GASTRIC ULCER

Peptic Ulcer- An ulcer in the lower esophagus, stomach or duodenum can be commonly called peptic ulcers. Duodenal ulcers are not malignant, but about 5% gastric ulcers are cancerous.

The exact reason for the production of ulcer is unknown, but the various factors that can lead to ulcer:

• Gastric hypersecretion: can be one among the reasons for the causation of peptic ulceration. Severe intractable peptic ulceration is found in patients having very high acid secretion. Reduction in gastric acid secretion by drugs helps in ulcer healing.
• Acid Pepsin: Peptic ulcer is produced when the aggressive effects of gastric or duodenal mucosal resistance; as a result acid and pepsin of gastric juice digest the mucosa of stomach and duodenum.
• Heredity: Ulcer patients often have a family history of the disease. Incidence of gastric ulcer in relatives is 2 times that of incidence in common population.
• Mucosal Resistance: Gastric mucus, secreted by gastric mucus cells, coats the mucosal surface of the stomach. This mucosal barrier is broken by various agents like, alcohol, AIDS, acid reflux, aspirin, weak organic acids and decreased mucosal blood flow.

Gastric Ulcer Duodenal Ulcer

1. Number: usually single May be multiple.
2. Pain : after meals in between meals.
3. Gastric acid: low or normal Hyperchlorohydria.
4. Vomiting: common uncommon.
5. Relief: not relived by food relieved by food.
6. Common in lower socioeconomic class equal prevalence.
7. Pathology: may be benign or malignant.
8. Less chronic follows a chronic course for up to 20yrs

How to know that a gastric ulcer is malignant

• Symptoms; Anorexia and weight loss, dysphagia, epigastric pain not related to food.
• Signs

Epigastric mass

Metastasis indicated by; supra clavicular nodes, large irregular hepatomegaly, ascites, tumor of the ovary, deep vein thrombosis of leg.

• Radiological showing: filling defect and failure of peristalsis in a site other than middle 2/3 of lesser curvature.

Very large ulcer anywhere in the stomach. Leather bottle stomach.

• Gastroscopy and gastric cytology showing malignancy.
• Gastric endoscopic US shows degree and extent of infiltration.