A peptic ulcer is a “sore” that develops in the lining of the stomach or duodenum.

What are the symptoms?

The main symptom is epigastric pain. In a stomach ulcer, the pain is released with a meal, while in a duodenal ulcer, the pain subsides with food intake. Less common symptoms are flatulence, anorexia, nausea and vomiting.

Complications that may occur are:

1. Bleeding – it can manifest as hematemesis (vomiting blood) or as black (smelly, pitch-black stool).
2. Perforation.
3. Narrowing in the terminal part of the stomach.

How does the ulcer form?

Ulcers develop when there is an imbalance between the protective mechanisms of the epithelium and aggressive agents, which in the case of an ulcer is acid. So when the mucus that normally protects the cells of the digestive tract suffers some damage, the acid comes into contact with the cells and causes a wound, the ulcer.

The two main reasons are:

1. A bacterium called Helicobacter pylori (H.Pylori).
2. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These drugs (Voltaren, Ponstan, Mesulid, Brufen, etc.) weaken the protective layer of mucus and increase the acid’s ability to damage cells. Other drugs implicated and implicated are bisphosphonates (eg Fosamax) and serotonin reuptake inhibitors (SS-RIs, antidepressants).

How is the ulcer diagnosed?

Taking a good medical history plays a very important role. However, the diagnosis will be based on performing a gastroscopy, during which the mucosa of the stomach and duodenum is examined to find a “wound”, the ulcer. Biopsies can also be taken to detect H. Pylori.

Specifically, in stomach ulcers, a second gastroscopy should be performed after 2 months of treatment, to confirm the healing of the ulcer and to rule out possible malignancy (malignant ulcer) with biopsies.

What is the treatment of ulcer?

The mainstay of treatment is drugs that reduce the secretion of stomach acid. These drugs (Losec, Pariet, Nexium, Laprazol, Controloc) are given for a period of time proportional to the location of the ulcer. If the ulcer has been caused by Helicobacter pylori, additional antibiotics will need to be taken, while one month after the end of the treatment, its eradication will be checked with the breath test. It is also necessary to avoid drugs such as those mentioned above (NSAIDs, SS-RIs).

Finally, stopping smoking and alcohol seems to enhance the effectiveness of the treatment.