Gastric Ulcer
Disease Details
Family Health Simplified
- Description
- A gastric ulcer is a sore or lesion that develops on the lining of the stomach.
- Type
- Gastric ulcers are not typically classified as having a genetic transmission. They are usually caused by factors such as Helicobacter pylori infection, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, smoking, stress, and certain foods. While there may be a genetic predisposition to developing conditions that increase the risk of ulcers, such as higher susceptibility to H. pylori infection, the ulcers themselves are not directly inherited.
- Signs And Symptoms
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Signs and symptoms of a peptic ulcer can include one or more of the following:
abdominal pain, classically epigastric, strongly correlated with mealtimes. In case of duodenal ulcers, the pain appears about three hours after taking a meal and wakes the person from sleep;
bloating and abdominal fullness;
waterbrash (a rush of saliva after an episode of regurgitation to dilute the acid in esophagus, although this is more associated with gastroesophageal reflux disease);
nausea and copious vomiting;
loss of appetite and weight loss, in gastric ulcer;
weight gain, in duodenal ulcer, as the pain is relieved by eating;
hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer or from damage to the esophagus from severe/continuing vomiting.
melena (tarry, foul-smelling feces due to presence of oxidized iron from hemoglobin);
rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis and extreme, stabbing pain, and requires immediate surgery.A history of heartburn or gastroesophageal reflux disease (GERD) and use of certain medications can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAIDs (non-steroidal anti-inflammatory drugs) that inhibit cyclooxygenase and most glucocorticoids (e.g., dexamethasone and prednisolone).In people over the age of 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.The timing of symptoms in relation to the meal may differentiate between gastric and duodenal ulcers. A gastric ulcer would give epigastric pain during the meal, associated with nausea and vomiting, as gastric acid production is increased as food enters the stomach. Pain in duodenal ulcers would be aggravated by hunger and relieved by a meal and is associated with night pain.Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the person's age. Furthermore, typical ulcers tend to heal and recur, and as a result the pain may occur for few days and weeks and then wane or disappear. Usually, children and the elderly do not develop any symptoms unless complications have arisen.
A burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion, or heartburn. Pain is usually caused by the ulcer, but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours, and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night, and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for everyone. - Prognosis
- Prognosis for gastric ulcer largely depends on the underlying cause, timely diagnosis, and treatment adherence. With appropriate treatment, which often includes medications to reduce stomach acid and antibiotics if Helicobacter pylori infection is present, many individuals experience significant relief and healing within weeks to months. However, complications such as bleeding, perforation, or increased cancer risk can arise if the ulcer is untreated or persists. Lifelong management may include lifestyle modifications and ongoing medication to prevent recurrence.
- Onset
- Gastric ulcers typically develop gradually. Initial onset might include symptoms such as burning stomach pain, bloating, and nausea, which can worsen over time if left untreated.
- Prevalence
- Gastric ulcers, a type of peptic ulcer, affect about 1-2% of the global population annually. The prevalence increases with age and varies by region. Men are more commonly affected than women.
- Epidemiology
- The lifetime risk for developing a peptic ulcer is approximately 5% to 10% with the rate of 0.1% to 0.3% per year. Peptic ulcers resulted in 301,000 deaths in 2013, down from 327,000 in 1990.In Western countries, the percentage of people with H. pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80, etc.). Prevalence is higher in third world countries, where it is estimated at 70% of the population, whereas developed countries show a maximum of a 40% ratio. Overall, H. pylori infections show a worldwide decrease, more so in developed countries. Transmission occurs via food, contaminated groundwater, or human saliva (such as from kissing or sharing food utensils).Peptic ulcer disease had a tremendous effect on morbidity and mortality until the last decades of the 20th century when epidemiological trends started to point to an impressive fall in its incidence. The reason that the rates of peptic ulcer disease decreased is thought to be the development of new effective medication and acid suppressants and the rational use of nonsteroidal anti-inflammatory drugs (NSAIDs).
- Intractability
- Gastric ulcers are not necessarily intractable and can often be effectively treated with medication, lifestyle changes, and sometimes surgery. However, in some cases, ulcers can be difficult to treat and may recur despite treatment, particularly if underlying factors such as Helicobacter pylori infection or the continued use of NSAIDs (nonsteroidal anti-inflammatory drugs) are not addressed.
- Disease Severity
- Gastric ulcers, also known as peptic ulcers, can range in severity from mild to severe. Mild ulcers may cause discomfort and can be managed effectively with lifestyle changes and medications. Severe ulcers can result in significant pain, complications like bleeding, perforation, or obstruction, and may require more intensive treatment such as surgery. The severity depends on the depth and size of the ulcer, as well as any complications that arise. Prompt medical attention is crucial for effective management and to prevent serious outcomes.
- Healthcare Professionals
- Disease Ontology ID - DOID:10808
- Pathophysiology
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Gastric ulcer, a type of peptic ulcer, involves the formation of open sores on the lining of the stomach. The pathophysiology of gastric ulcers is primarily due to an imbalance between the mucosal defense mechanisms and aggressive factors such as gastric acid and pepsin.
Key elements include:
1. **Mucosal Defense Mechanisms**: Normally, the stomach lining is protected by a layer of mucus and bicarbonate secretion, which neutralizes stomach acid. Prostaglandins also play a crucial role in maintaining mucosal integrity by promoting mucus and bicarbonate production and enhancing blood flow.
2. **Aggressive Factors**:
- **Hydrochloric Acid and Pepsin**: Excessive production of hydrochloric acid (HCl) and pepsin can overwhelm the mucosal defenses.
- **Helicobacter pylori Infection**: This bacterium can disrupt the mucosal layer, leading to inflammation and ulceration.
- **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)**: Chronic use of NSAIDs can inhibit cyclooxygenase enzymes (COX-1), which are essential for prostaglandin synthesis, leading to reduced mucosal protection.
3. **Impaired Defense**: Factors like smoking, high alcohol consumption, and stress can impair the stomach’s ability to protect itself, making it more susceptible to ulcers.
As a result of these factors, the gastric mucosa becomes damaged, leading to ulcer formation characterized by localized tissue necrosis and inflammation. - Carrier Status
- Gastric ulcers are not caused by a specific carrier status, as they are not typically related to genetic factors that would involve carrier states. They are usually associated with factors such as Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), stress, and lifestyle factors like smoking and alcohol consumption.
- Mechanism
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Gastric ulcers, or peptic ulcers, are open sores that develop on the lining of the stomach. They result from an imbalance between aggressive factors like stomach acid, pepsin, and Helicobacter pylori (H. pylori) infection, and defensive factors such as mucus, bicarbonate, and blood flow to the gastric mucosa.
**Mechanism:**
1. **H. pylori Infection:** The bacterium H. pylori produces urease, an enzyme that hydrolyzes urea to form ammonia, which neutralizes stomach acid and creates an alkaline environment suitable for bacterial survival. The infection causes chronic inflammation and damages the mucosa, leading to ulcer formation.
2. **Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):** These medications inhibit cyclooxygenase (COX) enzymes, reducing the production of prostaglandins that protect the stomach lining by regulating mucus and bicarbonate secretion and maintaining mucosal blood flow.
3. **Excess Gastric Acid:** Conditions like Zollinger-Ellison syndrome result in the overproduction of gastric acid, overwhelming the protective mechanisms of the stomach lining and leading to ulcers.
**Molecular Mechanisms:**
1. **Inflammatory Response:** H. pylori triggers an immune response that releases cytokines, such as IL-1, IL-6, and TNF-α. These cytokines cause inflammation and mucosal damage.
2. **Apoptosis and Cell Proliferation:** H. pylori's virulence factors, like cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA), induce epithelial cell apoptosis and disrupt intracellular signaling pathways.
3. **Reactive Oxygen Species (ROS):** Chronic inflammation increases the production of ROS, causing oxidative damage to DNA, proteins, and lipids in the gastric mucosa.
4. **Disruption of Tight Junctions:** H. pylori infection can disrupt tight junctions between the epithelial cells, compromising the mucosal barrier and allowing acid and pepsin to penetrate and damage the stomach lining.
5. **COX Inhibition by NSAIDs:** Reduced prostaglandin synthesis leads to decreased mucosal defense, impairing the stomach’s protective mechanisms and making it more susceptible to acid damage.
Prevention and treatment of gastric ulcers involve eradicating H. pylori infection (if present), discontinuing NSAIDs, and using medications like proton pump inhibitors (PPIs) to reduce stomach acid production and promote healing of the gastric mucosa. - Treatment
-
Treatment for a gastric ulcer typically involves:
1. **Medications:**
- **Proton pump inhibitors (PPIs):** Reduce stomach acid production (e.g., omeprazole, lansoprazole).
- **H2-receptor antagonists:** Also reduce acid production (e.g., ranitidine, famotidine).
- **Antacids:** Neutralize stomach acid and provide quick relief.
- **Antibiotics:** If Helicobacter pylori infection is present, a combination of antibiotics (e.g., amoxicillin, clarithromycin) is prescribed.
- **Cytoprotective agents:** Protect the stomach lining (e.g., sucralfate, misoprostol).
2. **Lifestyle Changes:**
- Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen.
- Quit smoking.
- Limit alcohol consumption.
- Eat smaller, more frequent meals.
- Avoid foods and drinks that irritate the stomach, such as spicy foods, caffeine, and overly fatty foods.
3. **Surgery:** In rare cases where the ulcer does not heal with medication or complications arise (e.g., bleeding, perforation), surgical intervention may be required.
It is important to follow the treatment plan prescribed by a healthcare provider. - Compassionate Use Treatment
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For gastric ulcers, compassionate use treatments and off-label or experimental treatments may include the following:
1. **Compassionate Use Treatments:**
- **Investigational Medications:** Drugs not yet approved by regulatory bodies might be available under compassionate use programs for patients who have exhausted other options. This typically requires special authorization.
2. **Off-Label or Experimental Treatments:**
- **Proton Pump Inhibitors (PPIs):** Although standard treatment for gastric ulcers, PPIs like omeprazole or esomeprazole can sometimes be used in higher doses or for longer durations than officially approved, based on physician discretion.
- **H2-Receptor Antagonists:** Medications like ranitidine or famotidine may be used off-label in certain dosages or combinations.
- **Misoprostol:** Primarily used to prevent NSAID-induced ulcers, it can sometimes be used experimentally for other types of gastric ulcers.
- **Sucralfate:** While commonly used, it may be utilized in non-standard regimens or in combination with other treatments.
- **Antibiotics:** If an H. pylori infection is present, antibiotics not conventionally used for ulcers might be prescribed off-label to eradicate the bacteria.
- **Regenerative Medicine:** Approaches such as the use of stem cells and growth factors are being explored experimentally for their potential to enhance gastric mucosal healing.
Physician supervision and adherence to ethical guidelines are crucial when using any off-label or experimental treatments. - Lifestyle Recommendations
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Lifestyle recommendations for managing gastric ulcers include:
1. **Dietary Changes**:
- Avoid or limit spicy foods, acidic foods (like citrus and tomatoes), and fatty foods.
- Eat smaller, more frequent meals to aid digestion and reduce stomach acidity.
- Incorporate foods that may help protect the stomach lining, such as those rich in fiber.
2. **Avoid Alcohol and Smoking**: Both alcohol and smoking can exacerbate ulcer symptoms and delay healing.
3. **Stress Management**: Engage in relaxation techniques such as meditation, yoga, or deep-breathing exercises to help manage stress, which can worsen ulcer symptoms.
4. **Medications**: Follow your healthcare provider’s recommendations for medications, which may include proton pump inhibitors, H2-receptor antagonists, or antacids.
5. **Limit NSAIDs**: Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) as they can irritate the stomach lining. Discuss alternative pain relief options with your healthcare provider.
6. **Stay Hydrated**: Drink plenty of water to help digestion, but avoid beverages that can increase stomach acid, such as caffeinated drinks and sodas.
7. **Healthy Weight**: Maintain a healthy weight. Obesity can increase abdominal pressure, which may worsen symptoms.
8. **Regular Medical Checkups**: Keep up with regular medical appointments to monitor the condition and adjust treatment as necessary. - Medication
-
For treating gastric ulcers, common medications include:
1. Proton Pump Inhibitors (PPIs) - e.g., omeprazole, esomeprazole.
2. H2 Receptor Antagonists - e.g., ranitidine, famotidine.
3. Antacids - e.g., magnesium hydroxide, aluminum hydroxide.
4. Antibiotics - e.g., amoxicillin, clarithromycin, metronidazole (for Helicobacter pylori infection).
5. Cytoprotective Agents - e.g., sucralfate, misoprostol.
These medications aim to reduce stomach acid, protect the stomach lining, and, if necessary, eradicate H. pylori infection. - Repurposable Drugs
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Gastric ulcers, which are open sores that develop on the inner lining of the stomach, can potentially be treated with repurposed drugs originally intended for other conditions. Some examples of repurposable drugs include:
1. **Misoprostol**: Originally approved for preventing gastric ulcers caused by NSAIDs.
2. **Sucralfate**: Used to treat and prevent ulcers; forms a protective barrier on the ulcer site.
3. **Proton Pump Inhibitors (PPIs)**: Though primarily used for acid-related disorders, they can be repurposed for treating gastric ulcers (e.g., Omeprazole, Lansoprazole).
These drugs offer therapeutic benefits by reducing gastric acid secretion, enhancing mucosal protection, and promoting healing. Always consult a medical professional before starting any treatment. - Metabolites
-
Gastric ulcers can involve metabolites such as:
1. Hydrochloric acid (HCl) - often present in excess and contributes to the erosion of the stomach lining.
2. Pepsin - a digestive enzyme that can exacerbate mucosal damage.
3. Prostaglandins - these are protective in nature, and their decreased levels can impair mucosal defense.
4. Urea - resulting from the activity of Helicobacter pylori, a bacterium commonly associated with gastric ulcers.
5. Ammonia - produced by Helicobacter pylori from urea, which can further damage gastric tissue.
These metabolites play significant roles in the development, progression, and symptoms of gastric ulcers. - Nutraceuticals
- Nutraceuticals can play a supportive role in managing gastric ulcers. Nutrients like zinc-carnosine, probiotics, and vitamin C have shown potential in promoting ulcer healing and protecting the gastric mucosa. Zinc-carnosine may help to stabilize the stomach lining, probiotics can enhance gut health, and vitamin C offers antioxidant properties that aid in tissue repair. However, these should complement, not replace, conventional treatments prescribed by healthcare professionals.
- Peptides
- Gastric ulcers, also known as peptic ulcers, are open sores that develop on the inside lining of the stomach. Various peptides, such as ghrelin, have been implicated in the regulation of appetite and gastrointestinal function, and research is ongoing into their potential roles in ulcer formation and healing. NAN (Nicotinamide adenine nucleotide) isn't commonly associated with gastric ulcers.