It is a loss of substance from the stomach lining that extends, at least, to the muscularis mucosa.
This ulcer can be acute, of short evolution, or chronic, of longer duration, in which it is possible to observe the fibrous reaction to continued acid aggression, which when it is very intense causes the ulcer to be called callus.
The chronic ulcer shows periods of exacerbation, which alternate with others of calm. In acute periods, the lesion can advance beyond the muscularis mucosa and injure the muscular and serous layer of the stomach and become perforating in the peritoneal cavity or penetrating into a neighboring organ: pancreas, liver, colon.
Gastric ulcers (GU) are very rare in the mucosa of the fundus, where hydrochloric acid and pepsin are produced, and they are very frequent in the anthropyloric region where the mucosa does not secrete acid.
They are divided into three types:
- Type I: it is located in the body and is not associated with another gastroduodenal pathology.
- Type II: it is located in the body and is associated with an active ulcer or duodenal scar.
- Type III: it is located in the prepyloric area.
It is more common in men than in women. Its frequency increases with advanced age, being typical of this. It is more frequent at low economic level, perhaps because it is related to a diet that is more hydrocarbon than protein.
Causes of gastric ulcer
They are mainly due to an alteration in the defense mechanisms of the gastric mucosa.
Gastric secretion is normal or decreased and, consequently, the level of gastrin will be normal or increased proportionally to the degree of gastric acidity.
H. Pylori is found in 60-80% of gastric ulcer (GU) patients.
NSAIDs produce gastric ulcer more frequently than duodenal ulcer (DU), and they do so especially in those over 65 years of age, in patients who take steroids concominantly and in patients with a previous history of peptic ulcer.
A group of gastric ulcer patients have delays in gastric evacuation.
Only 10% of gastric ulcers would remain as idiopathic, that is, not associated with H. Pylori or taking NSAIDs.
Every ulcer is a consequence of the breakdown of the balance between aggressive agents, mainly hydrochloric acid, and the defense mechanisms of the mucosa. The causes of gastric ulcers are grouped into:
- Increased volume of gastric secretion.
- Gastric stasis that allows, due to the longer contact time, the penetration of acid and pepsin through the mucosal barrier.
Defective defense of the gastric mucosa against acid and pepsin by:
- Alteration of the protective mucus layer.
- Alteration of the regenerative capacity of gastric epithelium cells.
What symptoms appear?
Pain in the epigastrium is the most frequent symptom but follows a less typical pattern than that of a duodenal ulcer (DU). The pain is less intense than in UD and even upper gastric ulcers can be painless. The pain appears sooner after meals and tends to subside spontaneously more easily than in UD. Vomiting occurs more frequently without the need for a mechanical obstruction. Recurrences are usually asymptomatic.
Gastric ulcer diagnosis
After suspicion due to the symptoms, various studies should be carried out:
- Barium radiological studies: allows diagnosing between 80-90% of gastric ulcers.
- Endoscopy: it is the diagnostic procedure of choice. Between 4-8 biopsies of the ulcer edges and brushing of the ulcer bed should be taken for cytological study. Also biopsies of the gastric antrum to investigate H. Pylori infection.
- Gastric acidity studies. They are not usually done.
Gastric ulcer treatment
Medical treatment is similar to that of duodenal ulcer (UD), but it must be taken into account that gastric ulcer (UG) heal more slowly.
Treatment with an H2 antagonist for eight weeks, taken as a dose after dinner, is recommended for uncomplicated ulcers. If the ulcer measures more than 2 cm, it is recommended to treat for twelve weeks. Omeprazole does not offer great advantages over H2 antagonists in uncomplicated gastric ulcers.
If it is a complicated gastric ulcer, treatment with omeprazole is recommended. H. Pylori infection should be treated if it exists.
It is recommended to endoscopically check the healing of the UG.
Surgical treatment is indicated when:
- Refractory to medical treatment.
- Intratability based on subjective criteria.
- Inability to rule out gastric cancer.
The surgical procedure depends on the type of gastric ulcer. In type I, it would be a resection of the antrum followed by anastomosis to reestablish digestive transit. In type II and III, vagotomy and resection of the antrum.
How can I avoid it?
UG appears more frequently in peoples that preferentially eat rice than those that consume wheat, and in populations with diets high in carbohydrates and low in protein. The high protein diet protects against gastric ulcer.
A diet low in fruit predisposes to gastric ulcer. However, a diet rich in spices, which should increase gastritis and ulcer, does not cause a higher number of UG.
There is a positive relationship between the frequency of gastric ulcer and the intake of tea, carbonated drinks and alcohol with concentrations higher than 8%.
Tobacco, indomethacin, salicylates, aspirin, phenylbutazone, and corticosteroids should be avoided because they cause gastric ulcers
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.