STOMACH ULCERS

STOMACH ULCERS

·         Peptic ulcer diseases (PUD) are sores, gastric and duodenal ulcers in the mucosal lining of the stomach or the first part of the small intestine.

CAUSES

·         Pre-dominant causes are Helicobacter Pylori (H Pylori) bacteria and use of non-steroidal anti-inflammatory drugs (NSAID).

·         Smoking, alcohol, and certain genetic and dietary factors aggravate PUD.

·         Mucosal injury and subsequent ulcer formation could occur because of an imbalance between the digestive juices and the gastro-duodenal mucosal defence which protects the stomach lining.

·         Duodenal ulcer is caused by increases in the acid and pepsin loads, and are related to H.Pylori infection.

·         Gastric ulcer is caused by increased intake of NSAID, and H Pylori infection may be present.

·         Both ulcers are associated with an imbalance between protective and aggressive factors, with inflammation being a leading cause of the imbalance.

·         Individuals infected with H Pylori have a 10-20 percent lifetime risk of developing peptic ulcers.

·         H Pylori releases a toxin that causes inflammation and increases acid production in the stomach, which often causes ulcer formation in the duodenum.

·         H Pylori is commonly found in duodenal and gastric ulcer patients and in those with active chronic gastritis.

SYMPTOMS

·         Patients report different symptoms; some have no symptoms at all, or may develop potentially life-threatening complications such as perforation, bleeding and gastric outlet obstruction.

·         Symptoms could include episodic abdominal pain, vomiting, weight loss, indigestion and fat intolerance.

·         Patients generally complain of a burning sensation and pain in the upper abdomen, bloating, excessive burping, nausea and vomiting.

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Chronic PUD is usually accompanied with upper abdominal pain.

·         Pain typically occurs a couple of hours after food intake.

·         It may aggravate at night between 11 pm to 2 am, when acid secretion is highest and may awaken a person from sleep.

·         The pain is usually relieved by food or an antacid.

·         If the inflammation is too much, bleeding is possible from the stomach lining or from an ulcer.

·         It shows up as blood in the vomit and as black stools.

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Moderate bleeding can cause foul-smelling black or tarry stools.

TREATMENT

·         Focus should be on controlling active bleeding, healing the ulcers, and preventing recurrence.

·         An upper gastrointestinal endoscopy identifies the superficial lesions, ulcer scars and the degree of active bleeding.

·         Testing for H Pylori is also done.

·         Treatment includes simple dietary modifications and antacids, avoiding NSAID, besides gastric acid suppression and eradication of H Pylori infection.

·         Surgery is suggested for patients resistant to medical therapy or at high risk of complications.

MANAGEMENT

·         Lifestyle modifications are important to halt progression of the disease.

·         Eat small meals at regular intervals and a light snack before bedtime to reduce acid concentrations in the stomach.

·         Avoid smoking and drinking alcohol.

·         Have a balanced diet, avoiding spicy, fried and oily food.

·         Avoid tea and carbonated drinks.