Gastritis is a condition in which the stomach lining becomes inflamed. This inflammation can ultimately lead to the formation of peptic ulcers which is a sore in the lining of the gastrointestinal tract most commonly the stomach and duodenum. It was originally believed that ulcers were caused by high levels of pepcin and acid hence the term “peptic ulcers” but this is not the case. Rather, most ulcers result from compromises to mucosal defense mechanisms allowing normal amounts of pepsin and acid to damage the mucosal lining causing ulcers.
The two principle causes of peptic ulcers are Non Steroidal Anti-Inflammatory Drug (NSAID) use and Helicobacter pylori (HP) infection. NSAID induced ulcers typically occur in the stomach while HP ulcers are found in the duodenal bulb. Other more uncommon conditions can lead to gastritis and possible ulcer formation including malignancy (adenocarcinoma, lymphoma and neuroendocrine tumors), illicit drug use, Crohn’s disease, systemic mastocytosis, radiation exposure, autoimmune disorders, other infections and eosinophilic gastroenteritis. Despite public perception psychologic stress does not cause ulcers even though patients have an upset stomach when stressed. However, patients who are under a great degree of physiologic stress like ICU patients with brain injury or burns victims can develop ulcers.
Helicobacter pylori (HP) is a spiral shaped bacteria that has developed unique mechanisms to live in the acidic environment of the stomach. Humans acquire HP from their environment during childhood through contaminated food or water or exposure to body fluids from someone actively infected. Symptoms interestingly do not manifest until adulthood.
Once the stomach is infected HP causes an acute followed by chronic gastritis resulting in indigestion-like symptoms. With long-term infection patients are increased risk of developing ulcers usually in the duodenum and various types of gastric cancer.
HP can be diagnosed using a variety of tests including biopsy of the stomach during endoscopy, blood tests for antibody levels, stool tests for bacterial protein and breath tests for bacterial function.
Because HP is a difficult infection to eradicate treatment often requires a combination of antibiotics over a 7-14 day period followed by a confirmation test to confirm it’s clearance through a breath or stool test. Dr. Mantas has expertise in determining the best combination of antibiotics for you even in cases of prior failed treatments.
NSAIDs are medications that are commonly taken to reduce inflammatory symptoms of pain, fever and swelling. In the form of aspirin they are used to prevent heart attacks.
NSAIDs are widely available over-the-counter while stronger ones require prescription. Multiple NSAIDs are available and below are some common ones with their generic and trade names.
Patients with peptic ulcers classically present with gnawing/burning epigastric pain lasting minutes to hours. Other associated symptoms include nausea, bloating and poor appetite. It is important to know, however, that some patients remain asymptomatic only until complications occur. When suspected peptic ulcers are diagnosed with upper endoscopy. Surrounding areas are then biopsied to aid in determining the underlying etiology. Ulcers are also classified based on their stigmata for prior hemorrhage or propensity for future hemorrhage.
Peptic ulcers can lead to a variety of serious complications including bleeding, perforation and obstruction occurring in 15%, 5% and 2% of patients respectively. These conditions can be fatal and one should seek immediate care if they experience sudden sharp, sudden, persistent, severe pain and gastrointestinal bleeding with bloody stools, black stools, bloody emesis or coffee-ground emesis.
Dr. Mantas is able to determine the best treatment option for you. The foundation for treatment rests on eliminating the underlying cause including cessation of NSAIDs or treatment of HP infection. Other treatments that aid in healing include proton pump inhibitors and endoscopic therapies for bleeding ulcers including injection, thermal coagulation or clipping.
It is important to that various conditions can compromise ulcer healing including steroid use, alcohol use and smoking. Avoidance is critical especially for large complicated ulcers. Some patients have persistent ulcers not amenable to medical or endoscopic treatment. Such patients sometimes require surgical intervention including various kinds of gastrectomies with vagotomies.
Following treatment periodic surveillance with endoscopy is needed to assess for healing as some ulcers are precursors to gastric cancer.
A variety of other disorders can affect the stomach. Suggestive symptoms include upper abdominal pain, nausea, vomiting, regurgitation, indigestion, heartburn, early satiety and poor appetite. Please visit Dr. Mantas if you feel that you have a gastric disorder. Other common gastric disorders include hiatal hernia, gastroparesis and gastric cancer.