Gastro Intestinal Diseases
This generally occurs when a person is in his or her sixties, and usually ten years after duodenal ulcer. Gastric ulcer can be benign or malignant. About 55% of ulcers occur in males.
Acid and pepsin are important in the pathogenesis. Some patients have duodenal ulcers in addition. The exact mechanism is uncertain but damage to the mucosal lining occurs. Regurgitation of bile from the duodenum can be a factor in genesis.
The most characteristic is that of pain in the epigastric area (where the ribs diverge at the bottom of the sternum). The pain can be relieved or precipitated by food. Other symptoms are nausea, vomiting, bloating and fullness after meals. Gastric ulcer is less frequent than duodenal ulcer. Weight loss is common as many avoid eating because of the pain. Gastric ulcers can heal and recur in the same location, mostly in the antral region of the stomach. Haemorrhage is present in 25% of cases. Mortality, if perforation of the stomach occurs, is greater than in duodenal ulcers as the patients are older. There may be gastric outlet obstruction if the ulcer is in the pyloric area.
Endoscopy and barium meal are the two diagnostic methods. The latter gives an accuracy of almost 90%. Larger ulcers are often malignant (about 5% of ulcers are). A biopsy is needed to confirm malignancy. Endoscopic assessment allows cytological studies.
Antacids are the mainstay. Though acid hypersecretion is not the feature of this disease, drugs like ranitidine, cimetidine and famotidine are useful in healing the ulcers as they inhibit acid secretion, allowing the area to heal. Side effects to these include rash, breast enlargement in males (gynaecomastia), reduction in sperm count, and impairment of mental status in elderly patients. The drugs need to be taken twice daily. The patient should follow a bland diet. Carbenoxelone, a drug from the liquorice plant, is effective in healing ulcers. It increases the life span of mucosal cells and the secretion and viscosity of mucus. Side effects include salt and water retention. Failure to heal in three months should suggest malignancy. Surgery is reserved for refractive medical therapy. With effective medical treatment this can be avoided.