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Ulceration within the stomach is a common surgical complaint with a wide spectrum of type and severity of presentation. The incidence and complexity of disease in the UK is reducing with the widespread use of drugs for symptoms of “indigestion” which completely suppress stomach acid production.
The recognition that many ulcers are caused by a bacterial infection or particular types of painkilling drugs has also changed the nature of the condition in the UK in the last twenty years.
Causes of stomach ulcers
Helicobacter Pylori Infection: A bacterium found in the stomach (often in individuals without symptoms) has been shown to have a role in the development of duodenal ulcers and is often responsible for them failing to heal when treated with acid suppression drugs.
Excessive secretion of stomach acid: Is found in some but not all cases of stomach ulceration.
Non-Steroidal Anti-inflammatory drugs (NSAID): Widely recognised to cause ulceration in some patients
Smoking: May cause and certainly potentiates the development of duodenal stomach. Alcohol and Caffeine do not appear to have any effect
Unusual Conditions: Some Liver, Kidney and Thyroid conditions
Ill or hospitalised patients: A very common finding in this patient group usually with poor nutritional intake
- Abdominal Pain usually centrally in the upper abdomen
- Anaemia usually showing Iron deficiency
- Vomiting blood (haematemesis)
- Black stools (melaena)
- Collapse and shock
Ulcers may be diagnosed by a variety of means but the most accurate and useful is an OGD (Oesophago-Gastro-Duodenoscopy). A flexible endoscope is inserted via the mouth into the oesophagus, stomach and duodenum. The ulcers may be diagnosed and must biopsied. Samples may be taken for Helicobacter Pylori and certain treatments (particularly for bleeding) undertaken.
The vast majority of stomach ulcers will heal with a six to twelve week course of acid suppression therapy using a proton pump inhibiting drug (Omeprazole, Esmoprazole etc) and eradication of Helicobacter Pylori (if present) with a week long course of two antibiotics in combination.
Clearly treatment should also address other stimulants of ulcer formation, smoking and NSAID (aspirin, Ibuprofen etc) use. Complete healing should be confirmed by repeating the OGD and re-biopsied if not completely healed.
Only very occasionally since the advent of complete acid suppression therapy, do stomach ulcers that fail to heal completely, require surgery and this is undertaken by general surgeons with specialist interest in oesophago-gastric surgery.
However stomach ulcers that present as an emergency to hospital with either bleeding or perforation do require aggressive treatment. Bleeding may be controlled in an emergency by endoscopy and the use of injections, application of heat and clips to the vessels in the stomach wall. In some cases when this is unsuccessful surgery is necessary.
Perforation is almost always treated with urgent operation. Both conditions are treated surgically by either excision of the ulcer with closure of the hole created in the stomach or removal of part of the stomach, a gastrectomy.