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 make the top and middle of your tummy hurt. It might feel like a cramp or strong hunger pain. This pain often comes one to three hours after you eat, or at night. Eating some food or taking medicine for stomach acid can help the pain go away.
Sometimes, the pain comes and goes for a few weeks, then you might feel fine for a while. You could also feel a little sore under your ribs. For some people, eating doesn’t change the pain at all. Some ulcers don’t hurt at all, so you might not know you have one.
Doctors sometimes find ulcers when they are checking your tummy for other reasons. Remember, not all tummy pain means you have an ulcer.
Many people have stomach aches for other reasons, like acid coming up from the stomach (called reflux), or a sore stomach (called gastritis) that isn’t an ulcer.
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 is some information to help you get ready for this test.
What is an upper gastrointestinal endoscopy?
This is a test where a doctor looks inside your food pipe, stomach, and the first part of your small intestine.
The doctor uses a thin, bendy tube called an endoscope.
This tube has a tiny camera and a light on it.
The doctor puts the tube in through your mouth or nose.
The endoscope lets the doctor see if there are any problems, like sores or swelling, inside your tummy.
The doctor can also use little tools through the tube to take a small piece of tissue (a biopsy) or remove something stuck, like a bone.
Sometimes, the doctor needs to stop bleeding or take out a lump during this test.
A special doctor called a gastroenterologist does this test.
You might get medicine to help you sleep or feel relaxed, or you might just get a spray to numb your throat.
Sometimes, the doctor uses a special endoscope that can also take pictures using sound waves (ultrasound) to see things even more clearly.
Medications for stomach or duodenal ulcers:
The goal of treatment is to heal the ulcer. A special stomach doctor and your regular doctor work together to help you get better. Treatment does a few things: it stops pain fast, helps the ulcer heal, and keeps the problem from coming back.
There are two main types of medicine for ulcers.The first is called proton pump inhibitors (PPIs). PPIs are medicines that lower the acid in your stomach.
Some examples are lansoprazole, omeprazole, and pantoprazole. You take these for 4 to 8 weeks for a stomach ulcer, or 4 weeks for a duodenal ulcer.
If you have a germ called Helicobacter pylori, you need antibiotics too.
Doctors find out which antibiotics work best by testing a tiny piece of your stomach. Usually, you take three medicines for 10 days: a PPI, amoxicillin, and clarithromycin. If clarithromycin doesn’t work, it can be swapped for levofloxacin. If you’re allergic to amoxicillin, you get metronidazole instead.
If the germ doesn’t go away, or if you can’t take some medicines, doctors use a mix of four medicines for 10 to 14 days.
The main goal is to make your tummy feel better and heal the sore inside.
Notice that antibiotic treatment is contraindicated during pregnancy and breastfeeding.
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