Peptic Ulcer Symptoms, Diagnosis and Treatment
Deep ulcers or peptic ulcers are called deep ulcers caused by the damage of the layer called mucosa, which covers the inner face of the esophagus, stomach and intestine in the digestive system with stomach acid, digestive enzymes or drugs.
What is the frequency of ulcer?
Although stomach acid is a strong acid, it does not normally cause damage to the stomach and duodenum. There is a thick layer of mucus on the surface of the mucosa that prevents the gastric acid from reaching the mucosa. There is a balance between mucosal damage factors such as acid, pepsin and bile acids in the gastric mucosa and mucosal protective factors. Changing this balance in favor of aggressive factors leads to disruption of mucosal integrity and ulcer formation. Ulcers in the stomach are called gastric ulcers, ulcers in the duodenum are called duoedenum ulcer or bulbar ulcer. They can be from 3-5mm to 5cm wide.
Approximately 10% of the population is thought to have peptic ulcer disease at any time in their lives. It occurs twice as often in men as in women.
HOW DOES ÜLSER FORM?
Although gastric acid is a strong aggressive fate, it seems impossible to form an ulcer alone. Because ¼ of the patients with ulcer gastric acid secretion increased and half of the normal limits. In some diseases where gastric acid secretion is excessively increased, ulcers almost always occur, but such conditions are very rare (such as Zollinger Ellison syndrome). However, the term "no acid no ulcer" is still valid today, as it is not possible to heal the stomach or duodenal ulcer without suppressing gastric acid secretion. Nowadays, it is accepted that ulcer has two main reasons. Many stomach and duodenal ulcer patients are infected with a bacterium called Helicobacter pylori (HP) (75%).
In another group of patients, long-term aspirin or non-steroidal antirheumatic drugs (NSAIDs) have been used. It is known that 15 million people in the world use NSAIDs, 60% of them describe stomach complaints, 10% have stomach and / or twelve fingers bowel ulcers, and on average 3-4% have serious complications that require hospitalization. On the other hand, failure to detect HP infection or use of antirheumatic drugs in approximately 1/5 of the patients with ulcers is an indication that the etiopathogenesis of ulcer is not yet fully understood.
Although the stress factor, which was thought to be an important cause of ulcer formation in the previous years, has lost its importance nowadays, in cases where the body is exposed to excessive stress (such as extensive body burns, head traumas and staying in the intensive care unit), severe stomach and / or duodenal ulcers may be exposed to stress. It is known that their complaints may increase after their stay.
WHAT ARE THE SYMPTOMS OF THE ULSER?
The most common manifestation of the ulcer is a blunt pain in the upper abdomen, between two ribs and between the lower end of the breastbone and the navel, usually in the palms. The pain may also be in the form of crushing, scraping or burning, spreading between the two shoulder blades and on the sides of the abdomen. Can wake you from sleep at night. Nausea and vomiting may occur with pain. The pain can last from 15-20 min to several hours. It may start after starvation.
It is usually alleviated or passed by food or antacid intake. Therefore, patients may need to eat frequently. In patients with gastric ulcers, pain may increase after eating, and bloating and flatulence may be more pronounced. Bleeding or perforation may be the first sign of ulcer in some patients with no findings. Weight loss may occur in patients with vomiting. In some patients, the symptoms can be exacerbated by seasonal changes, especially in the spring.
HOW IS ULSER DIAGNOSED?
The diagnostic method to be used in patients who apply to a doctor with ulcer-like complaints is endoscopy (Gastroscopy), which allows direct diagnosis of the ulcer and diagnosis when necessary. In rare cases, radiographs of gastric duodenum with barium may be helpful in diagnosis. Endoscopic examination should be performed to remove the possibility of cancer in patients with suspected stomach ulcer and tissue sample (biopsy) should be taken for examination.
HOW IS ULSER TREATED?
The first step in the treatment of ulcers is the reduction of gastric acid. When acid secretion is suppressed, pepsin, an enzyme that can only be activated in the acid medium, is also inactivated. Nowadays, ulcer treatment can be performed successfully thanks to the drugs that strongly suppress gastric acid secretion. Your doctor will decide how long active drug treatment will continue. In addition to reducing acid secretion, the second thing to do in the treatment of ulcers is to treat this bacteria in patients with HP in their stomachs. This treatment is usually performed using 1 or 2 week treatment regimens containing at least two types of antibiotics. Your doctor will decide which treatment regimen to choose.
HP treatment is especially important in preventing ulcer recurrence. Treatment of the bacterium alone is insufficient for the treatment of ulcers; gastric acid needs to be suppressed for a sufficient period (usually 6-8 weeks) to heal the ulcer. Gastric ulcers usually require a longer treatment. Gastric ulcers should be endoscopically checked after treatment and the patient should not be left unattended until they are completely healed.
In patients with ulcers, aspirin and / or antirheumatic drugs should be discontinued. These medicines can only be used under the supervision of a doctor when they are very necessary.
While medication is in progress, it is appropriate to make changes in patients' lifestyles, such as discontinuing smoking and reducing alcohol consumption. Ulcers recur more frequently in patients who continue to smoke. Spicy, spicy, acidic and caffeine-containing foods and beverages and alcohol may cause increased complaints during periods of ulcer activity, which may limit their consumption in the early stages of treatment.
In addition, a special diet is not required in patients with ulcers. Patients who like to drink milk can be allowed to drink 1-2 glasses of milk per day. It is inconvenient to drink the milk frequently for therapeutic purposes. Approaches to reduce stress in patients living a stressful life may help in treatment. (Focusing on hobbies, psychotherapy, yoga, etc.)
Surgical treatment is currently applied only when there are complications such as bleeding, obstruction and puncture that do not respond to medical and endoscopic treatment.
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