Gastric ulcer

The symptoms of gastric ulcers can vary, and some people may not experience any symptoms at all (asymptomatic ulcers). When symptoms occur, they often include:

• Abdominal pain: Gnawing pain just below the ribcage is the most common symptom of gastric ulcers.
• Indigestion (dyspepsia): People with gastric ulcers often experience a sense of fullness, bloating, or discomfort after eating, which can be accompanied by nausea or heartburn.
• Nausea and vomiting: Ulcers can lead to nausea and, in more severe cases, vomiting.
• Loss of appetite: This may result from the discomfort caused by eating, which can exacerbate ulcer pain.
• Unintentional weight loss: This may occur due to a reduced appetite and difficulty eating because of pain.
• Bloating: This may be caused due to gastric inflammation.
• Blood in stools or vomit: These are signs of gastrointestinal bleeding, which can occur if the ulcer erodes into a blood vessel.

If gastric ulcers are suspected, doctors may use several diagnostic methods to confirm the diagnosis:

• Endoscopy (EGD): This is most common diagnostic test for gastric ulcers. It allows the direct observation of the ulcer, assessment of its size, and collection biopsies if needed (e.g., to test for H. pylori infection or to rule out cancer).
• Helicobacter pylori testing: Various tests, such as breath tests, blood tests, and stool tests can be used to detect H. pylori infection and determine its invasion into the gastric system.
• X-rays or barium swallow: Although not commonly used, an upper gastrointestinal series (barium swallow) may be performed to detect gastric ulcers. In this technique, the patient swallows a liquid containing barium, which then coats the stomach lining, making ulcers visible on X-ray.
• CT scan: CT may be used if there is suspicion of complications such as perforation or obstruction.

Key treatment approaches for gastric ulcer include:

• Medications:
  • Proton pump inhibitors (PPIs): Medications like omeprazole, lansoprazole, or pantoprazole reduce stomach acid production and help the ulcer heal. PPIs are often the first-line treatment for gastric ulcers.
  • Antibiotics (for H. pylori infection): If the ulcer is caused by H. pylori, a combination of antibiotics (e.g., amoxicillin, clarithromycin, metronidazole) is prescribed along with a PPI to eradicate the infection.
  • H2-receptor antagonists: These medications decrease the production of stomach acid.
  • Antacids and antisecretory drugs: Antacids (e.g., calcium carbonate) or sucralfate can help neutralise stomach acid and promote healing.
  • Cytoprotective agents: These agents (e.g., misoprostol) protect the stomach lining and are sometimes used to manage ulcers caused by NSAIDs.
• Discontinuation of NSAIDs and alcohol: If ulcers are caused by NSAIDs or alcohol, it is important to stop using these substances to allow the ulcer to heal.
• Surgical intervention: Surgery may be necessary in cases of complications like perforation, severe bleeding, or gastric outlet obstruction.

To reduce the risk of developing gastric ulcers, the following steps may be helpful:

• Limit NSAID use: Use NSAIDs only when necessary and under the supervision of a doctor, and take them with food to minimise stomach irritation.
• Avoid smoking and excessive alcohol consumption: Both smoking and alcohol increase stomach acid production and impair healing.
• H. pylori eradication: If you have a known H. pylori infection, get appropriate treatment to prevent ulcers.
• Healthy eating: While spicy or acidic foods are not a direct cause of ulcers, eating a balanced, nutritious diet can support overall gastrointestinal health.
• Stress management: Managing stress through yoga or deep breathing may help reduce the risk of gastritis and ulcers.