Stomach or duodenal ulcer what to do...
A stomach or duodenal ulcer can manifest also as a pain in the epigastric cavity or be asymptomatic. An upper digestive endoscopy visualizes the damaged mucosa, and biopsies are performed in cases of gastric ulcer. The bacterium Helicobacter pylori is sought.
What are the symptoms of the stomach or duodenal ulcer ? A peptic ulcer can cause pain in the epigastrium (top and middle of the). Located in this part of the body, it resembles a cramp or a painful feeling of hunger, and occurs one to three hours after a meal. This epigastric pain can also occur at night. It is calmed by taking food or medication against acid secretions.
It often manifests itself in outbreaks lasting a few weeks, alternating with symptom-free phases. The regions of Anatomical diagram of the abdomen, composed of the epigastric region, the umbilical region, the pelvic region and the pair of iliac fossae (see detailed description below).
A stomach or duodenal ulcer can also cause more atypical manifestations, such as simple discomfort under the ribs. In certain forms of the disease, meals and food intake have no influence on the pain. Finally, some ulcers are asymptomatic.
Their presence can be revealed by performed for another reason, for example, monitoring gastritis (inflammation of the stomach). Be careful, stomach pain is not always synonymous with an ulcer. Not everyone who has a stomach ache has an ulcer. Very often, it is gastro-oesophageal reflux disease (GERD) which is the cause of their stomach pain. It can also be simple gastritis (inflammation of the) without ulcer or dyspepsia.
If you got pain near the stomach, more than two weeks, it is suggested to consult your family doctor to talk about it and know if you can get some test to search if you are in case of gastric or duodenal ulcer.
What next? The attending physician asks his patient about his symptoms and looks for contributing factors (e.g.: smoking, taking anti-inflammatories). The doctor palpates the to localize any pain.
If a stomach or duodenal ulcer is suspected, an assessment is then carried out, in collaboration with specialist doctors (gastroenterologist, infectious disease specialist, radiologist, etc.).
Indeed, to confirm the diagnosis, several additional examinations must be carried out. Upper digestive endoscopy confirms the diagnosis of stomach or duodenal ulcer Carried out under local or general anaesthesia by a gastroenterologist, upper digestive endoscopy allows you to visualize the inside of the stomach and duodenum using a small camera.
If an ulcer is present in one of these organs, it appears as a crater with regular, raised, red edges. This crater is dug in the Mucosa and reaches deep into the muscular layer.
If the ulcer is gastric, the doctor takes several biopsies of its edges to check that there is no cancerous lesion.
If the ulcer is duodenal, ulcer biopsies are useless: this type of condition never progresses to cancer.
Testing for the presence of Helicobacter pylori in the stomach:
1) With biopsies: The doctor has to check whether the patient has been contaminated by the Helicobacter pylori bacteria. Screening for Helicobacter pylori during analysis of gastric biopsies (at least 5 biopsies from various parts of the stomach for and 2 biopsies for bacteriological examination) makes it possible to search for precancerous lesions in the event of a stomach ulcer.
It also makes it possible to detect H. pylori infection by a bacteriological examination with culturing of Helicobacter pylori and evaluation of sensitivity to antibiotics.
2) Blood serology: Search for Helicobacter pylori outside the Blood serology When the patient has already taken anti-secretory drugs (proton pump inhibitors) which reduce stomach acidity or has recently taken antibiotics which distort the results of biopsy analyses, a search in the blood for specific antibodies (serology) is very useful in diagnosing Helicobacter pylori infection.
This technique is not used in cases of risk factors for stomach cancer. Serology is not indicated to monitor H pylori eradication because antibodies persist for months after treatment.
3) Testing for antigens in stools This technique is possible for the diagnosis and control of eradication, but normally it is not reimbursed by Health Insurance care in the United Kingdom.
4) Upper digestive endoscopy: This test, often called gastroscopy, consists of observing the esophagus, stomach and duodenum, using a flexible tube fitted with a small camera and performing samples and surgical procedures.
Here are some information to better understand this exam and prepare yourself well for it. What is an upper gastrointestinal endoscopy? The upper digestive is the observation of the interior of the esophagus, stomach and duodenum (first part of the small intestine). This examination is carried out using an endoscope or gastroscope inserted through the mouth or nose. It is a flexible tube equipped with a miniature camera, a lamp and various surgical instruments as needed (forceps, needles, wires, coagulation instruments, etc.)
The endoscope allows: to observe the walls of this part of the digestive tract in search of lesions present in various diseases (gastro-oesophageal reflux, peptic ulcer, Crohn's disease, oesophageal varices present in cases of liver cirrhosis, dyspepsia, oesophageal cancer or stomach...); to perform, using surgical instruments, gestures: a sample or biopsy for tissue analysis; the removal of a benign tumour or a foreign body ingested and blocked in the digestive tract (fish bone, rabbit bone fragment, flat battery, etc.); clotting of blood vessels (e.g. oesophageal varices).
This technic is performed by a gastroenterologist: either under classic general anaesthesia (especially if a surgical intervention is planned) or light (sedation); either under local anaesthesia (the latter helps to avoid nausea when introducing the endoscope into the esophagus). Upper digestive ultrasound endoscopy: another use of to obtain very precise ultrasound images, an echo endoscope is used which combines the functions of the ultrasound with the functions of ultrasound. They are delivered by a source integrated into the endoscope.
Medications for stomach or duodenal ulcers: Objective of treatment: healing of the ulcer Drug treatment for peptic ulcer disease is implemented by a gastroenterologist, in collaboration with the treating physician.
It has several objectives: rapid relief of symptoms; healing of the ulcer; prevention of recurrence and complications.
They are two types of medications in the treatment of gastric or duodenal ulcer Anti-secretory drugs: proton pump inhibitors Proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, esomeprazole) reduce stomach acid secretions and help the ulcer heal. This kind of treatment lasts 4 to 8 weeks in case of stomach ulcer and 4 weeks in case of duodenal ulcer. In the event of a stomach ulcer, monitoring of proper healing is necessary during an upper digestive endoscopy.
Eradication of Helicobacter pylori In the event of infection with the Helicobacter pylori bacteria, antibiotics combined with anti-secretory agents. Culture of gastric biopsies taken during upper digestive tract (see Symptoms and diagnosis of peptic ulcer) allows us to study the sensitivity of Helicobacter pylori to different antibiotics, highlighting possible antibiotic resistance.
A treatment lasting 10 days is recommended combining 3 medications: proton pump inhibitor (PPI), amoxicillin and clarithromycin for 10 days. In case of resistance to clarithromycin, it is replaced by levofloxacin (10-day protocol including proton pump inhibitor (PPI), amoxicillin and levofloxacin). In case of allergy to amoxicillin, it is replaced by metronidazole (10-day protocol including proton pump inhibitor (PPI), clarithromycin and metronidazole).
Another protocol of the same duration of 10 days is possible in the event of allergy to amoxicillin or in the event of persistent infection after the first treatment, combining 4 medications: a proton pump inhibitor, bismuth citrate, metronidazole and a tetracycline. In the absence of evaluation of the sensitivity of Helicobacter pylori, probabilistic antibiotic treatment combines 4 antibiotics for 10 to 14 days.
Notice that antibiotic treatment is contraindicated during pregnancy and breastfeeding.
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