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A gastric ulcer is a disintegration of the stomach lining which interferes with the production of the mucous that coats the lining allowing stomach acid to come in contact with the stomach. This causes pain to the patient after eating, which encourages the production of stomach acid. Given time, the acid can eat right through the lining, exposing the capillaries beneath, leading to a bleeding gastric ulcer, which increases the pain. If left unattended, the ulcer can become perforated, leading to peritonitis and sepsis, either of which is life threatening.
Until the 1990s, it was believed that the ulcer was caused by stress or a poor diet which interfered with mucous production in the stomach, leaving the lining unprotected from stomach acid. However, in Nobel Prize winning work, an Australian scientist discovered gastric ulcers were always associated with an acid loving bacteria, Heliobacter pylori. In a move worthy of House, he confirmed his theory by ingesting the bacteria and developing the symptoms of the disease. Most bacteria are killed by stomach acid, but Heliobacter can thrive in such conditions. However, as a side effect, it interferes with mucous production leaving the lining susceptible to disintegration from stomach acid.
As eating produces stomach acid, most patients with a gastric ulcer do not feel symptoms when their stomach is empty. When undiagnosed, this can lead to an avoidance of food, which becomes easier as the bacteria also affects appetite. The patient starts to lose weight despite never feeling hungry.
Gastric ulcers are difficult to diagnose. Depending on the location of the ulcer, the symptoms can be confused for other common digestive system ailments from acid reflux to gallstones. There are only three ways to confirm an ulcer exists:
- Treat the patient and hope the symptoms improve. However, this is not recommended for patients who are sensitive to powerful antibiotics, and treatment takes at least a week.
- Do an endoscopy. However, this is considered an invasive procedure and can usually only be done on an empty stomach.
- Perform a carbon-14 test. This consists of taking a breath sample of the patient and then giving them a capsule of radioactive material and taking a second breath sample after 15 minutes. If the bacteria is present, it will metabolize the carbon which will subsequently turn up in the breath. However, this is not a procedure that can usually be scheduled quickly, and cannot be performed where radiation exposure might be a concern.
Treatment of the disease used to be with tranquilizers (to reduce stress) and a diet of bland food. However, Heliobacter reacts well to antibiotics, and a treatment of antibiotics combined with antacids can usually clear up the symptoms in as little as one week with little risk of recurrence.