mucin. This protective function of mucus can be disrupted with increased removal of mucus or its reduced production. In such case, hydrochloric acid comes into direct contact with the gastric mucosa and damages it. Deep circular bearing of different sizes is created. Protective barrier of the stomach can be disrupted by various factors. These are:
- Presence of Helicobacter pylori, a bacterium that is commonly found in the stomach, which is able to survive in the harsh conditions of stomach. This bacterium has an enzyme called urease which breaks through mucus and thus this bacterium can move through it more easily. Helicobacter pylori is among the main factors for development of stomach ulcers.
- Medications that disrupt the protective barrier of stomach and also contribute to the formation of stomach ulcers. These are called non-steroidal analgesics including acetylsalicylic acid. Acetylsalicylic acid is located in Aspirin, Anopyrin, Ibalgin and others. Another group of drugs causing ulcers are glucocorticoids.
- Stress is another possible cause of ulcers as aforementioned glucocorticoids are washed out, these are essential to coping with stressful situations.
- Zollinger-Ellison syndrome is a rare disease in which is increased production of the hormone gastrin, this hormone also excites the protective mucus lining of stomach.
Symptoms of gastric ulcer
Symptoms of stomach ulcer are not very characteristic, and therefore its diagnosis is quite difficult. Gastric ulcer is usually located in the small curvature of stomach. Generally, we can say the higher is ulcer located the sooner after meal will come to stomach pain. Pain may also occur on an empty stomach. Other symptoms are loss of appetite, nausea, vomiting and diarrhoea. There comes to bleeding in up to 10% of patients with gastric ulcers. In this case, so-called hematemesis can occur, i.e. vomiting of blood or its presence in the stool. Stool is very dark due to partial digestion of blood, and therefore we talk about Melena. If bleeding is long-term the patient may suffer from anaemia.
Diagnosis of gastric ulcer
As already mentioned, the symptoms of peptic ulcer are relatively nonspecific, and therefore we can not make a diagnosis only in view of clinical manifestations. However, it is necessary, as part of the anamnesis, to ask about these symptoms and also check what medications is the patient taking. For proper diagnosis of gastric ulcer is the decisive gastroscopy. It is endoscopic examination of the stomach in which is through mouth, after application of local anaesthetic, loaded hose device into the stomach. The device is fitted at its end with light, camera and part through which we can implement other necessary tools. Image taken by the camera is transferred to the screen where the doctor has visual view on the structure of stomach and its possible changes. During this examination are taken samples from the affected area, and they are sent for histological examination and detection of Helicobacter pylori. This intervention is done also urgently when bleeding ulcers occur, when it is possible to stop the bleeding endoscopically.
Complications of gastric ulcer
In case of late diagnosis or ineffective treatment of a peptic ulcer can come to number of complications. The most common complication is bleeding from ulcer. This bleeding may be small and long-term, and therefore the patient may it not even notice. It can manifest as black-colored stools, called melena, or anaemia. However, it may be also massive haemorrhage when the patient vomits blood and has severe abdominal pain. Another possible complication is, i.e. perforation of the organ. In this case, it comes to spillage of stomach contents into the abdominal cavity which causes peritonitis and acute abdomen arises. Penetration is another complication that is based on ingrowth of ulcer through the entire wall of stomach to adjacent organs. The most affected organ is pancreas. Therefore, the patient has abdominal pain radiating to back. In the case of healed ulcer or swelling, pyloric stenosis may occur, i.e. narrowing of the sphincter that separates the stomach from the duodenum. Chyme can not proceed further into intestine and accumulates in the stomach. This manifests in the patient as vomiting and belching. It is necessary to treat all complications of gastric ulcer surgically.
Risk factors for gastric ulcer
There are many factors that represent significant risk for the development of gastric ulcers. These are mainly smoking, frequent drinking of coffee and alcohol, too spicy food, frequent use of certain drugs which particularly contain acetylsalicylic acid. An important risk factor is stress.
Treatment of gastric ulcer
Treatment of gastric ulcer is designated by discovery of all patient's difficulties, his habits, lifestyle, eating habits but also by prevention of possible vices. In the treatment of peptic ulcer we can choose between regime measures, pharmacological treatment and surgical treatment. However, these methods must be often combined.
Regime measures for gastric ulcer
Regime measure is an important method within the treatment of gastric ulcer. It is advisable to avoid all risk factors. Healthy lifestyle with balanced diet and regular mental peace is recommended. In case of smoking, it is advisable to reduce the dose of nicotine per day and stop smoking on an empty stomach. Similarly, we should also avoid drinking coffee on the empty stomach. For alcoholic beverages, it is recommended to avoid mainly distillates and white wine. Within use of medications that promote the formation of gastric ulcers, it is necessary to consult your doctor about their possible withdrawal or replacement.
Pharmacological treatment of gastric ulcer
Nowadays the treatment with medications is the main way in fight against this disease. Wide scale of drugs is used. These are especially so-called proton pump inhibitors which block an enzyme essential for the production of gastric juice. Furthermore, there are antacids, drugs which bind to already established hydrochloric acid and thus they reduce the time of its contact with gastric mucosa. If Helicobacter pylori is main causation of the disease its eradication is necessary. This is achieved by deployment of combined therapy of two antibiotics and one proton pump inhibitor. Repeated gastroscopy with sampling is advisable to reassure if microbe was eradicated.
Surgical treatment of gastric ulcer
Surgery of peptic ulcer is rarely chosen. Nowadays operation is confined mainly to the complications of peptic ulcer disease. It is especially the bleeding that can not be stopped endoscopically or by stenosis of gastric ulcer. In this case, it is necessary to remove the affected part of stomach and to replace it with the part of small intestine.