hpbStomach ulcer

Stomach ulcer are erosion of stomach mucosa and open surface inside the stomach cavity.

 

Causes:

Gastric ulcer is very common problem but its incidence is decreasing. Common causes are medicine (NSAIDs like ibuprofen, steroids), H. pylori infection, Alcohol, smoking, Zollinger Ellision syndrome, stress, after massive burn, trauma, critically ill patients.

Symptoms:

Usually presents as upper abdominal pain after eating. Gastric ulcer complications present with a more profound clinical picture. Recurrent ulcers at the pylorus can result in stricture formation and cause a gastric outlet obstruction. Gastric ulcers can bleed, especially when a blood vessel is visible in the base of the ulcer on endoscopy. While many of these ulcers can be injected and cauterized endoscopically, some require surgical resection. Before the bleeding lesion is identified endoscopically, patients often present with either vomiting of blood or passage in stool. Perforation will present with acute epigastric pain and tenderness with guarding and rigidity of abdominal muscles. Obstruction will present with persistent nausea and vomiting.

Diagnosis:

H. pylori by antibody detection tests. Upper endoscopy.

Management:

Stopping alcohol, smoking, drugs and medicines which are common offenders. Treatment for H pylori. Change in diet. Proton pump inhibitors like omeprazole, lansoprazole, pantoprazole, esmoprazole. Surgery by removing part of the stomach.
Management of perforation by surgery in most of the cases, very uncommonly patient can be managed by just watching and conservative management if they are stable and perforation is very small.