Gastric ulcer

Ulcers are a gastrointestinal problem frequent, affecting approximately 10% of the population. Gastroduodenal ulcer usually appears from the 50-60 years of age and it is more frequent at the duodenal level than at the gastric level.

How is it produced?

The appearance of ulcers is considered to be multifactorial cause. An imbalance between stomach acid, an enzyme called pepsin and the defense barriers of the stomach lining. This imbalance leads to a inflammation, which can be made worse by the presence of certain risk factors, such as tobacco use, alcohol consumption or radiotherapy treatment.

There is a clear relationship between infection by a bacterium called and the appearance of a duodenal or gastric ulcer. A person infected by this bacterium has a higher risk of developing ulcer disease throughout his life. Not all ulcer patients have a Helicobacter pylori infection, but this bacterium is detected in a large percentage of patients with this pathology. The spiral shape of H. pylori allows it to penetrate the mucosa of the stomach or duodenum to be able to adhere to it, producing a series of toxins that inflame and damage it.

Ulcers can also appear in relation to the drug use such as corticosteroids and non-steroidal anti-inflammatory drugs. One of the undesirable effects of anti-inflammatory is that they increase the risk of gastrointestinal bleeding or ulcer disease, since its prolonged use can damage the mucosa of the digestive tract to cause an ulcer or worsen it if it already exists.

In certain rare cases, ulcers not associated with these two main factors (H. pylori and the use of anti-inflammatory drugs) may occur. Many of them are related to an acid hypersecretion syndrome, in which there is an excess of gastric acid secretion that damages the mucosa.

Symptoms

The most common symptoms of an ulcer are usually:

• Abdominal pain. It is the main symptom, it is usually an acute pain, referred to as burning or stinging, located in the epigastrium, with outbreaks of 2 to 4 weeks duration and that usually calms with the intake or with antacids. In gastric ulcer pain is more characteristic immediately after meals.
• nausea and vomiting
• Pyrosis, that is, a burning sensation in the esophagus.
• Abdominal bloating and changes in bowel habits. In some cases the ulcers are asymptomatic or give little discomfort and are diagnosed after the appearance of a complication such as:
  • Digestive hemorrhage, which appears in the form of hematemesis (vomiting of red blood) or melena (black stools due to the presence of blood).
  • Perforation, when the peptic ulcer penetrates the different layers of the gastroduodenal wall until they are perforated. It is manifested by the appearance of the so-called acute abdomen, characterized by sudden, intense pain in the epigastrium and with hardening of the muscular wall.
  • Pyloric stenosis, consisting of the narrowing of the area where the stomach meets the duodenum. The patient usually has nausea and a feeling of fullness.

Diagnosis

The diagnosis of ulcer disease is based on the clinic history of the patient, the presence of symptom ulcers, physical examination and, if considered necessary, a series of complementary examinations.

Diagnostic methods are aimed at visualizing the ulcer (endoscopy) and detecting Helicobacter pylori. They are basically divided into:

Invasive methods:

• • • , in which a tube with a small camera is inserted through the mouth and esophagus until reaching the stomach and duodenum to be able to visualize the entire digestive tract for possible alterations. If the ulcer is visible, small tissue samples (biopsy) can be taken.
    • Upper gastrointestinal transit, which consists of having the patient take a barium preparation and perform a series of X-rays to assess the motility of this part of the digestive system and possible irregularities in the mucosa.

Non-invasive methods:

• • • Detection of antibodies against Helicobacter in blood (serology).
    • Helicobacter detection in feces.
    • , a very precise test both for the detection of Helicobacter and to check the recurrence of the infection after antibiotic treatment. It basically consists of drinking a viscous liquid with carbon-marked urea and then blowing into a small tube to determine if there is marked carbon in the exhaled carbon dioxide, a sign that the bacteria present have metabolized it.

Treatment

To relieve symptoms and reduce pain, it is indicated Pharmacotherapy. The drugs commonly used are antacids and gastric protectors, H2 receptor antagonists or proton pump inhibitors, the best known being. The latter block the acid secretion of the stomach (they are the most powerful). Long-term treatment may be necessary.

If there is an H. pylori infection, the main goal is to eradication of the bacteria causing the problem. Treatment is based on the use of a proton pump inhibitor to decrease acid secretion from the stomach, combined with antibiotics. It is administered for a few days, after which the food test is usually repeated to verify that the H. pylori infection has disappeared. If this has not been achieved, a new treatment regimen can be repeated.

Treatment of complications such as bleeding is usually treated by endoscopy, which localizes the bleeding ulcer and can cauterize bleeding. If there is gastric perforation, urgent surgical treatment is required.

It can be indicated surgical treatment in those patients who do not respond to drug treatment or endoscopy. Surgical procedures for gastroduodenal ulcers include:

• Vagotomy: consists of cutting the vagus nerve, which is what controls the production of gastric acid in the stomach.
• Partial gastrectomy, that is, removal of part of the stomach.

Likewise, it is recommended to follow a series of measures such as maintaining a balanced and healthy diet, avoiding foods rich in fat and eating small meals during the day at regular intervals. It is also advisable to avoid tobacco, tea, coffee and caffeinated drinks, as well as alcohol and the consumption of non-steroidal anti-inflammatory drugs if it is not strictly necessary.

Prevention

Eating a healthy diet and if you are at risk of ulcers, avoiding taking non-steroidal anti-inflammatory drugs or doing it associated with a gastric protector can reduce the risk of suffering from a gastroduodenal ulcer.

The symptoms of the ulcer can appear suddenly and with force, so being able to have the advice of a family doctor at any time of the day or night is very positive to act quickly and, above all, reassure ourselves. MAPFRE Salud insurance includes the free Family Medical Guidance Service for the insured.

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• There is a clear relationship between the appearance of gastric ulcer and infection by the Helicobacter pylori bacteria.
• The most common symptoms are: abdominal pain, nausea and vomiting, burning in the esophagus, abdominal distention.
• Pharmacological treatment is indicated to alleviate the symptoms. In case of not responding, surgical treatment may be indicated.

Dra. Eva Ormaechea Alegre Intensive Medicine Specialist