Duodenal and gastric ulcers

A peptic ulcer is a tissue deficiency condition that most often develops in the stomach or in the initial stages of the duodenum.
Excessive stomach acid production plays a significant role in the development of gastric ulcers.
In some cases, this can lead to self-digestion of the mucosa.

So, in the case of a stomach or duodenal ulcer, the layer of mucus that protects the mucous membrane from stomach acid is simply damaged.
The injury causes the mucous membrane to become ulcerated and difficult to heal because of the presence of stomach acid.
The patient feels the typical corrosive sensation of the disease when the stomach acid comes into contact with the wounded surface.

When acidic gastric juice cannot be neutralised once it reaches the duodenum, duodenal ulcers can develop.

The development of a stomach ulcer can be triggered by several factors.
The most common of these is Helicobacter pylori, a bacterium resistant to stomach acid (found in 70-90% of people with peptic ulcers and 95% of people with duodenal ulcers).
If Helicobacter positivity is confirmed during an ulcer investigation, it can be treated with a course of antibiotics.

Stomach ulcers can also be caused by certain medicines (especially so-called nonsteriodal anti-inflammatory drugs and corticosteroids), injuries and infections.
It was previously thought to be triggered by excessive coffee consumption, alcohol or too much stress, or by eating spicy foods.
However, these are not direct causes, but at most contribute to the worsening of the disease.

There is also the acute stress ulcer, which is often the first symptom of acute stress ulceration, often without pain and with acute bleeding.

Complications of ulcer disease can include bleeding, perforation, and narrowing of the stomach lining.

The bleeding usually starts with dizziness and fainting, and the patient vomits most of the blood in the stomach.
The blood in the intestinal tract is digested, turning the stools pitch black.
The small amount of blood in the stool is not visible to the naked eye but can be detected by laboratory tests.

Perforation is associated with sudden, severe pain.
Gastric valve stricture is characterised by vomiting over several days, which may include food eaten days before.

The management of peptic ulcers is influenced by a number of factors, including the patient’s age, living conditions, health and previous or existing medical conditions.
The extent of the disease, its condition and whether the patient is Helicobacter positive or sensitive to medication should be taken into account.
There are several options for treating gastric ulcers: lifestyle changes, medication and, in the last resort, surgery.

LIFE MANAGEMENT It is recommended to learn some stress management techniques, to eliminate or treat possible triggers of anxiety.
The patient should avoid harmful factors (alcohol, smoking, ulcer-causing drugs) and change his/her eating habits.
For peptic ulcers and duodenal ulcers, frequent, small meals are recommended, which in practice means eating every 2-3 hours.
Avoid strong, spicy, hot and fatty foods, onions, white wine, coffee and sweets.

PHYSICIANS If medication is not effective, you should make sure that the ulcer is not malignant.
This requires a gastroscopy, during which a histological sample of the ulcer can be taken.
Gastroscopy should be repeated 4-6 weeks after the start of treatment to assess the effectiveness of the treatment.
Repeat gastroscopy is necessary until healing is certain.

OPERATION Most duodenal ulcers can be successfully treated with medicines.
However, if healing does not start within three months of treatment, surgery may be necessary.