Therapy of gastric ulcer

Initiation of gastric ulcer therapy

The therapy of gastric ulcer is very important as it is life-threatening Gastric bleeding, Scarring, but also with chronic inflammation an increased risk of stomach cancer - there is a risk.

Therapy improvement through cooperation

Also important is the active cooperation (compliance) of the patient himself, who can significantly influence the success of the therapy by taking the medication independently.

Therapy of gastric ulcer

The therapeutic options of one Stomach ulcer Respectively:

  1. general measures
  2. medical therapy
  3. endoscopic measures (mirroring / endoscopy)
  4. surgical measures

1. General measures

First of all, the patient should change their lifestyle by temporarily turning on alcohol, Smoke (Stomach irritants) and renounce harmful medication.
A special one diet is for a Gastric ulcer not indicated and according to many studies not relevant for gastric ulcer healing either. However, it is still recommended to avoid very fatty, spicy and fried food.

2. Drug therapy

The therapy for gastric ulcers aims at the eradication of Helicobacter pylori.
  1. Acidity lowering
    Nowadays, gastric ulcers are treated with medication with proton pump inhibitors (e.g. omeprazole, pantoprazole / Pantozol® etc.).
    Treatment takes about a week. As the name suggests, the "proton pump" in the acid-forming stomach cells (parietal cells) is inhibited and the gastric acid formation is actively reduced. For a stomach ulcer caused by NSAIDs, proton pump inhibitors are given for 4-8 weeks, as the healing rate is worse with these.
    Other drugs such as H2 blockers and acid binders (antacids), such as those used in reflux disease (chronic heartburn), are not indicated (indicated).
    The drug sucralfate can be given in addition to proton pump inhibitor therapy. This drug covers the gastric mucosa like a protective film and thus also over the ulcer / stomach ulcer.
  2. Eradication therapy
    This is understood to mean a drug combination therapy consisting of a proton pump inhibitor (e.g. omeprazole 2x20 mg / d) and two different antibiotics (clarithromycin 2x 250 - 500 mg / d in combination with amoxicillin 2x 1g / d or metronidazole 2x400 mg / d) for 7-10 Days. The Helicobacter pylori bacterium is killed and the ulcer / stomach ulcer healed at the same time. The success of the therapy is checked 8 weeks later by a stomach mirror or a breath test (see above). The therapeutic success rate is 85%.

3. Endoscopic therapy for a gastric ulcer

The less invasive endoscopic therapy (gastrointestinal mirroring), which is used for complications of gastrointestinal ulcers, is less stressful for the patient than open abdominal surgery.
At a bleeding ulcer you can, for example, use a small cannula that is pushed through the endoscope to treat the ulcer with medication such as adrenaline inject. The adrenaline constricts the vessels in the vicinity of the ulcer and thus stops the bleeding. Are also used Fibrin glue or certain resins used to glue and compress bleeding vessels.

When complicating a Gastric outlet obstruction a probe (thin tubular instrument) is advanced through the endoscope (movable tube camera) up to the constriction. At the end of this tube there is a balloon, which is then slowly filled with air or water and carefully stretches the gastric mucosa. With this method, you can gently expand the constriction in several sessions and thus avoid open surgery. In this procedure the Gastric ulcer therapy However, there is always the risk of a tear in the gastric mucosa, which then leads directly to open surgery.

Further information on this topic can be found at: Endoscopy

4. Surgical therapy

The significance of the surgical treatment of ulcers / gastric ulcer is nowadays very low, as drug therapy has become very efficient in the last few decades.
Only if the stomach or intestine breakthrough (Ulcer perforation) Because of the ulcer, there is an absolute necessity for suturing the ulcer.
In most cases, a bleeding ulcer can be easily controlled endoscopically. Endoscopically insatiable ulcer bleeding is rarely followed by open surgery. Also the Narrowing of the stomach outlet (hourglass stomach) can be overtly surgically removed if endoscopic therapy has failed.

Surgical techniques for various ulcer locations

Duodenal ulcer (duodenal ulcer)
Here is the selective proximal vagotomy the means of choice. During this surgical procedure, part of the fibers of the parasympathetic vagus nerve (Vagus nerve), which supply the stomach nervously and thus also control gastric acid production. This is how the upper (proximal) sections of the stomach become (Fundus and body of the stomach; see also stomach), which are particularly rich in gastric acid-producing parietal cells, cut off from the nerve stimulus of the vagus nerve (Denervation). This method makes the Acid production reduced by approx. 50%.

Please also read our topic: Duodenal ulcer

Ulcus ventriculi (stomach ulcer)
In the case of treatment-refractory gastric ulcer, there is an indication for 2/3 stomach removal (resection) according to Billroth I or Billroth II, mostly in combination with a vagotomy is carried out.
With these surgical techniques, parts of the stomach are removed, depending on the ulcer location, and the remaining stomach is sutured back to the intestine in various ways (anastomosis). It is important to remove parts of the antrum and body because this is where the parietal cells and, in some cases, the G cells, which are crucial for acid production, are located.
The vagotomy is very important in such cases, because, despite the operation, recurrent ulcers (recurring ulcers) can occur in the further course of the intestine and the vagotomy (see above) lowers gastric acid production somewhat.

Gastrointestinal breakthrough
The gastric or intestinal perforation is the only absolutely necessary indication for surgery in the case of ulcer disease and the most serious complication besides an injecting ulcer bleeding. The ulcer is sewn over in an open operation. The operation can occasionally also have a Laparoscopy (Laparoscopy).This means that various surgical tools and a camera are inserted through narrow incisions in the abdominal wall. In this way, the sore defect can also be sewn.