Gastric And Duodenal Ulcer

Gastric and duodenal ulcer

Every year around 50 out of 100,000 people - mostly over 50 years of age - develop a gastric ulcer (stomach ulcer). Women and men are affected about equally often. The duodenal ulcer occurs about three times as often, mostly between the ages of 30 and 50. Men get it around 3.5 times more likely than women. Overall, the incidence of gastric and duodenal ulcers is falling in industrialized countries. An endoscopy of the stomach and duodenum is the safest way to identify an ulcer.

Medicines to reduce stomach acid are usually administered for therapy. In many cases, Helicobacter pylori eradication with acid inhibitors and antibiotics leads to lasting recovery. It is important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for NSAID ulcers or at least to give an acid inhibitor for protection.

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• What are the causes of a stomach ulcer or a duodenal ulcer?
• What are the symptoms?
• How is the diagnosis made?
• How are gastric and duodenal ulcers treated?
• What complications can arise?
• What can I do myself?
• Whom can I ask?
• How are the costs going to be covered?

What are the causes of a stomach ulcer or a duodenal ulcer?

The ulcers are delimited inflammatory defects in the mucous membrane that extend into deeper layers of the stomach or intestinal wall. Their diameter can be from a few millimeters to more than three centimeters. The following factors are primarily responsible for the development of ulcers:

• Helicobacter pylori (Hp) infection: This bacterium produces enzymes that can damage the cells of the stomach lining. The infection usually occurs from person to person, rarely through contaminated food and drinking water. It is usually acquired in childhood.
• Anti-inflammatory and analgesic drugs: non-steroidal anti-inflammatory drugs (NSAIDs such as acetylsalicylic acid, diclofenac, ibuprofen) over a longer period of time.
• Other diseases: e.g. Zollinger-Ellison syndrome (tumor-related overproduction of the hormone gastrin, which stimulates gastric acid production).

Usually the simultaneous presence of several factors is necessary for the development of a gastric ulcer (gastric ulcer) or a duodenal ulcer (duodenal ulcer). Favoring factors include:

• Genetic predisposition to a sensitive stomach (familial accumulation, blood group 0).
• Psychosocial stress, stress and conflicts: promote, among other things, an increase in gastric juice production.
• Unhealthy lifestyle: especially excessive consumption of alcohol, coffee and nicotine.
• Chronic gastritis.
• Older age.

The ulcer can appear alone or multiple times. If ulcers recur over the years, it is a so-called chronic-recurrent ulcer disease.

What are the symptoms?

Both ulcer diseases can remain undetected for a longer period of time if the symptoms are not clear or are very minor. The following symptoms can indicate a stomach or duodenal ulcer:

• Upper abdominal pain: cramp-like, pressing, dull, pinching or stabbing, often radiating to the left side of the body. Often the pain is directly related to food intake. With gastric ulcer, the pain disappears for a few hours after eating.

• Pain during the night:

  - Hunger pains: especially when the stomach is empty, typical of duodenal ulcer.

  - Early pain: especially immediately after eating, typical of ulcers in the stomach.

  - Late pain: most severe one to three hours after eating, predominantly with ulcers in the gastric porter and in his immediate vicinity.

• Intolerance or aversion in connection with certain foods: especially those that strongly stimulate gastric juice production (e.g. alcohol, wine, coffee, hot spices, fatty foods, baked goods).
• Nausea, vomiting, weight loss.

About every tenth ulcer begins to bleed to varying degrees. This bleeding is often barely noticeable, but can have serious consequences, such as:

• Repeated small oozing bleeding: can lead to iron deficiency and anemia with general fatigue and pale skin color.
• Heavy bleeding: manifest in the form of black, sticky stool ("tarry stool") or vomiting blood (hematemesis) and can sometimes lead to life-threatening shock.

How is the diagnosis made?

In the anamnesis, the doctor asks about current symptoms, about previous ulcer attacks and their therapy as well as about lifestyle, etc. This is followed by a physical examination, including palpation of the abdomen. In addition, the stomach and small intestine are mirrored (gastroduodenoscopy), usually with a tissue sample taken. This enables, above all, the clarification of an infection with Helicobacter pylori (possibly together with a so-called urease rapid test) and the exclusion of a malignant disease.

Bleeding can also be stopped as part of the mirroring. The bleeding activity of an ulcer is also determined and a blood count is used to determine whether there is anemia.

How are gastric and duodenal ulcers treated?

More than a third of gastric and duodenal ulcers resolve on their own, especially if factors that damage the mucous membrane are avoided. These include alcohol, smoking and stress. Learning to deal better with stress is also helpful. For more information, see Stress Management. Easily digestible food in several small meals is also recommended. Herbal supplements (phytotherapeutic agents) can relieve symptoms. If necessary, psychotherapeutic treatment can also have a supportive effect.

Medical therapy

The goals of therapy are rapid pain relief, ulcer healing and prevention of relapse.

Decrease in stomach acid

Gastric juice is produced for digestion. This is a very acidic liquid, contains substances that break down proteins and can also damage the inflamed mucous membrane. Various groups of substances are available to reduce stomach acid in order to accelerate the healing of ulcers. Today, proton pump inhibitors are used almost exclusively.

Proton pump inhibitors (PPIs) (e.g. esomeprazole, pantoprazole, lansoprazole, rabeprazole): reduce gastric acid secretion

• Histamine H ₂ antagonists (e.g. ranitidine, famotidine, nizatidine, roxatidine): also reduce, but to a lesser extent, gastric acid production.
• Antacids: neutralize stomach acid that has already been formed.
• Protective film-forming agents (e.g. alginates, sucralfate): cover the gastric mucous membrane or the chyme with a film that protects against aggressive gastric acid.

Stomach protection

If drugs (e.g. for pain relief and anti-inflammatory measures) are (partly) responsible for the development of the ulcers, treatment consists in discontinuing the triggering active ingredients. Here it should be checked whether newer substances that are more gastric compatible can be used. If this is not possible or not sufficient on its own, drugs to reduce gastric acid production (proton pump inhibitors) are used.

Kills the Helicobacter pylori bacteria

In up to 80 percent of patients, an ulcer occurs again within a year if only drugs that inhibit acid secretion were used to heal the previous ulcer. The focus of ulcer treatment with Helicobacter detection is therefore the killing of the Helicobacter pylori bacteria (eradication). This not only heals the current ulcer, but also provides effective prophylaxis.

A combination of a proton pump inhibitor and three antibiotics is recommended, usually over a period of two weeks. This allows the infection to be treated successfully in 85 to 100 percent of cases. Only less than one percent of those affected become infected again with Helicobacter pylori within a year. So the healing of the infection is usually permanent.

In the case of a stomach ulcer, PPIs are then administered for several weeks. The success of the therapy is checked after a few weeks as part of a new gastrointestinal mirror. If the effect is insufficient, the PPI therapy is intensified and extended. Usually, gastric or duodenal ulcer healing is achieved within four or eight weeks. Stomach ulcers that have not healed after six months are operated on.

What complications can arise?

In general, gastric and duodenal ulcers have a favorable prognosis. However, various complications can arise. These include:

• bleeding ulcer,
• Breakthrough of the ulcer in the abdomen,
• Invasion of the ulcer into neighboring organs,
• cicatricial constriction of the stomach outlet.

Therapy depends on the complication present and its severity. It ranges from endoscopic interventions and angiographies to emergency operations and drug treatment.

What can I do myself?

• Avoid alcohol, nicotine, and caffeine.
• Avoid food and drinks that are irritating to the stomach and not well tolerated by the individual. You can find more information in the brochure “Stomach, Intestines, Bile & Co - Nutrition According to Need” from the Austrian Health Insurance Fund.
• If necessary, discontinue stomach-damaging drugs after consulting a doctor.
• Avoid stressful situations, learn how to cope with stress, perform regular relaxation exercises.
• Take prescribed medication regularly and for the scheduled duration of treatment to ensure success.

Whom can I ask?

To clarify stomach or digestive problems, you can contact the following offices:

• General Practitioner,
• Specialist in internal medicine.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is required

In some situations, hospitalization may be necessary to treat a stomach or duodenal ulcer. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

Further information is available under What does a hospital stay cost?