Stomach ulcer

Helicobacter pylori:  The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers.

It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion).

Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations.

Ulcer bleeding: This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication.

Symptoms of a peptic ulcer can be  :
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e.g. dexamethasone and prednisolone).

In patients over 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents, therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2–3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum.

Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient’s age. Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear.Usually, children and the elderly do not develop any symptoms unless complications have arisen.

Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for every sufferer.

A gastric ulcer develops once the formation of small erosions along the stomach lining form. Erosion is caused by the acidity of the stomach fluids, which contain hydrochloric acid and the enzyme pepsin (hence the name peptic ulcer). Usually, a thick mucosal layer protects the lining of the gastrointestinal (GI) tract. This layer is continually rebuilt as the acid continually destroys it. Overproduction of acid tips the equilibrium in favor of those forces favoring breakdown, and as the mucosa begins to degrade, erosion occurs and an ulcer begins to form. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause or worsen this condition.

The mechanisms of erosion are still not fully understood, but somehow, Helicobacter pylori are able to survive stomach’s acidic environment and reproduce in its mucosa. This infection causes tissue damage and leads to ulcer formation.

If you think you might have an ulcer, it’s important to seek medical advice for diagnosis and treatment. If left untreated, an ulcer can further erode the mucosa until bleeding, obstruction, or perforation occurs. Follow-up is always recommended, as recurrence is likely if H. pylori is not completely eradicated. In some untreated cases, gastric ulcers have been shown to progress to malignancy, leading to a greater chance of developing stomach cancer.

A wide range of therapies exist to effectively treat symptoms and heal ulcers, so only in rare cases is surgery needed. So it’s important to realize that treatment failure does not necessarily mean that your case is untreatable. The main reason treatments fail is noncompliance (i.e., not sticking to the medical treatment your doctor has suggested). Risk factors like alcohol, caffeine, aspirin and other NSAIDs, (such as ibuprofen) and especially cigarettes have been shown to aggravate existing ulcers, so it’s important to follow your doctor’s advice regarding diet and lifestyle modifications.

Story: 1stnews9