Peptic ulcer (gastric and duodenal ulcers)
What is it?
Peptic ulcer is a pathological condition characterized by damage to the mucous membrane of the stomach or duodenum, which spreads deep into the inner layers. Duodenal ulcer is much more common and appears earlier. Gastric ulcers are less common, appear later in life, and are usually associated with chronic atrophic gastritis. After healing, there is a high recurrence rate.
The main factor in the genesis of peptic ulcers is infection of the stomach with the bacterium Helicobacter pylori, which can cause inflammation and ulcer formation both in the stomach and, due to its influence on acid secretion, in the duodenum. Genetic characteristics, nervous stimuli, smoking and alcohol are other factors involved in the genesis of the disease.
In peptic ulcer, on the other hand, gastric acid secretion plays no role, and in many cases is reduced due to atrophic gastritis. A particular type of ulcer, localized mainly in the stomach, can be caused by long-term ingestion of anti-inflammatory drugs, such as aspirin, which suppress the production of protective factors (mucus and bicarbonate) normally able to protect the stomach from the effects of acid.
Which are the symptoms?
The most common symptoms are pain and heartburn. In duodenal ulcers, they occur mostly at night and on an empty stomach, whereas in stomach ulcers they occur immediately after a meal. Gastric ulcers are often associated with dyspeptic symptoms (difficulty digesting, early satiety, bloating), probably due to concomitant chronic gastritis. Complications include progressive anemia or acute bleeding (characterized by a discharge of liquid stools known as "melena," or bloody vomiting). In rarer cases, the ulcer may perforate, causing worsening painful symptoms.
- pain and burning in the stomach
- digestive problems
- early fullness
- bloating
- melena
- bloody vomiting
How is it diagnosed?
The diagnosis is made by gastroduodenoscopy, accompanied by a biopsy of the gastric mucosa. Gastric ulcer biopsy is important to rule out neoplastic pathologies. Searching for Helicobacter pylori infection is very important in order to proceed to definitive eradication with antibiotic therapy.
How is it treated?
There are various effective drugs, such as gastric acid secretion inhibitors (anti-H2, proton pump inhibitors) and mucous membrane protectors, but only eradication of Helicobacter pylori (with combinations of various drugs, especially antibiotics) can permanently solve the problem of relapses. Treatment of acute bleeding is mainly endoscopic, with peripleural administration of vasoconstrictors or metal clips to stop bleeding.
Where do we treat it?
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