What is Gastric Ulcer?
Gastric ulcer or stomach ulcer disease is a very painful, nagging condition. Peptic ulcer disease or PUD is the term that it is medically used for stomach ulcer. The stomach lining is locally affected by erosion or a formation of a hallow surface (ulcer). This causes pain and possible bleeding. Many have complained of such as pain felt during meals or after meals. This condition may come and go but if it has severely progressed, recurrence is extremely expected. So without proper treatment and care, most likely the condition can bug you in the long course of your life.
Gastric Ulcer Symptoms
Since there is damage of the stomach lining, the end result would be the following:
Abdominal pain – usually described as burning and gnawing sensation accompanied by feeling of fullness.
Loss of appetite, accompanied by weight loss –with the excruciating pain felt during or after eating. The person affected tends to feel bloated and would lose ones appetite for eating.
Nausea and vomiting – body tends to remove food that causes discomfort.
Hematemesis – the vomiting of blood. This would entirely indication perforation of the stomach lining, a complication from severe ulceration.
Bleeding – is a sign of complication, either by a serious perforation or erosion of the mucous lining
Gastric Ulcer Causes
Stomach ulcers are primarily caused by the excessive production of hydrochloric acid, an essential digestive juice of the stomach. Once it is overtly produced, the mucosal lining becomes thin and as a result ulcerations happen. Another cause of gastric ulcer formation is the bacteria called Helicobacter pylori. This can be transmitted through contaminated food and water. An opportunistic bacteria that thrives in the stomach lining causing inflammation. These bacteria can be identified by a breath test called urea breath test. It can identify the presence of the H. pylori in the stomach if it turns out positive. How would you know? The bacteria can digest urea into carbon dioxide, so patient is given a capsule containing urea. The presence of H. pylori is indicated if a great amount of isotopic carbon is identified through the breath test. Direct culture of the specimen can also be done to identify the bacteria. Other risk factors include:
Stress – this triggers hydrochloric acid production, so the increasing amount of stress is proportionate to the amount of digestive enzyme
Stimulants – such as spices, chocolate, milk, coffee
Cigarette smoking – increases gastric acid and depletes mucous formation
Irritants – alcohol abuse, makes the mucous lining thinner
Drugs – use of NSAIDs and aspirin
Gastric Ulcer Treatment
The medical management for peptic ulcer disease is to medicate, reduce excessive acid secretions and lifestyle modifications. The use of antacids such as the famous Maalox and Tums is quite common in relieving pain. The use of cytoprotective drugs is essential in defending the mucosal lining and avoiding further damage of the stomach. Sucralfate (Carafate) and misoprostol (Cytotec) are the common drugs used for stomach ulcers. Proton-pump inhibitors such as omeprazole (Prilosec) and lansoprazole (Prevacid) target the inhibition of acid production. H2- antagonists’ reduces stomach acidity thus obstructing the delay of more ulcer outbreaks. The common generic name is ranitidine.
We need to control the bacteria H. pylori. There is no direct cure from this bacteria, but we can lessen the infection by taking medications. Amoxicillin (Amoxil) is a recommended antimicrobial. Other drugs include clarithromycin, metronidazole and tetracycline. Antibiotics are much very helpful if taken with a proton-pump inhibitor.
We’ve already known that stress, stimulants, irritants, and cigarette smoking can cause stomach ulcers. We just need to avoid these in order to make our digestive system free from ulcerations. Stress is unavoidable but techniques in stress-relieving actions should be learned or practiced regularly. Having a healthy lifestyle, diet and a restricted one would make you a step away from gastric ulcer.
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Gastric Ulcer Types
Peptic ulcer can be classified according to the areas affected. We have the duodenal and gastric ulcers.
Duodenal Ulcer
Duodenal ulcer – affecting the duodenum (first section of the duodenum that is just after the stomach). This varies from gastric ulcer in terms of symptom. Pain is not felt during meals instead after meal. This is basically because of the anatomical location of the duodenum. But after two to three hours, the pain starts. This is more common among men.
Gastric Ulcer
Gastric ulcer – affecting the stomach lining. The pain is felt during meals and it includes nausea and vomiting. Food worsens the discomfort, so it is much evident that a person suffering from gastric ulcer has weight loss in a matter of few days. This type of ulcer is more common in women than in men.
Ulcers can be classified with its severity and proximity according to the Modified Johnson Classification of peptic ulcers:
- Type I – The ulcer is located at the lesser curve of the stomach
- Type II – This is the presence of two ulcers found in the gastric and duodenal areas
- Type III – Located at the pyloric channel, prepyloric
- Type IV – Found between the esophagus and upper gastric area
- Type V – Occurs anywhere in the stomach
Gastric Ulcer Diet
Since Helicobacter pylori bacteria has been the main culprit for gastric ulcers, one should be very careful of what you eat. The bacteria may be consumed in poorly prepared foods or drinks. So a healthy diet is a must especially if you are currently being treated from gastric ulcer.
It is easier if we know what food items to avoid (Such as those acidic foods):
- Vegetables with added fat
- Lemons, oranges, pineapples and berries
- Milk, chocolate milk, cream and cheese
- Highly seasoned, spicy, fried meat, poultry and fish
These are the recommended food items:
- Bread
- Fruits and veggies that are all fresh and even frozen (aside from those mentioned above) especially those rich in fiber
- Low-fat foods
- Non-fat milk (others with low- or nonfat in label)
- Lean meat
Gastric Ulcer Surgery
Vagotomy
Procedure: A major surgical prodecure that involves the cutting of the vagus nerve. It has four types, depending on the severity of the situation:
These types vary from the severity of the situation. Recovery from this procedure would take weeks and risks are available. This would include the common abdominal surgery complication that is dumping syndrome. This is a condition wherein diarrhea, diaphoresis (sweating), tachycardia from sudden hypoglycemia are noted after eating. To avoid such phenomenon, fluid restriction is a must. Lying down after meals and avoiding walks after meals are advised so no abrupt digestion will occur.
Indication: The vagus nerve is responsible for acid secretion in the stomach. In emergency situations, when pain is intolerable from peptic duodenal ulcers and client is not having the desired effects from the medications, then this procedure is done. If the acid production in the stomach cannot be controlled the necessary cutting of the vagus nerve is done. When severe bleeding, perforation and an obstruction are noted, resection of the vagus nerve is elected.
Antrectomy
Procedure: This procedure involves in the removal of a subpart of the stomach called antrum. This part is located at the lower third of the stomach. Since it’s a removal of the portion of the stomach, it is sometimes referred as partial gastrectomy. The risks of this condition are the same with vagotomy. But we have to include possible weight loss and malnutrition, a common side effect when a part of your stomach is taken out.
Indication: This is indicated to patients suffering from peptic ulcer disease who are unresponsive to the medical treatments given by the doctor. Not only in cases of PUD but also in instances of stomach cancer and gastric obstruction. This is usually done together with vagotomy. This is performed in cases of severe stomach ulcerations and perforation.
Pyloroplasty
Procedure: Plasty –meaning surgical repair. The pyloric valve is cut open and re-sutured and finally relaxing the pyloric sphincter into the duodenum. It now makes the clearing of the stomach contents into the duodenum smoother. One risk, which was not mentioned above is the possible occurrence of an abdominal hernia. This leads to the reason for considering another surgical operation.
Indication: Peptic ulcer disease alters gastric emptying in a way of obstruction. This indicated when the pyloric valve has thickened and when digestion process is already hindered. This is a treatment for pyloric stenosis a possible complication when ulcerations have become severe.
