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Stomach ulcer, deep wounds that occur as a result of damage to the layer called mucosa, which covers the inner surface of the esophagus, stomach and duodenum in the digestive system, with stomach acid, digestive enzymes (pepsin, bile salts and pancreatic enzymes) or drugs (Aspirin and antirheumatic drugs). It is called an ulcer or peptic ulcer.
Gastric acid and pepsin (the enzyme that digests proteins in the stomach) are secretions that are extremely necessary for the digestion of food.
Although stomach acid is a strong acid (pH 1-2), it normally does not cause damage to the stomach and duodenum.
There is a thick mucus layer on the mucosal surface that prevents stomach acid from reaching the mucosa, (mucus= slimy substance). In the gastric mucosa, there is a balance between the factors that can damage the mucosa, such as acid, pepsin and bile acids, and the factors that protect the mucosa.
The change of this balance in favor of aggressive factors leads to deterioration of mucosal integrity and ulcer formation. Although popularly known as stomach ulcers, most peptic ulcers are found in the duodenum.
Stomach ulcers, gastric ulcers, duodenal ulcers are called duodenal ulcers or bulbar ulcers. They can be from 3-5mm to 5cm wide.
It is thought that approximately 10% of the population has peptic ulcer disease at some point in their lives. It occurs twice as often in men than in women.
While ulcers in the duodenum are common between the ages of 30-45, gastric ulcers occur at older ages (50-65).
Although stomach ulcer is a powerful aggressive factor, it seems impossible to form ulcers on its own. Because stomach acid secretion is increased in only ¼ of ulcer patients and it is within normal limits in half.
Although ulcer formation is almost always in question in some diseases in which stomach acid secretion increases excessively, such conditions are very rare (such as Zollinger Ellison syndrome).
However, the statement that there can be no ulcer without acid (No acid No ulcer) is still valid today, because it is not possible to heal stomach or duodenal ulcers without suppressing stomach acid secretion.
Today, it is accepted that there are two main causes of ulcers. Many stomach and duodenal patients with stomach ulcer are infected (75%) with a bacterium called Helicobacter pylori (HP).
In another group of patients, long-term use of aspirin or non-steroidal antirheumatic drugs (NSAIDs).
It is known that 15 million people in the world use NSAIDs, 60% of them describe stomach complaints, 10% of them develop stomach and/or duodenal ulcers, and an average of 3-4% of them have serious complications that require hospitalization.
On the other hand, the inability to detect HP infection or use of antirheumatic drugs in approximately 1/5 of the ulcer patients is an indication that the etiopathogenesis of ulcer is not yet fully understood.
Although the stress factor, which was thought to be an important cause of ulcer formation in previous years, has lost its importance today, in cases where the body is exposed to extreme stress (such as extensive body burns, head traumas and staying in intensive care), serious stomach and/or duodenal ulcers may occur and the patient with ulcer is exposed to stress. It is known that complaints can increase after the stay.
The most common manifestation of ulcer is a blunt pain felt in the upper abdomen, between the two rib arcs, and between the lower end of the breastbone and the navel, in an area usually expressed with the palm of the hand.
The pain may be crushing, scraping or burning, and may radiate to the back between the two shoulder blades and to the sides of the abdomen. It can wake you up at night.
Nausea and vomiting may sometimes be accompanied by pain. The pain may last for a period ranging from 15-20 minutes to several hours. It can start after fasting.
It is usually relieved or resolved with food or antacid intake. Therefore, patients may need to eat frequently. In patients with stomach ulcers, the pain may increase after eating, and bloating and gas may be more pronounced.
In some patients, bleeding or perforation may be the first sign of an ulcer when there are no symptoms. Weight loss can be seen in patients with a predominant complaint of vomiting. In some patients, the complaints may be exacerbated by seasonal changes, especially in spring.
The diagnostic method to be applied in patients who apply to a doctor with stomach ulcer complaints is endoscopy (Gastroscopy), which allows the diagnosis of the ulcer by directly seeing and taking tissue samples when necessary.
In rare cases, barium gastric duodenal radiography may be helpful in the diagnosis. In order to exclude the possibility of cancer in patients with suspected stomach ulcer, endoscopic examination should be performed and a tissue sample (biopsy) should be taken for examination.
The first step in the treatment of stomach ulcer is the reduction of stomach acid. When acid secretion is suppressed, pepsin, an enzyme that can become active only in an acid environment, is also inactivated.
Today, ulcer treatment can be done quite successfully thanks to drugs that suppress gastric acid secretion strongly. Your doctor will decide how long the active drug treatment will continue.
In addition to reducing acid secretion, the second thing to do in ulcer treatment is to treat this bacteria in patients with HP in their stomachs.
This treatment is usually done using 1 or 2 week treatment regimens that include at least two types of antibiotics. Your doctor will decide which treatment regimen to choose. HP treatment is especially important for the prevention of ulcer recurrence.
Treating the bacteria alone is insufficient to treat ulcers, a sufficient period of suppression of gastric acid is required for the ulcer to heal (usually 6-8 weeks).
Stomach ulcers usually require longer treatment. Stomach ulcers should be checked endoscopically after treatment and the patient should not be left unfollowed until they are completely healed.
In patients with ulcers, aspirin and/or antirheumatic drugs should be discontinued. These drugs can only be used when necessary under the supervision of a doctor.
It would be appropriate to make some changes in the lifestyles of patients, such as quitting smoking and reducing alcohol consumption, while drug therapy is ongoing in gastric ulcer.
Ulcer recurs more frequently in patients who continue to smoke. Since spicy, spicy, acidic and caffeine-containing foods and beverages and alcohol may cause an increase in complaints during the active periods of ulcer, their consumption may be restricted in the early stages of treatment.
Apart from this, it is not necessary to apply a special diet in the patient with ulcer. Patients who like to drink milk may be allowed to drink 1-2 glasses of milk a day. It is undesirable to drink milk at frequent intervals for treatment purposes. In patients living a stressful life, approaches to reduce stress can be helpful in treatment.
Today, surgical treatment is applied only when complications such as bleeding, obstruction and perforation occur that do not respond to medical and endoscopic treatment.
