Gastroscopy: Addressing Concerns for Chronic Ulcer Patients

Gastroscopy

Hello Doctor, I would like to ask you a question.
My mother has a long-term chronic gastric ulcer and has experienced severe pain that required emergency care.
Since it has been a long time since her last examination, the doctor wanted to schedule an endoscopy for her, but she always refuses.
Is the endoscopy very painful? Sometimes I see her in so much pain that she can hardly move, which makes me both frustrated and worried.
Thank you!

Yangguang, 30~39 year old female. Ask Date: 2007/02/16

Dr. Cai Yaozhou reply Gastroenterology and Hepatology

Peptic ulcers, which are not painful during endoscopy, most commonly include gastric ulcers and duodenal ulcers.
It is estimated that about 10% of the general population will experience a peptic ulcer at some point in their lives.

Causes: The etiology of peptic ulcers is quite complex.
Intrinsic factors in patients include constitution (excessive gastric acid secretion), weakened mucosal resistance (aging, diabetes, shock, significant stress), and infection with Helicobacter pylori.
Extrinsic factors include the use of analgesics and alcohol consumption.
Symptoms of peptic ulcers: The most typical symptom is upper abdominal pain that occurs when hungry, which is temporarily relieved by eating.
Some patients may even wake up at night due to pain.
However, atypical symptoms are also common, such as a feeling of bloating or burning in the upper abdomen.
Some individuals may be asymptomatic until complications such as bleeding or perforation occur, at which point a diagnosis is made.
It is particularly important to emphasize that some symptoms of gastric cancer can resemble those of peptic ulcers, making it difficult to diagnose based solely on symptoms; further examination is necessary.
Diagnosis of peptic ulcers: This includes upper gastrointestinal barium studies and endoscopy.
The advantage of the former is that it is less painful, while the disadvantage is that it involves radiation exposure and does not allow for biopsy.
The disadvantage of endoscopy is that it can be more painful, but its advantage is that it allows for biopsy or sampling for Helicobacter pylori testing when necessary.
Treatment: Historically, treatment focused on controlling gastric acid, such as using antacids to neutralize gastric acid or employing H2 receptor antagonists and proton pump inhibitors to suppress gastric acid secretion.
Recent findings have established a close association between Helicobacter pylori infection and the recurrence of peptic ulcers, particularly duodenal ulcers.
Consequently, recent treatment strategies have focused on eradicating Helicobacter pylori.
The key to successful treatment lies in completing the full course of therapy.
Follow-up: As mentioned, peptic ulcers have a high recurrence rate, making regular follow-up essential.
Particularly, gastric ulcers can sometimes be a manifestation of gastric cancer, so regular endoscopic surveillance is indispensable.

Reply Date: 2007/02/16

More Info

Gastroscopy, also known as esophagogastroduodenoscopy (EGD), is a procedure that allows doctors to visually examine the upper digestive tract, including the esophagus, stomach, and duodenum, using a flexible tube with a camera. It is a crucial diagnostic tool for patients with chronic gastric ulcers, as it helps identify the extent of the ulcers, any potential complications, and the presence of other conditions such as gastritis or esophageal issues.

Your concern about your mother's reluctance to undergo a gastroscopy is understandable, especially given her history of chronic ulcers and the pain she experiences. It is important to clarify that while the procedure may cause some discomfort, it is generally well-tolerated and is performed under sedation or local anesthesia to minimize pain. Most patients report that the discomfort is manageable and brief, especially compared to the pain associated with untreated ulcers.

Chronic gastric ulcers can lead to significant complications if left untreated, including bleeding, perforation, and gastric obstruction. The symptoms of a gastric ulcer can vary but often include abdominal pain, bloating, nausea, and in severe cases, vomiting blood or having black, tarry stools. Given that your mother has experienced severe pain to the point of requiring emergency care, it is critical to address her condition proactively.

If your mother is hesitant about the procedure, it may be helpful to have a candid discussion with her about the benefits of gastroscopy. Explain that the procedure can provide valuable information that can lead to more effective treatment options, potentially alleviating her pain and improving her quality of life. Additionally, you can reassure her that the medical team will take every measure to ensure her comfort during the procedure.

In terms of management, if the gastroscopy reveals the presence of ulcers, the typical treatment involves proton pump inhibitors (PPIs) to reduce stomach acid and promote healing. If Helicobacter pylori infection is present, antibiotics may also be prescribed. Lifestyle modifications, such as dietary changes, stress management, and avoiding irritants like NSAIDs and alcohol, are also crucial in managing chronic ulcers.

It is also important to consider the psychological aspect of her condition. Chronic pain and the fear of medical procedures can lead to increased anxiety, which may exacerbate her symptoms. Encouraging her to speak with a healthcare professional about her fears and concerns can help her feel more at ease with the idea of undergoing the procedure.

In summary, while the thought of undergoing a gastroscopy may be daunting for your mother, it is a vital step in managing her chronic gastric ulcer condition. The potential benefits far outweigh the temporary discomfort associated with the procedure. Open communication about her fears, along with reassurance about the care she will receive, can help her make an informed decision. Ultimately, addressing her condition through proper diagnosis and treatment can significantly improve her quality of life and reduce the risk of complications associated with chronic ulcers.

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