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GASTRIC-ULCERS

It is defined as a mucosal erosion of the stomach lining. Peptic Ulcer is a general term used to define a hole or holes in the gut lining of the stomach, duodenum, or esophagus. 
About 2% of population has an active form of ulcers and ten percent have developing ulcers in the United States.

Causes:
It may occur because acidic digestive juices secreted by secretory cells of mucosa injure the protective layer of stomach. The causes for this are:
1.Infection- caused by bacterium H. pylori.
2.Prolonged intake of nonsteriodal anti-inflammatory drugs (NSAIDs) - Prostaglandins are substances which are important in helping the gut linings resist corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach.
3.Cigarette smoking- not only causes ulcer formation, but also increases the risk of ulcer complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer medication treatment failure.  
4.Alcohol intake.
5.Prolonged used of spicy food.
6.Stress- one of the most important causation of development of gastric ulcers.

Symptoms:
1.Abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal.
2.Bloating and abdominal fullness;
3.Waterbrash.
4.Nausea, and copious vomiting;
5.Loss of appetite and weight loss;
6.Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting.
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for ulcer.

Diagnosis:
The diagnosis of an ulcer is made by either a barium upper GI x-ray or an upper endoscopy (EGD-esophagogastroduodenoscopy) The barium upper GI x-ray is easy to perform and involves no risk or discomfort. Barium is a chalky substance administered orally. Barium is visible on x- ray, and outlines the stomach on x-ray film. However, barium x-rays are less accurate and may not detect ulcers up to 20% of the time. 
An upper endoscopy is more accurate, but involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the stomach, esophagus, and duodenum. Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection. Biopsies can also be examined under a microscope to exclude cancer. While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous. Therefore, biopsies are often performed on gastric ulcers to exclude cancer. 

Complication:
1.Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels.
2.Perforation (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. The first sign is often sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis; pain in this situation often radiates to the back.
3.Penetration is when the ulcer continues into adjacent organs such as the liver and pancreas.
4.Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. Patient often presents with severe vomiting.
5.Pyloric stenosis

Treatment:
1.Self care-Patients with gastric ulcers can make several lifestyle changes to prevent their recurrence, including avoiding unnecessary use of aspirin and NSAIDs, giving up smoking, and cutting down on alcohol, tea, coffee, and sodas containing caffeine. Other preventative measures include eating balanced, nutritious meals, learning how to manage stress, getting plenty of rest and exercising as recommended.
2.Homeopathy offers some very good medicines for gastric ulcer disease. But for a homeopath, the symptoms of the disease are much more important than the ulcer itself. This is because to select the right medicine a homeopaths needs to differentiate between the finer presentations of a disease which, vary from person to person. A homeopath not only tries to heal the ulcer, but also tries to remove the general predisposition to acquire it and to find a medicine the homoeopath has to take a complete case history of the patient including his/her past history, family history, medical history and other characteristics features of the patient.

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