Boundless Thoughts

What is it?

A gastric ulcer, also called a stomach ulcer, is a raw, eroded area in the lining of the stomach.

Who gets it?

Gastric ulcers occur in people who take anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen; drink alcohol; smoke tobacco; have a high caffeine intake and often feel stressed.

What causes it?

A gastric ulcer develops when stomach acids and digestive juices injure the stomach’s lining of protective mucus. Gastric ulcers most commonly are caused by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen. Aspirin is the NSAID most likely to cause ulcers.

Gastric ulcers may also develop from the presence of bacteria called Helicobacter pylori (H. pylori), decreased resistance of the lining of the stomach to gastric acids, increased production of gastric acids and infection, certain types of medication, and disorders that cause over secretion of stomach juices. Ulcer can also be caused by the use of tobacco, alcohol and caffeine.

What are the symptoms?

The symptoms of gastric ulcers include indigestion and heartburn in the middle of the upper abdomen, nausea and loss of appetite, weight loss and repeated episodes of gastrointestinal bleeding. About 30% of patients with gastric ulcers are awakened by pain at night. Many patients have periods of chronic ulcer pain alternating with symptom-free periods that last for several weeks or months. The pain may be relieved by eating or taking antacids, and may get worse a couple of hours after meals or before meals.

If the gastric ulcer is bleeding, the patient may vomit bright red blood or digested blood that looks like brown coffee grounds and have black, tarry bowel movements.

How is it diagnosed?

To diagnose a gastric ulcer, the doctor may first examine the patient and look at the medical history. The doctor may suspect gastric ulcers based on risk factors such as male sex, age over 45, location of pain, anemia, history of using NSAIDs, history of heavy smoking and alcohol use, and family history of ulcers or stomach cancer.

The doctor may perform an endoscopy and imaging studies to determine if the patient has a gastric ulcer. An endoscopy is considered the best procedure for diagnosing gastric ulcers and for taking samples of stomach tissue for biopsies. An endoscope is a slender tube-shaped instrument that allows the doctor to view the tissues lining the stomach and duodenum.

The doctor may also test for H. pylori because almost all ulcer patients who are not taking NSAIDs are infected. Noninvasive tests include blood tests for immune response and a breath test. The doctor may also take a blood test to see if the patient is anemic due to a bleeding ulcer.

What is the treatment?

To treat a gastric ulcer the doctor may prescribe drugs that will lower the rate of stomach acid secretion or protect the mucous tissues that line the stomach. Surgical treatment of ulcers is usually recommended if the doctor suspects complications and malignancies. Possible complications of untreated ulcers include hemorrhaging, a perforation of the stomach wall, and an obstruction (ulcer scarring that prevents passage of food).

The doctor may also recommend treatment to eliminate H. pylori in order to prevent ulcer recurrences. Without such treatment there is an eighty percent chance the ulcer will reoccur within one year. The usual regimen used to eliminate the bacterium is a combination of tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol).

Self-care tips

Patients with gastric ulcers can make several lifestyle changes to prevent their recurrence, including avoiding unnecessary use of aspirin and NSAIDs, giving up smoking, and cutting down on alcohol, tea, coffee, and sodas containing caffeine. Other preventative measures include eating balanced, nutritious meals, learning how to manage stress, getting plenty of rest and exercising as recommended.

Treatment for gastroenteritis varies according to the type and severity of the illness. Most cases resolve on their own within several days. Mild cases may be treated by replacing fluids and electrolytes (chemicals needed for normal body function) to prevent dehydration. Increasing fluid intake is particularly important for children because they become dehydrated faster than adults. Diarrhea that is caused by medications (e.g., antacids, antibiotics) is treated by stopping the drug.

Tips for replacing fluids include:

* Begin by drinking small amounts of clear liquids (4 or more ounces each hour) as tolerated. Soft drinks, tea, coffee, fruit juice and sports drinks should be avoided because they do not replace electrolytes appropriately.

* Drink plenty of oral rehydration solutions (liquids with glucose and electrolytes designed to replace fluids lost due to diarrhea) if diarrhea is severe. This is especially important for children.

* Take antidiarrheal medications to ease symptoms of diarrhea. However, these medications should be avoided by children and patients experiencing a high fever or blood in the stools. Also, these medications should not be taken more than three days unless directed by a physician.

After vomiting subsides, patients may start to gradually eat solid foods. Some diet tips include:

* Eat foods that contain salt, such as crackers or pretzels, to replace lost sodium.

* Eat foods such as oatmeal, white rice, applesauce and bananas to help slow down bowel movements.

* Eat foods that are easy to digest, such as broth or chicken soup.

* Do not eat or drink foods and beverages, such as chewing gum and apple juice, that contain sorbitol, a sugar alcohol that worsens diarrhea.

* Limit intake of dairy products, fatty and greasy foods (e.g., pizza) and high-fiber foods (e.g., bran cereal, whole-grain breads) because they may worsen diarrhea.

Cases of gastroenteritis that cause severe dehydration may require hospitalization. Patients may receive fluids intravenously (through a vein). Patients may be given antidiarrheal medications to ease diarrhea or antiemetics to treat nausea and/or vomiting. Although antiemetics are not typically administered to children, research shows that one such drug may be effective in treating youngsters with gastroenteritis.

Patients are rarely given antibiotics to treat a bacterial infection. There are only a few types of gastroenteritis (such as shigellosis) that require antibiotic treatment. In fact, antibiotics can cause gastrointestinal infections in some people. Patients who have eaten foods contaminated with pesticides or other types of toxins may have their stomachs pumped (lavage) to remove the contents.

Researchers are also currently working to develop new treatments for gastroenteritis. For example, a molecule in coral has proven effective in fighting the virus that causes gastroenteritis, which may prove promising in the development of improved treatments.

Signs and symptoms of gastroenteritis vary among individuals and depend upon the type and quantity of the pathogen (disease-causing organism). Symptoms may appear within hours or days of being infected. They usually last from one to two days but may last 10 days or longer. Diarrhea is the most common symptom. Other symptoms include:

* Loss of appetite
* Nausea
* Vomiting
* Abdominal cramping
* Audible rumbling of intestines
* Malaise (general sick feeling)
* Fever
* Aching muscles
* Exhaustion

Patients who experience severe vomiting and diarrhea due to gastroenteritis may also experience the following signs and symptoms:

* Dehydration, including excessive thirst, weakness, lightheadedness, decreased frequency of urination, dry mouth or lack of tears in infants

* Low levels of potassium in the blood (hypokalemia)

* Low levels of sodium in the blood (hyponatremia)

* Imbalances of water or electrolytes (chemicals needed for normal bodily function)

Most cases of gastroenteritis do not require a visit to a physician. However, a physician should be consulted if:

* Symptoms persist for longer than 36 hours
* Blood is present in diarrhea or vomit
* Patients have a fever of 103 degrees Fahrenheit (39.4 degrees Celsius) or higher
* Patients feel lightheaded or faint after standing
* Patient becomes unusually drowsy or confused
* Abdominal pains are severe
* Patients show signs of dehydration

Gastroenteritis is an inflammation or irritation of the lining of the stomach and intestines, which often results in diarrhea, nausea, vomiting or stomach cramps.

In healthy adults, gastroenteritis is not usually a serious condition. However, the condition can cause life-threatening dehydration or electrolyte imbalance in infants and children, or in adults who are unable to care for themselves. People with other medical conditions or weakened immune systems may be at risk for developing severe gastroenteritis.

Gastroenteritis is most often caused by viruses spread by close contact with an infected person, or by consuming food contaminated by bacteria. The condition can also be caused by parasites, protozoans, chemicals or toxins. Certain types of medications may also cause the condition.

Gastroenteritis may be diagnosed during a physical examination that includes a medical history. If patients have been experiencing symptoms for 48 hours or longer, physicians may request a stool sample, which will be put in a culture medium and bacteria and protozoa that may be causing the illness will grow and will be characterized in a lab. Viruses are usually detected by a culture. In many cases, people with gastroenteritis recover after several days without seeing a physician.

Mild cases of gastroenteritis may be treated at home by increasing fluid intake to avoid dehydration. This is particularly important for children, who usually become dehydrated faster than adults. More severe cases may require hospitalization and intravenous administration of fluids.

Gastroenteritis may be prevented in a variety of ways. Washing hands thoroughly can help prevent spread of infection. Cooking meat and eggs properly and making sure food is refrigerated at an appropriate temperature can help prevent contamination of food.

A physician should be consulted if:

* Symptoms persist for longer than 36 hours
* Blood is present in diarrhea or vomit
* Patients have a fever of 103 degrees Fahrenheit (39.4 degrees Celsius) or higher
* Patients feel lightheaded or faint after standing
* Patients become unusually drowsy or confused
* Abdominal pains are severe
* Patients show signs of dehydration