i. Peptic ulcer disease and gastritis
Peptic ulcer disease (PUD) and gastritis (inflammation of the stomach) have very similar causes and so are usually discussed together. PUD can occur in the stomach or the duodenum. Both PUD and gastritis can cause similar symptoms – pain in the upper abdomen being the most important.
The two most common causes of PUD and gastritis are:
- Non-steroidal anti-inflammatory drugs (NSAIDs) – e.g. Aspirin, ibuprofen, diclofenac, Grandpa tablets.
- Helicobacter pylori – A bacteria that colonizes the stomach, causing disturbances in the normal gastric physiology.
The best way to diagnose these conditions is to perform a gastroscopy. This allows direct visualization of the stomach and duodenum, as well as collection of biopsy samples for examination. These samples can help to establish a cause for the ulcer and also determine if it is cancerous. H. pylori can be tested for using a special kit in the endoscopy room, without needing to send specimens away for histological examination.
The treatment of PUD and gastritis involves:
If a cause is found: Removal of the cause e.g.:
- Eradication of H. pylori using antibiotics
- Discontinuation of NSAIDs
Therapy with anti-acid therapy. The duration depends on the cause and the severity of disease.
Gastric ulcers do carry a small risk of being cancerous and so should always be biopsied. Duodenal ulcers have a very low chance of being malignant, so are seldom biopsied unless they look atypical or are not healing. Gastric ulcers should always have a follow-up gastroscopy, usually around 8 weeks after commencing treatment, to confirm that they have healed.
ii. Functional dyspepsia
Certain individuals may experience pain or discomfort (“dyspepsia”) in the upper part of the abdomen without a doctor being able to find a cause after reasonable investigation. Such individuals are diagnosed with functional dyspepsia.
A set of criteria for functional disorders was created and is called the Rome IV criteria. According to the Rome IV criteria, the diagnosis of functional dyspepsia has the following requirements:
1. Must have at least one of the following:
- Bothersome epigastric pain
- Bothersome epigastric burning
- Bothersome early satiety
- Bothersome postprandial fullness
2. No evidence of structural disease that is likely to explain the symptoms
3. Symptom onset at least six months before the diagnosis and fulfilling the above criteria for at least the last 3 months Functional dyspepsia, like most functional disorders, usually does not respond well to treatment. Therapy is recommended as follows:
- Test for and eradicate H. pylori infection if present
- Trial of PPI therapy (anti-acid drugs)
- Pain modulating therapy e.g. Amitryptaline or pregabalin (Lyrica)