Stomach and Duodenal Ulcers: Diagnosis, Treatment, and Age Factors

Diagnosis, general treatment process, and common age of occurrence for "gastric ulcers" or "duodenal ulcers" (forwarded from the Minister's mailbox)?

1.
Is there a general diagnosis and treatment process for "gastric ulcers" or "duodenal ulcers"?
2.
What age group is most commonly affected by "gastric ulcers" or "duodenal ulcers"?
3.
Is it common to perform a subtotal gastrectomy for the treatment of "gastric ulcers" or "duodenal ulcers," and what is the necessity of such surgery?
4.
Is it reasonable for the timing of endoscopy to overlap with the timing of surgery?

Mr. Shen, 30~39 year old female. Ask Date: 2014/02/27

Dr. Chen Shidian reply Gastroenterology and Hepatology

Dear Mr.
Shen,
1.
A preliminary diagnosis will be made based on your medical history and physical examination, and if necessary, a gastroscopy will be performed for confirmation.

2.
This condition typically occurs in adults.

3.
It is often treated with medication, and surgery is only required in the case of complications.

4.
If you do not fully understand the issue, please let us know for further clarification.

Changhua Hospital cares about your health.

Sincerely,
Chen Shidian

Reply Date: 2014/02/27

More Info

Understanding stomach and duodenal ulcers involves a comprehensive approach that includes diagnosis, treatment, and considerations regarding age factors. Here’s a detailed overview addressing your questions:
1. Diagnosis and Treatment Process for Stomach and Duodenal Ulcers:
The diagnosis of stomach (gastric) and duodenal ulcers typically begins with a thorough medical history and physical examination. Symptoms such as abdominal pain, bloating, and changes in appetite may prompt further investigation. The most definitive diagnostic tool is an upper gastrointestinal endoscopy (EGD), which allows direct visualization of the stomach and duodenum. During this procedure, biopsies can be taken to rule out malignancy and to check for the presence of Helicobacter pylori, a common bacterial cause of ulcers.

Treatment usually involves a combination of medications aimed at reducing stomach acid and promoting healing. Proton pump inhibitors (PPIs) such as omeprazole or lansoprazole are commonly prescribed to decrease acid production. If H. pylori is detected, a regimen of antibiotics (such as amoxicillin and clarithromycin) along with PPIs is initiated to eradicate the infection. Lifestyle modifications, including dietary changes, avoiding NSAIDs, and reducing alcohol and tobacco use, are also recommended.

2. Age Factors in Stomach and Duodenal Ulcers:
While ulcers can occur at any age, they are more prevalent in adults, particularly those over 50 years old. The risk factors for developing ulcers include chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, excessive alcohol consumption, and stress. Additionally, the incidence of duodenal ulcers is higher in younger adults compared to gastric ulcers, which are more common in older adults.
3. Surgical Intervention for Ulcers:
Surgical treatment for gastric or duodenal ulcers is relatively uncommon and is usually reserved for specific cases, such as when there are complications like perforation, bleeding, or obstruction. Procedures such as vagotomy (cutting the vagus nerve to reduce acid secretion) or partial gastrectomy (removal of part of the stomach) may be performed in severe cases. The necessity of surgery is evaluated based on the patient's overall health, the severity of the ulcers, and their response to medical therapy. Most patients can manage their condition effectively with medication and lifestyle changes.

4. Overlap of Endoscopy and Surgery:
It is generally not common for endoscopy and surgical procedures to overlap in timing. An endoscopy is primarily a diagnostic tool, while surgery is a therapeutic intervention. If an endoscopy reveals significant findings that necessitate immediate surgical intervention (such as a perforated ulcer), then the timing may coincide. However, in most cases, the endoscopy is performed first to assess the condition, and if surgery is required, it is scheduled afterward to allow for proper preparation and planning.

In conclusion, understanding the diagnosis and treatment of stomach and duodenal ulcers involves recognizing the importance of early detection and appropriate management. Regular follow-ups with a gastroenterologist are essential for monitoring the condition and adjusting treatment as necessary. Lifestyle modifications play a crucial role in prevention and management, and patients should be educated about the signs and symptoms that warrant immediate medical attention.

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