Stomach ulcer

Disease Description (Causes and Symptoms)

• Definition: A peptic ulcer (gastric ulcer) in which the gastric mucosa is eroded, causing a defect that extends beyond the mucosa and may invade the muscular layer.
• Main causes: Helicobacter pylori (H. pylori) infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, excessive stress, and weakening of mucosal defense mechanisms. In some cases, excessive gastric acid secretion is involved.
• Pathophysiology (brief): Damage to mucosal defense mechanisms (including mucus, bicarbonate, blood flow, and cell regeneration) and the interaction of gastric acid and pepsin cause a mucosal defect. H. pylori and NSAIDs promote mucosal damage.
• Main symptoms: Epigastric (upper abdominal) pain (burning sensation, heartburn), pain after meals, indigestion, nausea and vomiting, decreased appetite, weight loss, gastrointestinal bleeding (hematemesis, melena), and anemia. Some cases are asymptomatic.

Treatment Methods

• Medication treatment
  • Acid-suppressing medication (PPI: for example, the omeprazole class) for 4–8 weeks is standard treatment (for healing).
  • Mucosal protectants (for example, sucralfate), with H2 blockers as an adjunct if necessary.
• H. pylori eradication treatment
  • Common options: Combination therapy with a PPI and antibiotics (clarithromycin-based triple therapy or, in situations involving drug resistance, bismuth quadruple therapy/concomitant therapy). Usually administered for 10–14 days.
  • Confirmation of eradication: At an appropriate time after treatment (usually 4 weeks after completion of eradication therapy and 2 weeks after stopping PPIs), confirmation is performed with a urea breath test (UBT) or stool antigen test.
• NSAID-related cases
  • If possible, discontinue or replace NSAIDs (consult a doctor regarding options such as selective COX-2 agents if necessary).
  • If long-term NSAID use is necessary, consider combining it with a PPI or using misoprostol (as determined by a doctor).
• In cases of complications such as bleeding, perforation, or obstruction
  • Endoscopic hemostasis (for bleeding), endoscopic balloon dilation (for some obstructions), or surgical treatment (for perforation, severe bleeding, or complex complications) may be necessary.
• Lifestyle management and precautions
  • Stop smoking (for healing and prevention of recurrence), avoid excessive alcohol consumption, and avoid unnecessary anti-inflammatory analgesics (aspirin and NSAIDs).
  • Limit irritating foods (extremely spicy or salty foods) if they worsen symptoms.
  • Stress management is recommended.
• Course and prognosis
  • With appropriate treatment, healing generally occurs within 4–8 weeks. If H. pylori is not treated, the recurrence rate is high (several tens of percent according to standard literature).
  • If complications (bleeding, perforation, or gastric outlet obstruction) occur, hospitalization, procedures, or surgery may be necessary, and the risk of death may increase.

Checklist Before an Outpatient Visit (Including Preparation Items and Sample Questions)

• Items to bring (before an outpatient visit/endoscopy)
  • A list of all medications currently being taken (including brand names, dosages, and dosing frequency), especially aspirin, anticoagulants, antiplatelet agents, and NSAIDs.
  • Previous test results (prior endoscopy findings, H. pylori test results, and blood tests such as liver function and anemia tests).
  • A record of symptoms (date symptoms began, nature and timing of pain, relationship to meals, presence or absence of bleeding symptoms, and weight changes).
  • History of allergies (including allergies to antibiotics).
• Information to tell the doctor first during the outpatient visit
  • Whether there has recently been hematemesis, melena, or dizziness (presyncope symptoms).
  • Whether there is persistent or severe abdominal pain or fever.
  • Possibility of pregnancy (in relation to antibiotics and radiologic tests).
• Sample questions to ask during the visit (questions the patient should ask the doctor first)
  • “Do the medications I am currently taking affect the test or treatment?”
  • “When should I start fasting before the endoscopy?”
• Emergency symptoms (go to the ER immediately)
  • If massive hematemesis, fainting or symptoms of orthostatic hypotension, acute severe abdominal pain (suspicious for perforation), shortness of breath, or decreased consciousness occurs, go to the emergency room immediately.

General Sample Questions to Ask the Doctor

• What are the expected side effects of this medication (the prescribed PPI/antibiotic)? Are there any medications or foods I should avoid while taking it?
• When should I be retested after H. pylori eradication treatment, and what test will be used?
• If I need to continue taking NSAIDs, what preventive measures do you recommend?
• What additional tests are needed to rule out the possibility of cancer based on the endoscopy findings?
• What are the symptoms of complications such as bleeding, perforation, or obstruction, and how should I respond?

Disease-Specific Sample Questions

• Regarding abdominal symptoms (assessing urgency): “I have recently had melena (or hematemesis). Do I need emergency testing now? What symptoms mean that I should go to the emergency room immediately?”
• Regarding eradication treatment and follow-up: “I received H. pylori eradication treatment. When and with what test will eradication be confirmed? What lifestyle habits should I обязательно change to reduce reinfection and recurrence?”