Gastric ulcer

Gastric Ulcer

1. Definition: Gastric ulcer is a type of mucosal defect in the stomach lining, which can cause pain, bleeding, and perforation.

Gastric ulcers are a type of peptic ulcer, which also includes ulcers in the duodenum.

2. Synonyms: Gastric ulcer is also known as stomach ulcer.

3. Causes / Etiology:

• Helicobacter pylori (H. pylori) infection: H. pylori is a type of bacteria that can infect the stomach lining and cause inflammation, leading to ulcer formation.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Long-term use of NSAIDs can cause stomach lining damage and lead to ulcer formation.
• Acid-pepsin imbalance: An imbalance of stomach acid and pepsin can cause the stomach lining to erode, leading to ulcer formation.

4. Types / Classification:

• Acute gastric ulcer: An acute gastric ulcer is a sudden onset of symptoms, usually within a few days.
• Chronic gastric ulcer: A chronic gastric ulcer is a long-standing ulcer that can take months or years to develop.
• Benign gastric ulcer: A benign gastric ulcer is a non-cancerous ulcer that is not life-threatening.
• Malignant gastric ulcer: A malignant gastric ulcer is a cancerous ulcer that requires immediate medical attention.

Acute Gastric Ulcer:

• Causes: H. pylori infection, NSAIDs, and acid-pepsin imbalance.
• Clinical features: Severe abdominal pain, nausea, vomiting, and bleeding.
• Duration: Symptoms can last from a few days to a few weeks.
• Differences: Acute gastric ulcers are more likely to cause severe bleeding and perforation compared to chronic gastric ulcers.

Chronic Gastric Ulcer:

• Causes: H. pylori infection, NSAIDs, and acid-pepsin imbalance.
• Clinical features: Persistent abdominal pain, nausea, vomiting, and bleeding.
• Duration: Symptoms can last for months or years.
• Differences: Chronic gastric ulcers are more likely to cause chronic symptoms and complications compared to acute gastric ulcers.

5. Pathophysiology / Pathology:

• Stage 1: H. pylori infection or acid-pepsin imbalance causes inflammation of the stomach lining.
• Stage 2: Inflammation leads to erosion of the stomach lining, forming a small crater.
• Stage 3: The crater deepens and becomes a gastric ulcer.
• Stage 4: The ulcer can cause bleeding, perforation, or chronic symptoms.

6. Clinical Features:

• General features: Abdominal pain, nausea, vomiting, and bleeding.
• Specific features: Acute gastric ulcers may cause severe bleeding and perforation, while chronic gastric ulcers may cause chronic symptoms and complications.

7. Complications:

• Acute complications: Bleeding, perforation, and shock.
• Chronic complications: Chronic symptoms, chronic bleeding, and chronic perforation.

8. Investigations / Diagnosis:

• Routine tests: Endoscopy, upper gastrointestinal series, and blood tests.
• Specific tests: H. pylori testing, gastroscopy, and biopsy.
• Confirmatory tests: Endoscopy with biopsy and histopathology.

9. Differential Diagnosis:

• Gastroesophageal reflux disease (GERD): Similar symptoms, but no ulcer formation.
• Peptic ulcer disease (PUD): Similar symptoms, but different pathology.
• Cancer: Different symptoms and pathology.
• Gastrointestinal foreign body: Different symptoms and pathology.

10. Management / Treatment:

• General management: Rest, fluids, and pain management.
• Modern medicine treatment: Antibiotics for H. pylori infection, proton pump inhibitors (PPIs) for acid suppression, and NSAIDs for pain management.
• Diet and lifestyle advice: Avoid NSAIDs, avoid spicy and acidic foods, and maintain a healthy lifestyle.

11. Homeopathic Therapeutics:

• Arsenicum album:

  • Causation: Infection, trauma
  • Characteristic symptoms: Burning pain, nausea, vomiting
  • Modalities: Better with warmth, worse at night
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves burning pain and nausea

• Bryonia alba:

  • Causation: Trauma, overeating
  • Characteristic symptoms: Painful swallowing, nausea, vomiting
  • Modalities: Better with rest, worse with movement
  • Mental state: Irritability, anxiety
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves painful swallowing and nausea

• Carbo vegetabilis:

  • Causation: Overeating, poor digestion
  • Characteristic symptoms: Bloating, gas, nausea
  • Modalities: Better with rest, worse with movement
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Foul odor
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Phlegmatic, lymphatic
  • Helps in the disease: Relieves bloating and gas

• Lycopodium clavatum:

  • Causation: Overeating, poor digestion
  • Characteristic symptoms: Bloating, gas, nausea
  • Modalities: Better with rest, worse with movement
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Foul odor
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Phlegmatic, lymphatic
  • Helps in the disease: Relieves bloating and gas

• Natrum muriaticum:

  • Causation: Infection, trauma
  • Characteristic symptoms: Burning pain, nausea, vomiting
  • Modalities: Better with warmth, worse at night
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves burning pain and nausea

• Phosphorus:

  • Causation: Infection, trauma
  • Characteristic symptoms: Burning pain, nausea, vomiting
  • Modalities: Better with warmth, worse at night
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves burning pain and nausea

• Sulphur:

  • Causation: Infection, trauma
  • Characteristic symptoms: Burning pain, nausea, vomiting
  • Modalities: Better with warmth, worse at night
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves burning pain and nausea

• Urtica urens:

  • Causation: Infection, trauma
  • Characteristic symptoms: Burning pain, nausea, vomiting
  • Modalities: Better with warmth, worse at night
  • Mental state: Anxiety, restlessness
  • Thirst and appetite: Increased thirst, decreased appetite
  • Nature of discharges or secretions: Bitter taste
  • Physical generals: Weakness, fatigue
  • Suitable constitution: Sanguine, lymphatic
  • Helps in the disease: Relieves burning pain and nausea

12. Prognosis:

• Outcome: Treatment is usually successful, but complications can occur.
• Factors affecting outcome: Age, health status, and compliance with treatment.

13. Prevention:

• Avoid NSAIDs: Avoid long-term use of NSAIDs to prevent stomach lining damage.
• Maintain a healthy lifestyle: Maintain a healthy diet, exercise regularly, and manage stress.
• Monitor for symptoms: Monitor for symptoms of gastric ulcers and seek medical attention if they occur.

14. Diet:

• Recommended foods: Bananas, apples, toast, eggs, and plain rice.
• Avoided foods: Spicy, acidic, and fatty foods.
• Why: Avoid foods that can irritate the stomach lining and exacerbate symptoms.