Peptic ulcer of the stomach and duodenum

Content

Introduction

Peptic ulcers are wounds that develop in the inner wall of the stomach (gastric ulcers) and duodenum (duodenal ulcers). The duodenum is the part of the small intestine that begins just below the stomach.

The most common ailment of peptic ulcers is stomach pain.

Symptoms

The presence of stomach or duodenal ulcer is not always accompanied by disorders (symptoms). About 75% of people affected by peptic ulcers, in fact, do not show any symptoms or feel a sense of fullness of the stomach, difficulty digesting and nausea.

The most common symptom of ulcer is heartburn, a pain that appears in the central area of ​​the abdomen just below the ribs and can extend around the navel and also affect the back. The burning can last from a few minutes to a few hours. often begins shortly after eating and worsens between meals and at night on an empty stomach Pain may go away with eating food or drinking milk but usually returns shortly after ingestion.

Given the lack of characteristic signs, if persistent symptoms appear which include:

  • sense of fullness, having difficulty digesting the meal
  • nausea
  • weight loss
  • abdominal pain

See your doctor as they may indicate complications.

You should see your doctor right away, however, if you experience:

  • vomiting with blood, the blood may appear bright red or dark brown, with a grainy appearance, similar to coffee grounds
  • dark blood in the stool which appear black and tar-like and are particularly foul-smelling
  • sudden sharp pain in the belly which progressively worsens

These symptoms could be a sign of complications that require prompt medical attention.

Causes

Under normal conditions, the mucous membranes of the stomach and duodenum are protected from hydrochloric acid, produced by the stomach, by a "barrier" consisting of mucus containing bicarbonate, produced by the cells of the stomach and duodenum. Any condition affecting this protection (smoking , alcohol, anti-inflammatory drugs, infection with Helicobacter pylori) or that increases the production of acid favors the appearance of the ulcer.

Peptic ulcers develop when the lining of the stomach weakens and a wound is generated. Often, the cause is an infection caused by a bacterium, the "Helicobacter pylori, or prolonged or high-dose intake of acetylsalicylic acid (aspirin) or other non-steroidal anti-inflammatory drugs (NSAIDs).

The risk of an ulcer may also increase due to:

  • smoke
  • alcohol consumption, alcohol can irritate and corrode the lining of the stomach and increase the amount of stomach acid produced
  • stress
  • spicy foods

These factors alone do not cause ulcers but can favor ulcers, make them worse and make healing more difficult.

Complications

Ulcer complications are relatively rare but some of them can be very serious and potentially life-threatening.

Bleeding

When the ulcer affects a blood vessel, the following can occur:

  • small bleeding over time, in this case there are no symptoms but the loss of blood can cause anemia and, consequently, fatigue, shortness of breath, skin pallor and heart palpitations
  • severe and rapid bleeding, with vomiting or black or bloody stools

Drilling

When the stomach wall ruptures at the ulcer it is referred to drilling. The perforation of the gastric mucosa can be very serious because the contents of the stomach pour into the abdomen, causing a peritonitis (inflammation of the inner lining of the abdomen called, in fact, peritoneum).

When peritonitis occurs, the infection can spread rapidly in the blood (sepsis) and spread to other organs. In this case, multi-organ failure can occur which, if left untreated, can be fatal.

The most common symptom of peritonitis is the onset of sudden abdominal pain that progressively worsens over time. If you have this type of pain, you should contact your doctor immediately.

Perforation of an "ulcer, resulting in peritonitis, is an" emergency that requires hospitalization and surgery.

Gastric outlet obstruction

The obstruction of the gastric outlet is a very rare complication nowadays given the availability of very effective drugs in reducing gastric acidity and infection by Helicobacter pylori.

The obstruction of the gastric outlet is due to the scars that form in the healing process of repeated ulcers and that obstruct the passage of stomach contents into the duodenum. This condition can cause:

  • repeated episodes of vomiting, even with undigested food
  • persistent feeling of swelling or fullness
  • feeling full after eating less food than usual
  • unexplained weight loss

Diagnosis

The most suitable test for diagnosing gastric or duodenal ulcer is esophagus-gastro-duodenoscopy (EGDS), an exam that explores the upper digestive tract. The procedure involves introducing a tube into the stomach and duodenum with a camera, passing through the mouth or nose.During the examination it is possible to perform a quick analysis to detect the possible presence of Helicobacter pylori, by performing the so-called "urease which is carried out on a piece of tissue taken from the stomach. If a gastric ulcer is present, multiple biopsies are also done to rule out the presence of stomach cancer which, in some cases, may take on an ulcer-like appearance. In case of duodenal ulcer it is not necessary to perform duodenal biopsies.

Therapy

In most cases, the ulcers heal within a month or two, following specific treatments that depend on the causes that led to their appearance. Primarily, drugs are prescribed that are capable of reducing the amount of acid produced by the stomach (proton pump inhibitors).

If the ulcer is caused by the use of anti-inflammatory drugs (NSAIDs), the doctor usually prescribes proton pump inhibitors and indicates whether or not to continue the use of NSAIDs or to take alternative pain relievers to NSAIDs, such as paracetamol. In the case of treatment with low-dose aspirin (which is a drug belonging to NSAIDs), used to reduce the risk of cardiovascular disease (generally in people who have had vascular ischemias) the doctor should always indicate whether continue treatment.

If the ulcer is associated with an infection with Helicobacter pylori, antibiotic therapy is required.

During the peptic ulcer therapy there are no particular behaviors or lifestyles to follow but it is advisable to avoid stress, alcohol, spicy foods and smoking in order to reduce the symptoms of the ulcer.

After healing, the ulcers may return but if the cause is known, it is possible to intervene, preventing them from recurring after some time.

The complications of the ulcer require different interventions based on the severity:

  • bleeding ulcers, an endoscopic procedure is used to stop bleeding
  • severe and rapid bleeding, requires a procedure of embolization of the bleeding vessel through an angiographic examination. This procedure closes the bleeding vessel and stops bleeding
  • perforated ulcers, surgery is performed which, in most cases, preserves the integrity of the stomach and duodenum
  • obstruction of the gastric outletonce other causes have been excluded, such as the presence of tumors, dilation of the narrow tract is performed by applying a balloon connected to the endoscope and, at the same time, medical therapy is started to avoid the formation of other ulcers. If repeated dilations are ineffective, surgery must be performed

Bibliography

Kempenich, JW, Sirinek, KR. Acid Peptic Disease [Summary] The Surgical Clinics of North America 2018; 98: 933–944

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