Gastric ulcer is an ulcer inside the stomach wall, which involves the mucosa, submucosa and muscular layers. It is due to the lowered mucosal barrier's resistance to acids secreted in the stomach . The mucosal barriers are lowered usually due to ingestion of NSAIDs and infection with Helicobacter pylori.
Clinical features: Usually the patients with gastric ulcers are elderly or middle aged and are thin built or emaciated. The pain of gastric ulcer is chronic, is usually localised to the epigastrium, but may also be referred to the left hypochondrium or mid abdomen.It occurs or increases with intake of food. The pain is reduced by taking antacids or by lying down. There may be dyspepsia like symptoms with bloating, belching and burning in the abdomen. Some people may have nausea and vomiting. Bleeding from the ulcer causes hematemesis
Diagnosis: A gastric ulcer may be diagnosed by Barium meal radiographs. Upper Gastro-intestinal endoscopy shows the location, size and type of ulcer very clearly. Endoscopic biopsy may be necessary to differentiate a gastric ulcer from a cancer of stomach. The biopsy specimen may also be examined for existence of Helicobacter pylori infection.
Management: Because the gastric ulcer is amenable to medical treatment, gastric ulcer is treated medically at first. Mucoprotective drugs like bismuth salts, sucralfate are given along with antacids. Though these patients have lowered acid production in the stomach, a trial with H2 antagonists or Proton pump inhibitors may be useful. Helicobacter pylori infection is eradicated with bismuth salts, proton pump inhibitors, antibiotics and metronidazole in combination. A careful follow up with repeated endoscopy is mandatory. If medical treatment fails to cure the gastric ulcer or if there is a high probability of malignancy, surgical treatment is advised. Surgery: Partial gastrectomy with the inclusion of the ulcer area is the treatment of choice.