Diagnosis Of A Stomach Ulcer
Diagnosing a stomach ulcer is done using a range of methods, including:
- Endoscopy a thin flexible tube is threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer.
- Barium meal a chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable.
- Biopsy a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found.
- C14 breath test this checks for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women.
How To Test For Stomach Ulcers
If your doctor thinks you may have a stomach ulcer, the initial tests will include some blood tests. These tests will help to check whether you have become anaemic because of any bleeding from the ulcer. The blood test will also check to see that your liver and pancreas are working properly.
The main tests that are then used to diagnose a stomach ulcer are as follows:
What Happens When Your Stomach Lining Is Messed Up
Weakness in your stomach lining allows digestive juices to damage and inflame it, causing gastritis. Having a thin or damaged stomach lining raises your risk for gastritis. A gastrointestinal bacterial infection can also cause gastritis. The most common bacterial infection that causes it is Helicobacter pylori.
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What Tests Diagnose A Peptic Ulcer
To confirm a person has an ulcer a diagnostic imaging test will usually be ordered. The two most widely used tests are:
- Upper GI series : This is a type of X-ray. The patient is given a chalky liquid to drink that increases the contrast on the X-ray, making certain features easier to see. Because this liquid contains barium, this test is sometimes called a barium swallow.
- Endoscopy : An endoscope is a thin, flexible tube with a tiny camera at the end. The patient is given a mild sedative, and then the tube is passed through the mouth into the stomach. The doctor can see the lining of the stomach to diagnose a peptic ulcer. Tiny samples of the tissue will be taken , which are examined under a microscope.
If a diagnostic imaging test reveals an ulcer, the patient will most likely have a test to see if H pylori bacteria are present.
- It is important to be certain about this, because treatment of the H pylori is likely to heal the ulcer.
- Ulcers caused by H pylori are treated differently than ulcers caused by medications.
Three types of tests are available to detect H pylori.
Fast Facts On Stomach Ulcers
- Stomach ulcers are common in the West and easy to treat but can become serious.
- The most common causes are bacteria and use of nonsteroidal anti-inflammatory drugs .
- The classic symptom of a stomach ulcer is indigestion.
- Treatment for stomach ulcers normally focuses on removing the cause.
The classic symptom of a stomach ulcer is indigestion, also called dyspepsia.
Indigestion causes pain or discomfort in the stomach area. This symptom can be mistaken for heartburn, which can occur at the same time.
Acid reflux or gastroesophageal reflux disease may cause heartburn. It occurs slightly higher up from the stomach, and people will feel it in the lower part of the chest.
Stomach ulcer symptoms tend to be more distinct than heartburn, but symptoms can still be vague.
An ulcer also tends to produce a burning or dull pain in the center of the abdomen. People sometimes describe the pain as a biting or gnawing pain. Some individuals may describe a hungry sensation.
Individuals may also be able to relieve pain by eating, drinking, or taking antacids.
Some stomach ulcers go unnoticed and show no typical indigestion-type pains. These ulcers are less common, and doctors tend them after they have started bleeding.
Some ulcers can cause a hole in the stomach wall. Health experts call this perforation, which is a severe condition.
Stomach ulcer symptoms often change over time and can be difficult to spot.
Dietary changes can help prevent stomach ulcers from developing.
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What Should I Watch For While Using This Medication
Do not smoke cigarettes or drink alcohol. These increase irritation to your stomach and can make it more susceptible to damage from medication like ibuprofen and aspirin.
If you are female, do not use this medication if you are pregnant. Do not get pregnant while taking this medication and for at least one month after stopping this medication. If you can become pregnant, use a reliable form of birth control while taking this medication. Talk to your care team about birth control options. If you do become pregnant, think you are pregnant, or want to become pregnant, immediately call your care team for advice.
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What Are The Symptoms Of A Peptic Ulcer Does It Cause Pain
Ulcers do not always cause symptoms. Sometimes, a serious complication such as bleeding or a sudden, bad upper abdominal pain is the first sign of an ulcer.
The most common symptom of peptic ulcers is abdominal pain.
- The pain is usually in the upper middle part of the abdomen, above the belly button and below the breastbone.
- The ulcer pain can feel like burning, or gnawing, and it may go through to the back.
- Pain often comes several hours after a meal when the stomach is empty.
- The pain is often worse at night and early morning.
- It can last anywhere from a few minutes to several hours.
- The ulcer pain may be relieved by food, antacids, or vomiting.
Other symptoms of peptic ulcers include the following:
- Loss of appetite
Severe ulcers may cause bleeding in the stomach or duodenum. Bleeding is sometimes the only symptom of an ulcer. This bleeding can be fast or slow. Fast bleeding reveals itself in one of the following ways:
- Vomiting of blood or dark material that looks something like coffee grounds: This is an emergency and warrants an immediate visit to an emergency department.
- Blood in the stool or black, tarry, sticky-looking stools
Slow bleeding is often more difficult to detect, because it has no dramatic symptoms.
- The usual result is low blood cell count .
- The symptoms of anemia are tiredness , lack of energy , weakness, rapid heartbeat , and pale skin .
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Who Can And Cannot Take Pantoprazole
Adults and children aged 12 years and over can take pantoprazole.
Pantoprazole is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:
- have ever had an allergic reaction to pantoprazole or any other medicine
- have liver problems
- are pregnant, trying to get pregnant or breastfeeding
- are due to have an endoscopy
If you’re going to have an endoscopy, ask your doctor if you should stop taking pantoprazole a few weeks before your procedure. This is because pantoprazole may hide some of the problems that would usually be spotted during an endoscopy.
Which Way To Go With A Giant Gastric Ulcer
A large gastric ulcer was discovered in 65-year-old man who had no significant comorbidities. Two set of biopsy samples revealed only some probably reactive atypia. The images show the endoscopic appearance of the lesion. A CT has confirmed the presence of a large gastric ulcer with a couple of small nodes nearby that were reported as likely to be reactive.
Case Question 1
What would you do next?
a) Reassure the patient and organise a follow up in 3 months to confirm healing
b) Organise for another set of biopsy samples to be taken in the next week or so
c) Organise an endoscopic ultrasound
d) Organise a laparoscopy and wedge biopsy
e) Organise a distal gastrectomy
- Case question 1 answer and discussion
Correct answer: d.
This situation is a frequent conundrum in clinical practise. Of course, such cases should be discussed in your local cancer meeting. Poor healing appears to be more frequent in the elderly, those who have significant comorbidities and with certain drug treatments, such as NSAIDs, potassium chloride, bisphosphonates, doxycycline or nicorandil. Chronic gastric ulceration has also been reported secondary to nearby infiltrating adenocarcinoma, lymphoma or stromal tumours, cytomegalovirus infection and lymphoma.
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How Are Stomach Ulcers Treated
Ulcers can heal if they are given a rest from the factors that created them. Healthcare providers treat uncomplicated ulcers with a combination of medicines to reduce stomach acid, coat and protect the ulcer during healing and kill any bacterial infection that may be involved. Medicines may include:
- Antibiotics. If H. pylori was found in your digestive tract, your healthcare provider will prescribe some combination of antibiotics to kill the bacteria, based on your medical history and condition. Commonly prescribed antibiotics include tetracycline, metronidazole, clarithromycin and amoxicillin.
- Proton pump inhibitors . These drugs help reduce stomach acid and protect your stomach lining. PPIs include esomeprazole,dexlansoprazole,lansoprazole, omeprazole,pantoprazole and rabeprazole.
- Histamine receptor blockers . These reduce stomach acid by blocking the chemical that tells your body to produce it . H2 blockers include famotidine, cimetidine and nizatidine.
- Antacids. These common over-the-counter medicines help to neutralize stomach acid. They may bring some symptom relief, but they arent enough to heal your ulcer. They also might interfere with some antibiotics.
- Cytoprotective agents. These medicines help to coat and protect your stomach lining. They include sucralfate and misoprostol.
- Bismuth Subsalicylate. This over-the-counter medicine, commonly found as Pepto-Bismol, can help coat and protect your ulcer from stomach acid.
Eradication Of Helicobacter Pylori
Most peptic ulcers are caused by Helicobacter pylori infection. If a diagnosis of ulcer is probable, treatment to eradicate H. pylori should be considered if the patient has frequent attacks requiring repeated and/or prolonged treatments with antiulcer drugs over 8 weeks or in cases of complicated ulcers . Infection should be confirmed with a test where possible.
H. pylori resistance to antibiotics varies globally, follow national recommendations where available. If not, for information, administer a triple therapy for 7 days:omeprazole PO 20 mg 2 times daily + clarithromycin PO 500 mg 2 times daily + amoxicillin PO 1 g 2 times dailyaCitation a.In penicillin-allergic patients, amoxicillin PO can be substituted with metronidazole PO 500 mg 2 times daily..
In immunocompromised patients, consider mycobacterium avium complex infection or other nontuberculous mycobacterium infection prior to starting a clarithromycin-containing triple therapy.
If symptoms continue despite treatment, consider the differential diagnosis of gastric cancer. Refer for investigations if possible.
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What If An Ulcer Doesnt Heal Or Comes Back After Treatment
Taking medicines and treating the underlying cause heals most ulcers. However, if your ulcer doesnt heal or comes back after treatment, your doctor may
- check for and treat any factors that could be causing the ulcer, such as an H. pylori infection.
- recommend you quit smoking, if you smoke. Smoking can slow ulcer healing.
- recommend or prescribe more medicines to help heal the ulcer.
What About Complicated Ulcers
While most ulcers are successfully treated with medication, some complicated ulcers may require surgery. Ulcers that are bleeding, or that have perforated your stomach or intestinal wall, will need to be surgically repaired. An ulcer that is malignant, or obstructing a passageway, will need to be surgically removed. In severe cases, an ulcer that keeps coming back may be treated by surgery to cut off some of the nerve supply to the stomach that produces stomach acid.
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How To Treat A Gastric Ulcer Using Plantains
Here is what I used to cure my gastric ulcer.
Dosage: Take it once in the morning and once at night until it’s all finished. You should notice an improvement in attacks and symptoms. Repeat if symptoms persist.
Mucus And Blood In Stool With Abdominal Pain: 6 Causes Explained
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Common causes of abdominal pain, with blood and mucus in the stool are:
- Dysentery: the most common cause of acute abdominal pain with blood and mucus in stool.
- Inflammatory bowel disease .
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Symptoms And Signs Of Peptic Ulcer Disease
Symptoms of peptic ulcer disease depend on ulcer location and patient age many patients, particularly older patients, have few or no symptoms. Pain is most common, often localized to the epigastrium and relieved by food or antacids. The pain is described as burning or gnawing, or sometimes as a sensation of hunger. The course is usually chronic and recurrent. Only about half of patients present with the characteristic pattern of symptoms.
Gastric ulcer symptoms often do not follow a consistent pattern . This is especially true for pyloric channel ulcers, which are often associated with symptoms of obstruction caused by edema and scarring.
Duodenal ulcers tend to cause more consistent pain. Pain is absent when the patient awakens but appears mid-morning and is relieved by food but recurs 2 to 3 hours after a meal. Pain that awakens a patient at night is common and is highly suggestive of duodenal ulcer. In neonates, perforation and hemorrhage may be the first manifestation of duodenal ulcer. Hemorrhage may also be the first recognized sign in later infancy and early childhood, although repeated vomiting or evidence of abdominal pain may be a clue.
Alternative And Complementary Therapies
Certain lifestyle changes can help you recover from an ulcer.
- Watch your diet. If you know that there are specific foods that make your ulcer feel worse, avoid them until your treatment is over. For many people, these include alcohol, caffeine, fatty foods, spicy foods, and chocolate.
- Stop smoking. If you smoke, you are already at increased risk of getting an ulcer. The data also shows that ulcers take longer to heal in smokers and that the ulcer medication you are taking may be less effective. Scientists dont know exactly why smoking has these negative effects.
- Take pain medication carefully. NSAIDs, such as aspirin, ibuprofen, and many other commonly taken drugs, are taken for pain and fever, but can cause an ulcer if used too often. NSAIDs can also prevent an ulcer from healing as quickly as you would like, so talk to your doctor about what you can take for your other aches and pains while you are waiting for your ulcer to heal. Acetaminophen does not cause ulcers, so it may be an effective substitute. Also, be sure to read all drug labels some cough and cold liquids have NSAID ingredients in them, and you should avoid them, too.
- Cut back on alcohol. Stop drinking alcohol if you want to completely reduce your risk of additional ulcers and help your body heal.
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How Is A Peptic Ulcer Diagnosed
Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. Theyâll also check you for bloating in the belly and pain. That may be enough to make a diagnosis.
The only way your doctor can tell for sure if you have an ulcer is to look. They may use a series of X-rays or a test called an endoscopy. This test allows them to pass a thin, bendy tube down your throat and into your stomach and small intestine. The tube has a camera at the end so they can check the lining for ulcers. They may also take a small piece of the lining to test for H. pylori. Blood, breath, and stool sample tests also can screen for the bacteria.
When Should You Call Or See A Doctor
If you think you have a stomach ulcer, call your doctor. Together you can discuss your symptoms and treatment options. If you dont already have a physician, you can use the Healthline FindCare tool to find a provider near you.
Its important to get a stomach ulcer taken care of because without treatment, ulcers and H. pylori can cause:
- bleeding from the ulcer site that can become life-threatening
- penetration, which occurs when the ulcer goes through the wall of the digestive tract and into another organ, such as the pancreas
- perforation, which occurs when the ulcer creates a hole in the wall of the digestive tract
- obstruction in the digestive tract, which is due to swelling of inflamed tissues
- stomach cancer, specifically
Symptoms of these complications can include those listed below. If you have any of these symptoms, be sure to call you doctor right away:
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Can Stress Cause Erosive Gastritis
Stress-induced gastritisalso referred to as stress-related erosive syndrome, stress ulcer syndrome, and stress-related mucosal diseasecan cause mucosal erosions and superficial hemorrhages in patients who are critically ill or in those who are under extreme physiologic stress, resulting in minimal-to-severe …