Gastric ulcers

Gastric Ulcers

Gastric ulcers, also known as peptic ulcers, are open sores that develop on the lining of the stomach. They are a common condition that can cause significant discomfort and complications if not properly managed. This article provides an overview of the etiology, pathophysiology, clinical presentation, diagnosis, and management of gastric ulcers.

Etiology

Gastric ulcers are primarily caused by an imbalance between the aggressive factors, such as gastric acid and pepsin, and the defensive mechanisms of the gastric mucosa. The most common causes include:

• Helicobacter pylori infection: This bacterium colonizes the gastric epithelium and disrupts the mucosal barrier, leading to ulcer formation.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications inhibit prostaglandin synthesis, reducing the protective mucus layer of the stomach.
• Stress: Severe physiological stress, such as that from surgery or trauma, can lead to stress ulcers.
• Lifestyle factors: Smoking and excessive alcohol consumption can exacerbate ulcer formation.

Pathophysiology

The pathophysiology of gastric ulcers involves the breakdown of the gastric mucosal barrier, leading to exposure of the underlying tissue to gastric acid and pepsin. This results in inflammation and ulceration. The presence of Helicobacter pylori can further exacerbate this process by inducing an inflammatory response and increasing acid secretion.

Clinical Presentation

Patients with gastric ulcers may present with a variety of symptoms, including:

• Epigastric pain: A burning or gnawing pain in the upper abdomen, often occurring after meals.
• Nausea and vomiting
• Bloating and belching
• Weight loss
• Hematemesis or melena: Indicating bleeding from the ulcer site.

Diagnosis

The diagnosis of gastric ulcers is typically made through:

• Endoscopy: Direct visualization of the ulcer allows for assessment and biopsy if necessary.
• Urea breath test: To detect Helicobacter pylori infection.
• Stool antigen test: Another method to detect Helicobacter pylori.
• Serological tests: To check for antibodies against Helicobacter pylori.

Management

The management of gastric ulcers involves both pharmacological and lifestyle interventions:

• Eradication of Helicobacter pylori: Using a combination of antibiotics such as amoxicillin and clarithromycin, along with a proton pump inhibitor (PPI).
• Proton pump inhibitors (PPIs): To reduce gastric acid secretion and promote healing.
• H2-receptor antagonists: As an alternative to PPIs.
• Discontinuation of NSAIDs: If possible, or use of alternative pain management strategies.
• Lifestyle modifications: Including smoking cessation and reducing alcohol intake.

Complications

If left untreated, gastric ulcers can lead to serious complications such as:

• Perforation: A hole in the stomach wall leading to peritonitis.
• Bleeding: From erosion into a blood vessel.
• Gastric outlet obstruction: Due to scarring and swelling.

Prevention

Preventive measures include:

• Avoiding excessive use of NSAIDs.
• Managing stress effectively.
• Regular screening and treatment for Helicobacter pylori in high-risk individuals.

See Also

• Duodenal ulcer
• Gastroesophageal reflux disease
• Peptic ulcer disease

References

• "Peptic Ulcer Disease." National Institute of Diabetes and Digestive and Kidney Diseases.
• "Helicobacter pylori and Peptic Ulcer Disease." Centers for Disease Control and Prevention.