Why do stomach and duodenal ulcers occur?

Ulcers or ulcers are minor wounds located anywhere on our body. It is called a peptic ulcer, the ulcer in the stomach or the duodenum, to whose formation the action of stomach acid partially contributes. Stomach ulcers can be malignant (cancerous), which is not the case with duodenal ulcers.

  • The causes of stomach and duodenal ulcers are diverse:
  • More than 70% of peptic ulcers are associated with Helicobacter pylori infection, a bacterium that frequently lives in the stomach of healthy people and that, on some occasions, can lead to the development of ulcers.
  • The rest of the ulcers are due to taking aspirin, anti-inflammatories, or, more rarely, other medicines (any medicine that favours the appearance of ulcers is called “gastroerosive”).
  • A small percentage of ulcers result from other infections and diseases. After a small initial wound favoured by these agents, stomach acid favours its perpetuation.

Tobacco and alcohol consumption has been linked to the appearance of ulcers. These factors probably favour damage to the stomach or duodenum in people already infected by Helicobacter pylori or in those who take anti-inflammatory drugs.

Symptoms of peptic or stomach ulcer

A peptic ulcer usually causes pain and burning in the stomach area, which appears between 2 and 3 hours after eating and characteristically calms with food or taking antacids. However, the pain can sometimes be caused by food consumption, usually stomach ulcers. They can also produce heavy digestion and nausea.

Sometimes, the initial symptoms are derived from the appearance of an ulcer complication.

What complications do they produce?

Complications of a stomach ulcer are:

  • A digestive haemorrhage. It is the most frequent complication. It can be abrupt, manifested as the emission of red vomit or coffee grounds (hematemesis) or as the elimination of black stools (melena). Sometimes, the bleeding is slower and progressive, not observed by the patient, and manifested as iron deficiency anaemia.
  • A perforation. It consists of the perforation of the stomach or duodenum wall, with the subsequent exit of the contents of these organs into the abdominal cavity. It produces sudden and intense pain, usually in the stomach, spreading throughout the abdomen and back and even affecting the right shoulder.
  • A bowel obstruction. This is a complication of ulcers that have recurred and healed several times. After healing, the scar can retract the duodenum’s wall and obstruct the exit of food from the stomach, manifesting itself by slow digestion and frequent vomiting.

The symptoms of ulcers can easily be confused with those caused by other diseases such as hiatus hernia, gastroesophageal reflux, stomach cancer, etc., so it is necessary to carry out a series of tests for their diagnosis.

How is it diagnosed?

Diagnosis of a stomach ulcer is made by gastroscopy.

In general, blind treatment with stomach protectors should not be recommended for people with stomach discomfort since it is necessary to rule out the presence of stomach cancer, especially in elderly people.

Gastroscopy allows small ulcers to be identified, biopsies to be obtained if necessary, and the presence of Helicobacter pylori to be detected.

Currently, however, when faced with symptoms suggestive of an ulcer, some doctors prefer to perform a breath test and, if positive, eradicate Helicobacter. In addition, they would only serve a gastroscopy if the breath test was negative or if symptoms persisted after treatment.

How is a stomach ulcer cured?

The treatment of a peptic ulcer depends on its cause :

Helicobacter pylori infection 

If the ulcer is related to Helicobacter pylori infection, the treatment will be eradicating the bacteria with antibiotics to achieve a definitive cure. Strategies to eliminate Helicobacter usually involve administering 2 or 3 antibiotics (generally amoxicillin, clarithromycin, metronidazole or tetracyclines) for 1 or 2 weeks, associated with an acid secretion inhibitor for the same time.

Some doctors recommend confirming that there has been a total eradication of Helicobacter by performing a breath test a few weeks after the end of the treatment. However, other doctors only recommend performing the test at the end of treatment when symptoms persist or when there is a high risk of relapse. Different antibiotics can be used in treatment failure, sometimes up to four.

Due to taking anti-inflammatories

In case of ulcers associated with taking anti-inflammatory drugs, an attempt should be made to suspend the medication responsible for them and add an acid secretion inhibitor for 4 or 6 weeks. Inhibitors of acid secretion by the stomach are of 2 types: anti-H2 (cimetidine and ranitidine) and proton pump inhibitors. (omeprazole). In addition to acid secretion inhibitors, other treatments relieve symptoms, such as antacids (magnesium or aluminium salts), bismuth salts and sucralfate.

Refractory ulcer 

Currently, surgery is rarely used to treat ulcers. Instead, it is indicated for the treatment of refractory ulcers (those that do not respond to drug treatment) and when there are complications, such as continued bleeding, perforation of the stomach or duodenum, or significant obstruction. Currently, refractory ulcers are exceptional, so most operations are performed due to complications.

Jermaine Wyman

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