Gastric Ulcer - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Gastric ulcers or stomach ulcers develop when the digestive juices in the stomach reduce the thickness of the inner lining. Symptoms include dull stomach pain, nausea, unable to eat, bloating, burping, and heartburn. Laboratory tests like barium swallow, endoscopy, and blood tests are done to find the disease. Treatment includes antibiotics, proton pump inhibitors, and surgical intervention.

What Causes Gastric Ulcer?

• Helicobacter pylori (H.pylori) Infection: H.pylori is a bacteria that enters the body through food, water, or vessels. It lives in the stomach and intestines and does not cause any harmful effects for some people. However, they become harmful to some people and multiply rapidly, causing damage to the inner lining of the stomach wall. They develop sores in the stomach wall lining, causing various symptoms.

• NSAIDs (Non-steroidal Anti-inflammatory Drugs): Medications like NSAIDs (non-steroidal anti-inflammatory drugs) are painkillers that cause gastric irritation when taken for a long time. The medications like Ibuprofen, Naproxen, and Aspirin belong to the group of non-steroidal anti-inflammatory drugs and are available over the counter. However, these medications irritate the gastric lining and reduce the activity of certain enzymes that repair or heal the gastric lining. This causes breaks or sore formation in the stomach wall.

• Smoking and Alcohol Consumption: Smoking and consuming alcohol also irritate the gastric mucosa (inner lining of the stomach). This leads to the formation of ulcers or sores in the stomach wall.

• Zollinger- Ellison Syndrome: It is an uncommon condition that results in multiple tumor formations in the pancreas or the duodenum (first part of the small intestine). This condition causes increased gastric acid secretion leading to gastric ulcers.

• Physiological Stress: Severe injury or a serious illness can cause stomach ulcers. It alters the body’s pH (potential of hydrogen) balance, thus increasing gastric acid secretions.

What Are the Symptoms of a Gastric Ulcer?

• Bloating.

• Heartburn.

• Nausea or vomiting.

• Feeling full easily.

• Dull stomach pain.

• Unable to eat due to pain.

• Burping.

• Dark-colored tarry stools.

• Dark-colored vomit that looks like coffee grounds.

• Indigestion to fat-rich foods.

What Are the Tests to Diagnose Gastric Ulcer?

• Complete Blood Count: Complete blood count screens the blood parameters like the red blood cells, white blood cells, platelets, hemoglobin, eosinophils, and basophils. Any changes in the normal ranges of these parameters indicate infection.

• Stool Culture: A sample of the fecal matter is tested in a laboratory for evidence of allergy, infections, or digestive problems.

• Barium Swallow: A white chalky substance called barium is mixed with water and allowed to be consumed by the person about to take the test. The chalky substance coats the stomach; the ulcers are visible during an x-ray. This helps in the diagnosis of gastric ulcers.

• Breath Test: The breath test detects small intestinal bacterial overgrowth by analyzing the hydrogen, carbon dioxide, and methane gasses produced by the bacteria in the intestine. The H.pylori process the urea in the stomach and releases carbon dioxide. Therefore if the test is positive for carbon dioxide, H.pylori is present in the stomach.

• Endoscopy: A flimsy, flexible tube-like structure with a camera and a light is used in endoscopy. It is inserted into the mouth and moved further down to access the stomach and the intestine. The inner lining of the stomach and the intestine is viewed on the monitor outside.

• Computed Tomography (CT) Scan: Computed tomography uses a high-frequency radio wave to take pictures of internal organs at different angles on a computer screen. It shows the internal organs, surrounding tissues, and other bony structures.

How Is Gastric Ulcer Treated?

• Antibiotics: Antibiotics like Tetracycline, Metronidazole, Clarithromycin, and Amoxicillin are prescribed if the condition is caused by H.pylori bacterial infection.

• Proton Pump Inhibitors: Proton pump inhibitors are drugs that reduce the acid secretion in the stomach by suppressing the glands that secrete gastric acid. Omeprazole, Rabeprazole, Esomeprazole, Pantoprazole, and Dexlansoprazole are some of the proton pump inhibitors.

• Histamine Receptor Blockers: Histamines act like the police force and eliminate anything that harms the body. Histamine blockers lower stomach acid by inhibiting the chemical, instructing the body to make it. Histamine receptor blockers (H2 blockers) like Famotidine, Cimetidine, and Nizatidine are prescribed to suppress stomach acid secretion.

• Antacids: Antacids neutralize the acid secretion in the stomach. They reduce the severity of the symptoms but do not heal the ulcers. They are easily available over the counter.

• Cytoprotective Agents: Cytoprotective agents coat the stomach lining and protect them from acid secretion. Misoprostol and Sucralfate are examples of cytoprotective agents.

• Bismuth Subsalicylate: Bismuth subsalicylate is available over the counter with Pepto-Bismol. It coats the stomach lining and prevents acid secretion. However, it has side effects and causes dark-color stools.

What Are the Complications of a Gastric Ulcer?

• Internal Bleeding: Slow bleeding inside the stomach wall is not common in all cases. However, a few people encounter internal bleeding. It results in anemia and severe blood loss.

• Perforation: The continuous erosion of the ulcers in the stomach can lead to holes in the stomach wall or perforations. The bacteria from the gut move to the abdominal cavity and spread the infection. It is called peritonitis. The condition from the abdominal region spreads to other body parts leading to septicemia. This ultimately results in septic shock. Septic shock is the sudden drop in blood pressure leading to life-threatening conditions.

• Obstruction: Pyloric channel is a narrow pathway between the stomach and the intestine. The ulcers in the pyloric channel heal, forming scar tissues, making them bigger. It blocks the passage and prevents the food flow from the stomach to the intestine.

• Stomach Cancer: Stomach ulcers caused by H.pylori infection cause malignancies over time. However, this rarely happens.

What Dietary Recommendations Are Suggested for Gastric Ulcers?

• Consume fruits and vegetables along with acidic foods like grains, meat, and dairy products.

• Include probiotics like yogurt and kefir (fermented milk drink) to improve gut health.

How to Prevent Gastric Ulcers?

• Reduced the intake of NSAIDs (non-steroidal anti-inflammatory drugs). Discuss with a doctor and substitute Acetaminophen with non-steroidal anti-inflammatory drugs.

• Avoid irritants that can aggravate gastric acid secretion, like smoking and consuming alcohol.

• Take an H.pylori breath test to rule out infection.

Conclusion:

Gastric ulcers or stomach ulcers are a type of peptic ulcer. Stomach ulcers are caused due to continuous secretion of gastric acids that damage the stomach's inner lining. It can be due to Helicobacter pylori infection, too many non-steroidal anti-inflammatory drugs, stress, or smoking and alcohol consumption. It causes symptoms like dull stomach pain, heartburn, burping, easy stomach fullness, inability to eat due to pain, and bloating. Then a few tests like blood tests, stool samples, endoscopy, and barium swallow are done to determine the disease. In addition, it is treated with antibiotics, proton pump inhibitors, and antacids. It is not a serious condition; many people suffer from gastric ulcers. However, getting appropriate treatment will reduce the severity of the symptoms and improve the patient's life quality.