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Gastric Ulcers

What are gastric ulcers?

Gastric ulcers are also called peptic ulcer disease (PUD), which forms in the first part of the small intestine, breaking the lining of the stomach. It occasionally occurs in the lower oesophagus and is predominantly known as gastric ulcer due to its development in the stomach. Epigastric pain is one of the most common symptoms that are noted. A burning sensation after meals is also a sign of the presence of a gastric ulcer. Defects in the gastric mucosa, which extends through the muscularis mucosa, are indicative of peptic ulcer disease. When there is an irritation in the epithelial lining due to cholinergic stimulation, the epithelial cells secrete mucus (of the stomach and duodenum) in response. Usually, a physiological balance is maintained between the gastroduodenal mucosal defense and the secretion of gastric acid. Mucosal injury occurs when such a balance is disrupted thus causing peptic ulcer disease.

Causes

  • H.Pylori infection – chronic inflammation is noticed due to colonization if the H.Pylori in the antral mucosa
  • Drugs – use of NSAIDs is one of the most common causes of gastric ulcers – the gastric mucosa is protected by a layer of mucus, which is secreted by the prostaglandins. Cyclooxygenase 1 or cox-1 is essential for the production of prostaglandins. Intake of NSAIDs blocks the function of the cox-1.
  • Physiological stress – stressful conditions such as CNS trauma, severe medical illness, surgery, respiratory failure, hypotension, traumatic injuries, etc. can cause PUD
  • Genetic factors – patients with a family history of gastric ulcers are prone to PUD
  • Diet and lifestyle – excessive consumption of spicy food, intake of caffeine, alcohol consumption, etc. are known to cause gastric ulcers

Signs and Symptoms

  • Epigastric pain with burn sensations after a meal
  • Dyspepsia – bloating, belching, intolerance to fatty food
  • Heartburn and chest discomfort
  • Hematemesis or melena
  • Hematochezia due to a brisk, bleeding ulcer
  • Fatigue and dyspnea due to consistent anaemia

Diagnosis

  • Biopsy – for the detection of gastric cancer
  • Upper GI Endoscopy – discrete mucosal lesions are noticed on a smooth ulcer base filled with white fibrinoid exudates about 0.5 to 2.5 cm
  • Chest radiograph – for the detection of free abdominal air
  • Angiography – this is done when massive GI bleeds are noticed, and an endoscopy cannot be performed on the patient to detect the source of the bleeding
  • Serum gastrin levels – to screen for Zollinger-Ellison syndrome
  • Secretin stimulation tests – if the screen for Zollinger-Ellison syndrome at serum gastrin levels is negative
  • H.Pylori testing – urease test, fecal antigen testing, urea breath tests, IgG antibodies
  • CBC – to evaluate chronic blood loss
  • BUN, electrolyte and creatinine levels
  • aPTT, PT and INR
  • Amylase, lipase and liver transaminase levels

Treatment and Medication

Pharmacotherapy eradicates H.Pylori infection with proton pump inhibitors. Symptoms can be relieved with antacids or a GI cocktail. H2 Receptor blockers such as Cimetidine, antibacterial agents like Amoxicillin, Biaxin, Sumycin are used as prophylactic treatments. Antidiarrheal agents have antimicrobial actions and cytoprotective agents stimulate the production of mucus.

Consult Dr. Deepak at the Fortis Malar Hospital, Chennai, to know more about treatable gastric ulcers.

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