Stomach Ulcers: Symptoms, Diagnosis, and When to Get an Endoscopy

About gastric ulcers?

Hello Dr.
Yang, in June of this year, I experienced hunger-type abdominal pain, and at the beginning of July, I had tarry stools.
I was diagnosed with gastric and duodenal ulcers and was hospitalized for treatment.
Since then, I have been on medication, but I have not undergone a second endoscopy to confirm the treatment results.
However, for the past three weeks, I have frequently felt excessive stomach acid, usually after eating late at night around 10 PM.
Recently, I noticed that there is tenderness when I press on the left central part of my upper abdomen, with an area approximately 5 centimeters in diameter.
Should I be concerned about other gastric lesions? Is it necessary to undergo an endoscopy? Thank you.

Mr. C, 10~19 year old female. Ask Date: 2002/09/24

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! In general, over 90% of peptic ulcers heal after three months of treatment with ulcer medications.
Therefore, if you are still experiencing symptoms such as excessive gastric acid and left upper abdominal tenderness, it is important to consider whether there are still issues with the stomach or duodenum.
A follow-up gastroscopy would be the ideal approach.
If the stomach is found to be normal, further examinations should be conducted to rule out diseases of other organs (for example, an abdominal ultrasound to assess the liver, gallbladder, spleen, pancreas, and kidneys, which are simple and convenient tests).
Wishing you and your family peace and happiness.
Sincerely, Dr.
Yang Pei-Chen, Gastroenterology, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/09/24

More Info

Hello! Thank you for your question regarding stomach ulcers and your current symptoms. Based on your description, it seems you have a history of gastric and duodenal ulcers, which can lead to various complications if not monitored and treated properly.

Understanding Stomach Ulcers
Stomach ulcers, also known as peptic ulcers, are open sores that develop on the lining of the stomach or the upper part of the small intestine (duodenum). They can cause a variety of symptoms, including:
1. Abdominal Pain: Often described as a burning sensation, this pain can occur when the stomach is empty and may be temporarily relieved by eating or taking antacids.

2. Nausea and Vomiting: Some individuals may experience nausea, and in severe cases, vomiting may occur.

3. Changes in Appetite: Some people may feel less hungry or may avoid food due to pain.

4. Bloating and Belching: These symptoms can accompany the discomfort.

5. Dark or Tarry Stools: This can indicate bleeding in the stomach, which is a serious symptom that requires immediate medical attention.

Diagnosis and Monitoring
Diagnosis of stomach ulcers typically involves a combination of medical history, physical examination, and diagnostic tests. An endoscopy is often performed to visualize the ulcer and take biopsies if necessary. Given your history of peptic ulcers and the recent symptoms of increased gastric acid and localized abdominal pain, it is crucial to consider the following:
1. Persistent Symptoms: The return of symptoms such as increased gastric acid sensation and localized pain could indicate that the ulcer has not healed properly or that there may be new ulceration or complications such as gastritis or even malignancy.

2. Potential Complications: Complications of ulcers can include bleeding, perforation, and obstruction. The presence of tarry stools is particularly concerning as it suggests possible bleeding from the ulcer.

When to Get an Endoscopy
Given your symptoms, it is advisable to discuss the following with your healthcare provider:
- Repeat Endoscopy: Given your history of ulcers and the new symptoms, a repeat endoscopy may be warranted to assess the current state of your stomach lining and to rule out any complications.

- Medication Review: Ensure that your current medication regimen is appropriate for managing your symptoms. Medications such as proton pump inhibitors (PPIs) or H2 blockers can help reduce stomach acid and promote healing.

- Lifestyle Modifications: Consider dietary changes, such as avoiding spicy foods, caffeine, and alcohol, which can exacerbate symptoms. Eating smaller, more frequent meals may also help.

Conclusion
In summary, your symptoms warrant further evaluation, and a repeat endoscopy could provide valuable information regarding the status of your ulcers and any potential complications. It is essential to communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you in managing your condition effectively. Remember, early intervention can prevent more serious complications, so don’t hesitate to seek further medical advice. Thank you for your inquiry, and I wish you a speedy recovery!

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