Gastric and duodenal ulcers

The stomach, located between the esophagus and the duodenum, is a 25-cm long J-shaped pouch divided into three main sections: the fundus, the body and the antrum. Glands in the stomach secrete enzymes, which are proteins necessary for digestion, and hydrochloric acid, a powerful substance that activates the enzymes. The stomach lining is composed of four separate layers: the mucosa, the submucosa, the muscularis propria and the serosa.

Ulcers are caused by an overly high concentration of acid in the stomach combined with defense mechanisms that aim to protect the stomach from this acid. The gastric juice attacks the mucosa, first causing inflammation, then an ulcer. The symptoms of gastric and duodenal ulcers are practically identical:

• Cramps or a burning sensation in the pit of the stomach
• A painful feeling of hunger
• Belching and intestinal bloating

Patients often alternate between flare-ups that last several weeks and periods without symptoms.

An estimated 80 percent of ulcers are caused by the proliferation of a bacterium called Helicobacter pylori.
The following factors may also increase the risk of an ulcer:

• Heavy consumption of nicotine, alcohol or coffee
• Certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs)
• Psychological stress
• Physical stress caused by a serious injury, burn or other trauma
• Certain tumors that cause the stomach to produce excess acid, such as pancreatic gastrinomas, which secrete gastrin, a substance that stimulates the hypersecretion of acid

People at risk for developing ulcer-related complications such as bleeding, intestinal obstruction or perforation are those with a personal history of ulcers, particularly if they are 65 and over.

The doctor asks the patient about his or her symptoms and looks for triggering factors such as smoking or an anti-inflammatory drug treatment. An upper gastrointestinal endoscopy, or gastroscopy, allows the doctor to see the ulcer and remove biopsy samples in order to rule out cancer and infection by Helicobacter pylori. Unlike duodenal ulcers, which are always benign, a stomach ulcer can turn out to be cancerous. A follow-up endoscopy must be performed one to two months later. A follow-up exam is not generally necessary for duodenal ulcers.

In addition to eliminating symptoms, the purpose of treatment is to heal the ulcer. Treatment consists in discontinuing gastrotoxic medications (NSAIDs, aspirin) and using antisecretory drugs like proton pump inhibitors (IPPs) or histamine H2-receptor antagonists, commonly known as H2 blockers, to reduce acid secretion in the stomach.
If Helicobacter pylori is present, antibiotic therapy for 10 to 14 days is necessary.

• 10 percent of the population will suffer from a gastric ulcer in their lifetime
• 70-80 percent of ulcers are caused by the Helicobacter pylori bacterium
• Taking NSAIDs makes you three or four times more likely to develop an ulcer
• The mortality rate from ulcer-related complications is 10 percent