Gastric ulcers are open wounds that develop in the stomach lining due to damage caused by gastric acid and other factors. Although most cases are successfully treated with medication, a small percentage of patients may require surgical treatment due to complications or lack of response to conventional medical therapies. Below, we will explore the treatment options available, ranging from conservative to surgical.
What Are Gastric Ulcers?
Gastric ulcers are a type of acid-peptic disease affecting the stomach. These lesions may be associated with:
- Helicobacter pylori infection:
This bacterium is one of the main causes of gastric ulcers, as it weakens the stomach lining. - Prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs):
Medicines such as ibuprofen or aspirin can irritate the gastric mucosa and cause ulcers. - Excess Gastric Acid:
Conditions such as Zollinger-Ellison syndrome increase acid production in the stomach. - Risk Factors:
Chronic stress, excessive alcohol consumption, smoking and poor diet.
Symptoms of Gastric Ulcers
- Pain or burning in the upper abdomen.
- Nausea or vomiting (sometimes with blood).
- Unexplained weight loss.
- Feeling of early satiety or bloating.
- Dark or tarry stools due to bleeding.
- When these symptoms do not improve with medical treatment or complications develop, a surgical approach may be necessary.
Medical Treatments
Initial treatment for gastric ulcers focuses on addressing the underlying causes and promoting healing. The main options include:
- Eradication of Helicobacter pylori:
A combination treatment of antibiotics (amoxicillin and clarithromycin, among others) together with a proton pump inhibitor (PPI) such as omeprazole. - Proton Pump Inhibitors (PPIs):
They reduce gastric acid production, which allows the stomach lining to heal. - Gastric Protectors:
Medications such as sucralfate or misoprostol, which protect the gastric mucosa from further damage. - Suspension of NSAIDs:
Substitute safer alternatives, such as paracetamol, for anti-inflammatory drugs. - Diet and Lifestyle Changes:
Avoid alcohol, tobacco and irritating foods such as spicy or fatty foods.
When to Consider Surgery
Surgery is recommended only in severe cases or when ulcers do not respond to medical treatment. Situations that may require surgical intervention include:
- Persistent bleeding:
If an ulcer causes severe bleeding that is not controlled by endoscopy, surgery may be necessary. - Drilling:
An ulcer can perforate the stomach wall, causing peritonitis, a medical emergency requiring immediate surgery. - Gastric Tract Obstruction:
Ulcers can cause scarring that narrows the stomach or duodenum, making it difficult for food to pass through. - Lack of Response to Medical Treatment:
Ulcers that persist or worsen despite appropriate medical treatment.
Surgical Treatment Options
- Vagotomy:
The vagus nerve is cut to reduce gastric acid production.
It can be performed selectively (only affects the stomach) or truncally (hits the stomach and other organs). - Antrectomy:
The lower part of the stomach (antrum), where most of the acid-stimulating hormone (gastrin) is produced, is removed. - Pyloroplasty:
The opening between the stomach and the small intestine (pylorus) is widened to facilitate the passage of food and reduce the risk of obstruction. - Partial or total gastrectomy:
In severe cases, part or all of the affected stomach is removed. - Perforation Repair:
In cases of perforation, the opening of the stomach is closed and the abdominal cavity is cleaned.
Potential Complications of Untreated Ulcers
- Severe bleeding.
- Peritonitis (due to perforation).
- Intestinal obstruction.
- Malignant transformation in rare cases.
Gastric ulcers are a treatable condition, but in some cases surgery may be necessary, especially if complications are life-threatening or do not respond to medical treatment. If you experience persistent or severe symptoms, consult a specialist in gastroenterology or digestive surgery for proper diagnosis and treatment. A comprehensive approach can prevent serious complications and significantly improve quality of life.