Stomach ulcers are the malignant growth of the tissue in stomach characterized by pain, vomiting, loss of appetite and weakness in its advanced stage. It is also called gastric ulcers. Gastric ulcers are painful sores that can be found in small intestine or stomach lining. They occur when the thick layer of mucus that play very important role to protect your stomach from digestive juices is reduced, hence enabling the digestive acids to eat away at the lining tissues of the stomach.
Causes of Stomach Ulcers:
The exact cause is unknown. It occurs commonly in males, passed 60 years. It is common in blood group "A" subjects. There is some hereditary predisposition. The predisposing conditions are chronic gastritis, gastric ulcer, and gastric polypi. Other associated factors are - rich diet particularly with salt meat, spicy vegetable, smoked food; nitrates in the diet, etc.
Pathology of Gastric Ulcers:
It occurs in the pyloric end of the stomach and in the body of the stomach with the equal incidence of both sites. Three types are described - the large cauliflower type, the sessile ulcerative type, and infiltrating type. The large cauliflower type presents fungating polypoid mass usually at the greater curvature. The ulcerative type is most common at pylorus producing, symptoms of the pyloric obstruction. The infiltrating type is associated with diffuse fibrosis producing the so-called "leather-bottle" stomach.
The carcinomatous growth spreads by direct extension, by lymphatic & by the portal blood stream and systemic blood stream.
Clinical Features of Stomach Ulcers:
In early stages, there may be asymptomatic.
- Abdominal discomfort or pain initially not related to food and later aggravated.
- Heartburn.
- Eructation.
- Anorexia and nausea
- General weakness
- Anaemia
- Heartburn.
- Alternating constipation and diarrhea, etc.
- Anorexia and nausea
- Eructation
Medical Investigations Related to Gastric Ulcers:
- Stool examination for occult blood.
- Barium meal X-ray -filing defect in the pylorus or body of the stomach; stiffening of the wall; loss of normal peristalsis movement.
- Gastroscopy
- Exfoliative cytology - carcinoma cells detected in the gastric washing.
- Blood test - progressive anemia, E.S.R. –raised
- Gastric analysis, achlorhydria, sometimes histamine fast, with blood in the aspirated juice
- Exfoliative cytology - carcinoma cells detected in the gastric washing.
- Tetracycline Fluorescence Test
- Laparotomy — if the diagnosis is still doubtful, early exploration should always be advised.
- Gastric analysis, achlorhydria, sometimes histamine fast, with blood in the aspirated juice
- Tetracycline Fluorescence Test.
Complications Related to Stomach Ulcers:
(1) Septic Pneumonia
(2) Thrombosis is all possible consequences of this disease
(3) Gastric perforation and localized formation of abscesses.
Prognosis:
It is said to progress rapidly in the young and slowly in the aged. It depends on the type and location of the cancer & upon the resistance of the patient. Cure, however, is a remote possibility.
Management of Gastric or Stomach Ulcers by Conservative/Medical Treatment:
(1) Gastric lavage - the stomach should be washed out with 7-8% sodium bicarbonate solution daily, using a rubber tube.
(2) Diet - in the case of pyloric obstruction, liquid or semisolid diet only should be allowed.
(3) Sedatives - chlorpromazine (Largactil) 25 mg. thrice a day.
Management of Gastric Ulcers by Surgical Treatment:
In fact, the only possible treatment of Gastric cancer is surgery. Suggestive methods are
(1) Radical total gastrectomy.
(2) In some cases gastric exclusion or gastrojejunostomy.
(3) Radical proximal gastrectomy.
(4) Radical distal gastrectomy
Homoeopathic Remedies for Gastric Ulcers:
(1) Hydrastis- Malignant ulcers of the stomach have disappeared under the regular use of this remedy; jaded look, shallow complexion, the hide-bound state of skin, low spirits, loss of appetite; constipation.
(2) Conium - Cancer of the stomach with flying stitches, < at night; vomiting of chocolate-colored masses sour and acidic; burning, squeezing pain, extending from pit of the stomach into back and shoulder.
| Points |
Chronic Duodenal Ulcer |
Chronic Ulcer |
Gastric Cancer |
|
1) Age : 2) Sex 3) Pain: |
Mostly 20-40 yrs. Both, mostly males. Right side of Epigastrium & Right hypocondrium, Hunger pain. Food relieves pain. |
Mostly above 40 yrs. Both, mostly females. Epigastric discomfort later the pain may be constant or increase boring, by food. |
Mostly 20-40 years. Mostly males. Painless to start with, later dull or spasmodic pain increases after food. Upper abdominal discomfort. Pain is more persistent. |
| 4) Appetite: | Marked. | Less; afraid to eat. | Anorexia is an early and constant symptom. |
| 5) Bleeding: | Usually melaena. | Usually haernatemcsis. | Coffee ground vomit, hacmatemesis or melaena (persisting). |
| 6) Vomiting: | Usually absent. | Frequent relieves epigastric discomfort and pain. | May be present, does not relieve discomfort and pain. |
| 7) Loss of Weight |
Increases or normal |
Gradual (slightly). | Sudden, appreciable progressive. |
| 8) Anaema | Absent | Slight or absent | More constant. |
| 9) Malignancy | Never | Rarely occur. | Malignant. |
| 10) Incidence | More common. | Less. | Less. |
| 11) Acidity | Usually high. | Variable | Less. |
|
12) Tender – Ness |
To right of midline duodenal point |
Upper abdominal. | |
| 13) Pyloric stenosis | More common | Rarely occur. | May occur. |
| 14) Gastric Analysis. | Hyperchlorhydria. | Hyperchlorhydria. | Achlorhydra. |
| 15) Ba-meal E-ray | Duodenal cap deformed, gastric hypermotility. |
Stomach hypomotile, Usually ulcer crater In the lesser curvature |
Irregular feeling defect, hypomotility, lack of peristalsis. |
| 16) Perforation : | More common. | Rerely occur. | Rarely occur. |
| 17) Jaundice | Absent | Absent | May be present. |
| 18) Liver | Normal | Normal | May be enlarged & nodular for metastasis |
| 19) Abdominal Lump | Absent | Absent | Lump in the epigastriam may be present. |
| 20) Enlarged of Virchow’s gland | Absent | Absent | May be present. |
| 21) Ascites | Absent | Absent | May be present |
| 22) Prognosis | Good. | Good. | Bad. |
Symptoms of Stomach Ulcers:
-
Nausea with vomiting
-
Dark or black colored stool as a result of bleeding
-
Blood vomits
-
Feeling bloated
-
Heartburning sensation
Chronic Ulcers of Stomach:
It is a simple ulcer in the stomach which is the result of acid-pepsin digestion of the mucosa of stomach. It may be acute or chronic.
Common sites :
Mostly lesser curvature (near the pyloric antrum) Rarely – Geater curvature, fundus and cardia.
Causes:
(a) Hyperacidity. (b) Irregular dietary habits. (c) Spicy diet, tea, coffee etc. (d) Excessive smoking, and alcohol habits etc. (e) Improper chewing (inadequate mastication). (f) Genetic factor. (g) Endocrine factor – Zollinger Ellison syndrome multiple adenoma syndrome etc. (h) Increased parietal cell mass. (i) In some cases idiopathic. (j) Mucosal resistance.
Pathology:
Same as described in Chr. Duodenal ulcer.
Clinical Feature:
(a) Mostly in the female. (b) Older age (usually). (c) Pain – left side of (d) In the case of pre-pyloric gastric ulcer – acidity and heart bum present. (e) Vomiting induced by the patient. (f) Appetite is present but afraid to eat. (g) Loss of weight. (h) On examination – deep tenderness in the epigastrium.
Investigation :
(a) Total night juice test – fresh acid is either normal of just above normal. (b) Barium meal E-ray- presence “niche and a notch”. (c) Gastroscopy – may reveal the actual presence of the ulcer.
Management :
- Conservation – Same as described in Chronic Duodenal ulcer.
- Surgical Treatment – (a) Partial gastrectomy with gastroduodenal anastomosis is preferred. (b) Pyloroplasty – if the operation is considered hazardous – pyloroplasty is justified (gastrojejunostomy). Vagotomy – is added when the acid is high.
Home Remedies for Gastric Ulcers:
- Cabbage is very beneficial to control stomach ulcers
- Both ripe and unripe bananas are beneficial to get rid of ulcers
- Coconut has antibacterial properties so it is good for treating ulcers
- Boil and drink fenugreek seeds: it is beneficial in curing stomach ulcers.
