Stomach ulcers are considered a disease of modern civilization. As people become increasingly caught up in the race against time and work, the prevalence of this condition rises. Currently, 1 in 10 people experiences stomach pain.
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Stomach ulcer (Image: bvdaihoc) |
The majority of stomach ulcer cases are caused by the Helicobacter pylori (HP) bacteria. This bacterium is present in 90% of patients with duodenal ulcers and in 70% of those with stomach ulcers. This discovery earned Nobel Prizes for two Australian scientists, Marshall and Warren.
What is a stomach ulcer?
The stomach uses gastric juice to break down food. To protect the stomach lining from the corrosive effects of hydrochloric acid in gastric juice, a thick mucous membrane covers the inside of the stomach. However, when the regeneration of the mucous membrane cells is disrupted, the stimulation from gastric juice can create ulcers with diameters of a few millimeters. Duodenal ulcers occur in the duodenum, the junction between the stomach and small intestine, accounting for 90% of cases. Ulcers located in the stomach can lead to serious complications.
What causes ulcers?
For a long time, it was believed that the origins of stomach ulcers were due to psychological factors. However, today it is known that 99% of cases are caused by HP bacteria. This discovery has revolutionized the treatment of stomach and duodenal ulcers by targeting the eradication of this bacterium.
Nonetheless, ulcers can also be exacerbated by frequent use of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). These medications can be toxic to the stomach and reduce the natural protective mechanisms of the mucous membrane. Using these types of medications to treat pain can contribute to worsening ulcer conditions.
What are the symptoms of ulcers?
Ulcers cause pain that can feel like cramping, burning, or sharp spasms in the stomach. Pain typically occurs about 4 hours after a meal and can last until the next meal. Additional symptoms may include nausea, vomiting, and digestive disturbances. Eating food often helps alleviate the pain. Symptoms may persist for several days before becoming periodic.
When should you see a doctor?
If pain cannot be relieved with over-the-counter antacids, or if it recurs multiple times throughout the day or night, it is advisable to seek medical attention for early and effective treatment.
What are the factors that worsen stomach ulcers?
Several factors can exacerbate ulcers, even though they may not directly cause them. These include smoking, alcohol consumption, excessive coffee intake, chronic stress, the use of NSAIDs, and corticosteroids.
It is essential to eliminate these factors once a diagnosis of ulcers is made. A balanced diet rich in fruits and vegetables to provide fiber is crucial, while avoiding fried foods high in fat or spices. Taking time to eat is also important; rushed meals can increase gastric acid secretion, leading to pain at the ulcer site.
How is a stomach ulcer diagnosed?
Diagnosis typically requires a fibroscopy technique to clearly visualize the ulcer and obtain biopsies of the mucous membrane. Patients may not be very comfortable with this method, so indirect testing using a breath test can be an alternative.
What are the treatment options?
The fundamental approach is to use medications that simultaneously reduce gastric juice secretion and antibiotics to eradicate HP. Two main types of drugs are commonly used:
– Acid reducers to prevent the production of hydrochloric acid and promote healing of the mucous membrane damage: these are proton pump inhibitors typically used for 4-6 weeks.
– Antibiotics like amoxicillin and clarithromycin are used to eliminate HP, and treatment should last at least one week. Symptoms may subside within a few days, but it is essential not to discontinue treatment, as the condition can easily recur along with the emergence of HP strains resistant to previous treatment and antibiotics.
When is surgery necessary?
With advancements in treatment therapies, surgical interventions are becoming less common. However, in cases of gastric bleeding, surgeons may need to ligate blood vessels or stitch the ulcer. Concerns also arise regarding the potential for cancer development in chronic ulcers. After repeated episodes of untreated ulcers, or in cases of suspected deterioration, a surgeon may remove part of the stomach where the ulcer is located and may also cut the vagus nerve if necessary to reduce hydrochloric acid secretion.
What are the complications?
If left untreated, ulcers can develop complications such as gastric bleeding or perforation. Bleeding may be identified by vomiting blood (either red or black) or having black stools. Bleeding indicates serious damage to blood vessels.
Perforation of the stomach is usually accompanied by severe abdominal pain and requires immediate medical examination. This can often lead to peritonitis. Patients will need to be hospitalized and may require surgical intervention. Some patients may not experience severe pain but still have bleeding.
