ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Gastric ulcer; benign

Gastric ulcer; benign

Causes and Risks:
According for the Centers for Disease Control and Prevention, approximately 80% of gastric ulcers are caused by Helicobacter pylori (H. pylori) bacterium. This common, spiral-shaped bacterium can weaken the protective mucus coating of the stomach, allowing acid and bacteria to ulcerate the sensitive lining underneath. About two-thirds of the world's population is infected with H. pylori, but most of those infected do not exhibit symptoms related to the infection. Chronic or long-term use of aspirin or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, can also cause gastric ulcers. About 2% to 4% of gastric ulcers are caused by stomach or pancreatic cancer.

Gastric ulcers are not caused by spicy foods or stress .

Risk factors include H. pylori infection, NSAID use, chronic gastritis , group A blood type, and being over age 50. According to the National Institutes of Health, as many as 10% of the population will experience a peptic ulcer (gastric or duodenal) at some point in their lives.

Prevention:
People with a history of gastric ulcer should avoid aspirin and NSAIDs (ibuprofen, naproxen etc.) use. Check with your health-care provider about alternatives to NSAIDs.

Symptoms:

Abdominal pain
- May wake the person at night
- May be relieved by antacids or milk
- May occur two to three hours after a meal
- May be worsened by not eating
Nausea or vomiting , especially vomiting blood
Indigestion
Weight loss
Fatigue .

Note: There may be no symptoms.

The following symptoms can be life threatening. Contact your health-care provider immediately if you have any emergency symptoms such as:

Sharp, sudden, persistent stomach pain.
Bloody or black stool .
Bloody vomit or vomit that looks like coffee grounds.

Signs and Tests:

An upper GI series showing a gastric ulcer.
An endoscopy or esophagogastroduodenoscopy (EGD) and biopsy showing a benign gastric ulcer -- since a small percent of gastric ulcers are caused by gastric cancer , it is vital to undergo these tests that will check for cancer.
An H. pylori test, if ulcer is found; H. pylori can be diagnosed through a blood, breath, or tissue test.

Treatment:
If the ulcer is caused by H. pylori, treatment may include a combination of antibiotics that kill the bacteria, H ₂ -blockers and proton pump inhibitors that reduce stomach acids, and medications that protect the lining of the stomach. For example, "triple therapy" used to treat this type of ulcer consists of a two-week course of two antibiotics plus an acid-suppressing drug or a drug that coats the stomach lining.

The antibiotics used to kill H. pylori bacterium include metronidazole, tetracycline, clarithromycin, and amoxicillin. H ₂ -blockers to reduce stomach acids include cimetidine (Tagament), ranitidine (Zantac), famotidine, and nizatidine (Axid). Proton pump inhibitors, which block the mechanism by which acids enter the stomach, include omeprazole (Prilosec) and lansoprazole (Prevacid). Bismuth subsalicylate, an ingredient in Pepto-Bismol, and sucralfate (Carafate) are two medications that help coat the ulcer, allowing the ulcer to heal.

When the ulcer is caused by NSAIDs, NSAID use is usually discontinued and the symptoms may be treated with H ₂ -blockers, proton pump inhibitors, and bismuth subsalicylate or sucralfate.

Surgical intervention is sometimes necessary to manage ulcer complications (for example, bleeding, perforation, or obstruction) that do not respond to other treatments.

Self help measures include

Avoiding smoking
Avoiding tea, coffee, and caffeine -containing soft drinks
Avoiding alcohol
Avoiding aspirin or NSAIDs

Prognosis:
More than 90% of ulcers caused by H. pylori are effectively treated with antibiotics and ulcer-healing medications and do not recur.

Most NSAID-induced ulcers resolve after NSAID use is discontinued and ulcer-healing medications are administered.

Recurrent ulcers can lead to complications. Contact your health-care provider right away if symptoms persist or recur or new symptoms develop.

Complications:
Serious complications of stomach ulcers include bleeding, a perforation (hole) in the stomach wall, and the obstruction of food trying to get from the stomach to the intestines.

Call Your Healthcare Provider:
Call your health-care provider if ulcer symptoms worsen, do not improve with treatment, or new symptoms develop.

The following symptoms can be life threatening. Contact your health-care provider immediately if you have any emergency symptoms such as:

Sharp, sudden, persistent stomach pain.
Bloody or black stool .
Bloody vomit or vomit that looks like coffee grounds.

This is an example of a procedure called an upper GI series. The person swallows a substance called barium which allows for illumination of the organs in question. In this case, an ulceration is present in the stomach, seen on the right of the screen. This method is a means of diagnosing stomach ulcers as well as other anomalies along the upper gastrointestinal tract.