Gastric and duodenal ulcers

A peptic ulcer is a deep erosion of the wall of the stomach or the duodenum caused by acidity.

Ulcers most often remain asymptomatic and are discovered during a gastroscopy usually performed due to symptoms of gastroesophageal reflux disease , abdominal pain, or during ulcer-related complications, such as gastrointestinal bleeding (by erosion of a blood vessel caused by the ulcer) or perforation of the digestive tract.

The risk factors for ulcers are acid hypersecretion, infection with Helicobacter pylori leading to an alteration of the protective barrier of the duodenum  , as well as the consumption of non-steroidal anti-inflammatory drugs (NSAID).

Ulcer diagnosis

Diagnosis is based on gastroscopy, which allows the identification of the ulcer, its sampling with biopsies (to rule out cancer and check for Helicobacter pylori infection) and the treatment of any bleeding. Helicobacter pylori can also be looked for using blood test or expiratory test.

Ulcer treatment

Ulcers are treated by antacid medication  combined with eradication of Helicobacter pylori with antibiotics (if the bacterium is present). A follow-up gastroscopy is usually not necessary for duodenal ulcers, but should be performed after six weeks for gastric ulcers to rule out cancer and examine healing of the lesion.

In case of upper gastrointestinal bleeding, the bleeding is controlled and diagnosed by gastroscopy in the majority of cases. Very rarely, emergency surgery is necessary. 

Emergency surgery for ulcer perforation

In case of ulcer perforation, emergency surgery is necessary as the contamination of the abdominal cavity with digestive fluid leads to peritonitis and septic shock. This intervention is done either by laparoscopy or by laparotomy . Treatment can range from ulcer suturing to partial gastrectomy .