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Gastric ulcers

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VOL: 99, ISSUE: 01, PAGE NO: 28

Aetiology

Abstract

VOL: 99, ISSUE: 01, PAGE NO: 28

Aetiology

Aetiology

- Gastric ulcers are a type of peptic ulcer.

- They occur where the protective lining of the stomach has been eroded by the stomach’s gastric secretions.

- Peptic ulcers can also occur in the duodenum and oesophagus.

- Gastric ulcers are commonly associated with an infection of Helicobacter pylori, a bacteria found in stomach mucus. H. pylori is common, however, and can be present in people without causing any problems.

- Other associated factors include: a hereditary tendency; use of steroids; habitual use of NSAIDs (non-steroidal anti-inflammatory drugs), alcohol consumption and heavy smoking; a type-A personality (although this view is debated); hypercalcaemia and chronic diseases such as emphysema and rheumatoid arthritis.

Signs and symptoms

- A burning pain in the epigastric area that worsens with hunger.

- Nausea, vomiting and indigestion.

- Anorexia and weight loss may occur.

- Complications can include bleeding, malignant change and perforation of the stomach lining.

Diagnosis and tests

- Clinical examination - the patient may report deep tenderness.

- Gastroscopy.

- A urease indicator (CLO) test, where a tissue sample is tested for the presence or absence of H. pylori bacteria, may be performed during gastroscopy. 

- Barium meal and swallow examination. 

Treatment

- Antacid preparations to neutralise gastric acids, or drugs to diminish gastric secretions and/or motility. Carbenoxolone (a liquorice derivative) to increase mucous secretion.

- H. pylori positive patients: triple therapy of a proton-pump inhibitor such as omeprazole or metronidazole and either amoxycillin or clarithromycin. This achieves a 96 per cent clearance (McLatchie and Leaper 2002). 

- H. pylori negative patients: withdrawal of associated factors (see aetiology); drug therapy of H2 receptor antagonists or PPIs;

- Some complications including bleeding, pyloric stenosis and perforation may require surgical intervention.

Nursing implications

- Nutrition: aim to stabilise the patient’s weight. Give small portions of bland, low-fibre food six times a day. Missed meals can exacerbate symptoms.

- Patient should avoid tea and coffee as caffeine stimulates the production of gastric juice; alcohol should also be avoided as this irritates a gastric ulcer.

- Give medications at optimum times: for example, antacids are most effective one hour after meals.

- Look for ulcer complications such as haemorrhage, perforation and obstruction. The patient may experience vomiting, haematemesis or melaena.

 Research and development

- H. pylori is the focus of much research looking at why it causes ulcers in some people and not in others, how the infection is acquired, and which are the best and most cost-effective treatments.

NHS Direct Digestive Disorders Foundation

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