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Gastroduodenal Ulcer Disease – Causes and Treatment

Gastroduodenal ulcer disease refers to the formation of open sores in the lining of the stomach or duodenum. It is most commonly caused by bacterial infection or long-term use of pain-relieving medications.

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Things worth knowing about "Gastroduodenal Ulcer Disease"

Gastroduodenal ulcer disease refers to the formation of open sores in the lining of the stomach or duodenum. It is most commonly caused by bacterial infection or long-term use of pain-relieving medications.

What is Gastroduodenal Ulcer Disease?

Gastroduodenal ulcer disease encompasses both gastric ulcers (occurring in the stomach) and duodenal ulcers (occurring in the first part of the small intestine, the duodenum). These are open sores that develop when the protective lining of the stomach or duodenum is damaged, allowing digestive acid to erode the underlying tissue. The condition is common worldwide and can lead to serious complications if left untreated.

Causes

The two most frequent causes of gastroduodenal ulcer disease are:

Helicobacter pylori infection: This bacterium colonizes the stomach lining, weakens its protective mucous layer, and triggers inflammation that promotes ulcer formation. It is responsible for more than 70% of cases.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen and diclofenac inhibit the production of protective prostaglandins, reducing the stomach lining ability to defend itself against acid.
Excess stomach acid: When the balance between acid production and mucosal protection is disrupted, ulcers can form.
Additional risk factors: Smoking, excessive alcohol consumption, psychological stress, and rare conditions such as Zollinger-Ellison syndrome can also contribute to ulcer development.

Symptoms

Common symptoms of gastroduodenal ulcer disease include:

Burning or gnawing upper abdominal pain, often occurring on an empty stomach or at night
Nausea and occasional vomiting
Heartburn and acid reflux
Loss of appetite and unintended weight loss
In gastric ulcers: pain that tends to worsen after eating
In duodenal ulcers: pain that often improves temporarily after eating

Serious complications such as gastrointestinal bleeding (evidenced by black, tarry stools or vomiting blood) or perforation (a hole through the stomach wall) are medical emergencies requiring immediate treatment.

Diagnosis

Several diagnostic methods are used to confirm gastroduodenal ulcer disease:

Upper endoscopy (esophagogastroduodenoscopy, EGD): The gold standard for directly visualizing ulcers and obtaining tissue biopsies for analysis.
Helicobacter pylori testing: Options include the urea breath test, stool antigen test, or biopsy during endoscopy.
Blood tests: To detect anemia in cases of suspected bleeding.
Imaging: Contrast X-ray (barium swallow) may be used in selected cases.

Treatment

Medication-Based Therapy

Treatment is tailored to the underlying cause:

Helicobacter pylori eradication: When infection is confirmed, a combination of two antibiotics and a proton pump inhibitor (PPI) is prescribed (known as triple therapy). This approach is highly effective and significantly reduces the risk of recurrence.
Proton pump inhibitors (PPIs): Medications such as omeprazole or pantoprazole reduce stomach acid production and support mucosal healing.
H2-receptor antagonists: An alternative or supplementary option for acid suppression.
Discontinuation of NSAIDs: Where possible, pain-relief medications that irritate the stomach should be replaced with safer alternatives.

Lifestyle Modifications

Supportive lifestyle changes include:

Quitting smoking and reducing alcohol intake
Managing stress through relaxation techniques
Dietary adjustments, such as avoiding highly spiced or acidic foods

Surgical Treatment

Surgery is rarely required today and is reserved for complications such as perforation, uncontrollable bleeding, or gastric outlet obstruction.

Prognosis

With appropriate treatment, most ulcers heal completely. Successful eradication of Helicobacter pylori greatly reduces the likelihood of recurrence. Follow-up endoscopy is recommended for gastric ulcers to rule out malignant changes in the stomach lining.

References

Malfertheiner P. et al. - Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut, 2022. DOI: 10.1136/gutjnl-2022-327745
Laine L. - Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology, 2001; 120(3): 594-606.
Fashner J., Gitu A.C. - Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American Family Physician, 2015; 91(4): 236-242.

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