peptic ulcer disease

The ulcer of the stomach or duodenum can be manifested by pain in the epigastric pit or be asymptomatic. An upper digestive endoscopy visualizes the damaged mucosa and biopsies are performed in case of gastric ulcer. The bacterium Helicobacter pylori is sought.

Stomach or duodenal ulcer: what symptoms?

A peptic ulcer can cause pain in the epigastrium (upper and middle of theabdomen). Localized in this part of the body, it resembles a cramp or a feeling of painful hunger , and occurs one to three hours after a meal.

This epigastric pain can also occur at night. It is calmed by taking food or medicine against acid secretions.

It often manifests in flare-ups lasting a few weeks, alternating with symptom-free phases.

The regions of the abdomen

Anatomical diagram of the abdomen, composed of the epigastric region, the umbilical region, the pelvic region and the pair of iliac fossae (see detailed description below)

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A stomach or duodenal ulcer can also cause more atypical manifestations, such as simple discomfort under the ribs.

In some forms of the disease, meals and food intake have no influence on pain.

Finally, some ulcers are asymptomatic . Their presence can be revealed by aendoscopyperformed for another reason, for example to monitor gastritis (inflammation of themucosastomach).

Attention, gastric pain is not always synonymous with ulcer.

Not everyone who has a stomach ache has an ulcer. Very often, it is gastroesophageal reflux disease (GERD) that is the cause of their stomach pains. It can also be a simple gastritis (inflammation of the mucous membrane) without ulcer or dyspepsia .

Consultation and examinations in case of gastric or duodenal ulcer

The attending physician asks his patient about his symptoms and looks for predisposing factors (eg  smoking , taking anti-inflammatories ). The doctor palpates theabdomento locate any pain.

If a stomach or duodenal ulcer is suspected, an assessment is then carried out, in collaboration with medical specialists (gastroenterologist, infectiologist, radiologist, etc.). In fact, to confirm the diagnosis, several additional examinations must be carried out. carried out.

Upper digestive endoscopy confirms the diagnosis of stomach or duodenal ulcer

Performed under local or general anesthesia by a gastroenterologist, upper digestive endoscopy allows the inside of the stomach and duodenum to be viewed using a small camera.

If an ulcer is present in any of these organs, it appears as a crater with regular, raised, red edges. This crater is dug in themucosaand reaches deep into the muscular layer.

If the ulcer is gastric , the doctor makes several biopsies of its edges, to check that there is no cancerous lesion.

If the ulcer is duodenal , ulcer biopsies are useless  : this type of condition never progresses to cancer.

Endoscopyupper digestive tract

Diagram representing the route of an endoscope inside the upper digestive tract, along the esophagus and into the stomach (see detailed description below)

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Testing for the presence of Helicobacter pylori in the stomach

The doctor checks whether the patient has been infected with the bacterium Helicobacter pylori.

Search for helicobacter pylori during endoscopy

Analysis of gastric biopsies (at least 5  biopsies from various parts of the stomach for thepathological analysisand 2 biopsies for bacteriological examination) allows to search for precancerous lesions in case of stomach ulcer.

It also makes it possible to search for H. pylori infection by bacteriological examination with culture of Helicobacter pylori and evaluation of sensitivity to antibiotics.

Screening for helicobacter pylori outside of endoscopy

Blood serology

If the patient has taken antisecretory drugs (proton pump inhibitors) in the past, which reduce stomach acid, or has recently taken antibiotics which distort the results of biopsy tests, a blood test for specific antibodies ( serology) is very useful in diagnosing Helicobacter Pylori infection.

This technique is not used in case of risk factors for stomach cancer. Serology is not indicated to monitor the eradication of H pylori because the antibodies persist for months after treatment.

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