GASTRIC AND DUODENAL ULCERS

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Facts on Gastric and Duodenal Ulcers

What are Gastric and Duodenal Ulcers?

An ulcer means an open sore. In the digestive tract, ulcers generally affect the inner – most lining of your esophagus, stomach or upper portion of your small intestine, The duodenum. These are also known as peptic ulcers. Gastric ulcers are ulcers that form in your stomach and duodenal ulcers form in your duodenum.

Gastric and Duodental UlcersCauses and risk factors

Peptic ulcers occur when acid in digestive tract erodes away the inner lining layer – the mucosa of the esophagus, stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract normally has a protective coat of mucous that protects against acid. An ulcer develops if the amount of acid is increased or the amount of mucus is decreased. Common causes include:

  • Eating too much of spicy food
  • Infection by a particular bacterium – Helicobacter Pylori
  • Starvation for prolonged period of time
  • Repeated consumption of over the counter drugs, either steroids or non-steroidal drugs like aspirin and anti-inflammatory drugs
  • Smoking
  • Alcohol intake

Symptoms

These are the symptoms associated with gastric or duodenal ulcers

  1. Burning sensation felt in your tummy mostly when you are hungry.
  2. Nausea and Vomiting, which can sometimes be bloody
  3. Gaseous discomfort
  4. Poor appetite
  5. Chest pain
  6. Bloody or tarry stools and
  7. Weight loss

DiagnosisEndoscopy

An endoscopy is nothing but inserting a flexible tube, fitted with camera and light, down your throat to view the upper part of your digestive tract. The situation and size of ulcers and other complication sdue to ulcer like bleed, obstruction can be made out. Performing an endoscopy has other advantages, as well. It can help the doctor identify, if apart from ulcers you have coexisting tumour in the stomach. Tissue samples are taken from your stomach and analyzed for H.pylori infection and also to look for presence of tumours.

Blood or Stool samples

The other primary test doctors need to perform on patients, who are suspected with a typical Gastric or duodenal ulcers, is, check for the presence of the bacterium named H Pylori. This is done, apart from endoscopy, from the patient’s blood, stools or breath.

X-Rays

Though Biopsies are taken during endoscopy, X-rays add significant information to the clinician. A traditional upper GI (Gastro-Intestinal) series of X-rays are able to provide a better view of your upper digestive system, but these are rarely used now.

Treatment procedure for Gastric and Duodenal UlcersThe basic treatment of Peptic ulcers, is acid suppression and measures to heal the ulcer. This requires avoidance of the causative factors and the doctor prescribes certain types of medication or antibiotics, to suppress the production of acid or multiplication of the bacterium named H Pylori. These include

  1. Proton pump inhibitor
  2. H2 blockers and
  3. Mucosal protective agents

The overall functions of all the antibiotics or medications stated above, is to reduce the acid secreting capacity of the stomach, or to heavily line the mucus, so that peptic ulcers are suppressed.

If the gastric or duodenal ulcers do not subside with the maximum dose of over the counter drugs, medication or antibiotics, your doctor may advise surgery for you.

Surgical options

These are the standard surgical options that may be carried out

Vagotomy

This is a procedure that involves cutting parts of the vagus nerve. Vagus nerve is a nerve that transmits messages to the brain, from the stomach, to stimulate acid secretion. If your vagus nerve is cut , the interrupted messages can therefore suppress acid production.

Antrectomy

This is a surgical option, which involves removing the lower portion of the stomach namely the antrum. Again antrum is the main part of stomach that produces hormones that stimulate your stomach to produce digestive juices including pepsin and acid. Usually, a Vagotomy is performed in conjunction with an Antrectomy.

Pyloroplasty

This surgical procedure is done in patients who develop a narrowing of the pyloroduodenum due to long standing ulcer disease. This duodenal opening is enlarged so that acid and food pass out of the stomach without hindrance.

Laparoscopy

Most of these procedures are done by laparoscopy, where you are subjected to a few very small incisions on the abdomen and the procedure is carried out. The pain is much less and recovery time is faster allowing to return to work earlier.

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