Gastric Ulcer: Causes, Symptoms, and Treatment

Gastric Ulcers: Pathogenesis, Symptoms, Diagnosis, and Management

Introduction

Gastric ulcers, commonly known as stomach ulcers, are a prevalent health concern characterized by the erosion and inflammation of the lining of the stomach. They are a common form of peptic ulcer disease, which also includes duodenal ulcers. Gastric ulcers can cause significant discomfort and, if left untreated, can lead to serious complications. This article explores the pathogenesis, symptoms, diagnosis, and management of gastric ulcers.

Pathogenesis

Gastric ulcers develop when the protective mechanisms of the gastric mucosa become compromised, allowing gastric acid and enzymes to damage the underlying tissue. The primary causes of gastric ulcers include:

• Helicobacter pylori (H. pylori) infection: This bacterium is the most common cause of gastric ulcers, accounting for approximately 60% of cases. H. pylori weakens the gastric mucosa, making it more susceptible to acid and enzyme damage.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin, ibuprofen, and naproxen, inhibit the production of prostaglandins, which play a role in protecting the gastric mucosa. Prolonged use of NSAIDs can increase the risk of gastric ulcers.
• Other risk factors: Smoking, excessive alcohol consumption, stress, and certain medical conditions, such as Zollinger-Ellison syndrome, can also contribute to the development of gastric ulcers.

Symptoms

Gastric ulcers can present with a range of symptoms, including:

• Pain: Dull, burning, or gnawing pain in the upper abdomen, typically after meals or at night.
• Dyspepsia: Indigestion, bloating, gas, nausea, and vomiting.
• Heartburn and acid reflux: Burning sensation in the chest and regurgitation of stomach contents.
• Appetite changes: Loss of appetite or feeling full quickly.
• Bleeding: Gastrointestinal bleeding, which can manifest as bloody vomit or black, tarry stools.
• Perforation: In severe cases, a gastric ulcer can perforate (rupture) through the stomach wall, leading to peritonitis and life-threatening complications.

Diagnosis

The diagnosis of gastric ulcers involves a comprehensive evaluation, including:

• History and physical examination: The healthcare provider will inquire about symptoms, medical history, and lifestyle factors. They will also perform a physical examination to check for tenderness or other signs of gastric distress.
• Gastroscopy: This procedure involves inserting a thin, flexible tube with a camera into the esophagus and stomach to visualize the lining and identify any ulcers.
• Biopsy: During gastroscopy, the healthcare provider may obtain tissue samples from the ulcer to confirm the diagnosis and rule out other conditions, such as stomach cancer.
• Blood tests: Blood tests can detect H. pylori infection and assess for anemia caused by blood loss from the ulcer.

Management

The primary goal of management for gastric ulcers is to address the underlying cause and promote ulcer healing. Treatment strategies include:

• H. pylori eradication: For ulcers caused by H. pylori, antibiotics are prescribed to eliminate the bacteria.
• NSAIDs avoidance: Patients with gastric ulcers should avoid NSAIDs or take them with precautions, such as using a proton pump inhibitor (PPI) to reduce acid secretion.
• Medications:
  • Proton pump inhibitors (PPIs): PPIs, such as omeprazole and lansoprazole, reduce gastric acid secretion, allowing the ulcer to heal.
  • Histamine-2 receptor antagonists (H2RAs): H2RAs, such as famotidine and ranitidine, also reduce gastric acid secretion but are less potent than PPIs.
  • Cytoprotective agents: Bismuth and sucralfate are used to coat the ulcer and protect it from further damage.
• Lifestyle modifications:
  • Diet: Eating small, frequent meals, avoiding spicy or acidic foods, and limiting caffeine and alcohol can help reduce stomach irritation.
  • Stress management: Techniques such as yoga, meditation, or deep breathing can help reduce stress and its impact on gastric acid production.
  • Smoking cessation: Smoking damages the gastric mucosa and slows down ulcer healing.
• Surgery: In rare cases, surgery may be necessary to remove a perforated ulcer or treat complications such as gastrointestinal bleeding or obstruction.

Complications

Untreated gastric ulcers can lead to serious complications, including:

• Bleeding: Severe bleeding can cause anemia and even life-threatening hypovolemic shock.
• Perforation: A perforated ulcer can lead to peritonitis, a potentially fatal infection of the abdominal cavity.
• Obstruction: A large ulcer can obstruct the passage of food and liquids through the stomach, leading to malnutrition and other complications.
• Gastric cancer: Gastric ulcers can increase the risk of developing gastric cancer, particularly if they are present for a prolonged period or are associated with H. pylori infection.

Conclusion

Gastric ulcers are a common health problem that can cause significant discomfort and potential complications. Understanding the causes, symptoms, diagnosis, and management strategies is crucial for effective treatment and prevention. By addressing the underlying factors, employing appropriate medications and lifestyle modifications, and seeking prompt medical attention for complications, patients with gastric ulcers can improve their prognosis and maintain their overall well-being.