Chronic Gastric Ulcers and Esophageal Reflux: Key Insights

The user continues to ask?

Dear Dr.
Yang,
Thank you very much for your prompt response to my questions.
My father recently underwent another gastroscopy, and it was found that he still has multiple ulcers in his stomach.
The doctor prescribed medication, and after a week of treatment, his stomach no longer feels the sensation of heaviness and seems to be improving.
However, the diagnosis has returned as "chronic gastric ulcer," and currently, there is severe esophagitis, which may be the primary cause of the ulcers.
My father does not consume the spicy foods or alcohol mentioned by the doctor; the only possible reasons could be his preference for very hot (scalding) food and stress (emotional distress).
However, the doctor indicated that these factors should not cause esophagitis and reflux, so a nasal tube examination has been scheduled for the next visit.
I would like to ask you two questions:
1.
What is "chronic gastric ulcer"? Does it, as you mentioned, classify into benign and malignant types? The doctor performed a tissue biopsy but did not specify whether it is benign or malignant.
2.
Currently, the esophagitis is very severe, and there is a reflux phenomenon, which causes the sensation of acid regurgitation and a burning sensation in the chest.
I do not understand what "esophageal reflux" means, and what are the causes of esophageal reflux? Is esophageal reflux a major cause of gastric ulcers?
Sincerely,
Susan
20020808

Susan, 20~29 year old female. Ask Date: 2002/08/09

Dr. Yang Peizhen reply Gastroenterology and Hepatology

(1) Most gastric ulcers are chronic, and the causes of acute gastric ulcers include medications (especially nonsteroidal anti-inflammatory drugs), infections (bacterial or viral), certain foods (such as acidic or spicy foods), head trauma or stroke, and stress.
Gastric ulcers can be classified as benign or malignant, and particular caution is warranted with solitary gastric ulcers, as some early-stage gastric cancers may present similarly to gastric ulcers.
Therefore, a biopsy is necessary for diagnosis; even if the biopsy results are benign, there is still cause for concern, as cancer cells may be localized or hidden at the base, which could be missed during the biopsy.
A complete course of medication lasting eight to twelve weeks should be followed by a repeat endoscopy, and if healing is confirmed, the possibility of gastric cancer can be ruled out.

(2) Gastroesophageal reflux disease (GERD) primarily results from abnormal relaxation of the lower esophageal sphincter, leading to the backflow of gastric acid that causes esophageal irritation.
Thus, the underlying issue is often related to poor gastric function and excessive gastric acid production.
Treatment mainly involves potent acid-reducing medications, and dietary control is also crucial.
Avoiding irritants such as spicy foods, coffee, tea, cheese, cake, and ketchup is important.
Elevating the head while sleeping can help, as some individuals may have a predisposition to excessive gastric acid production, causing symptoms to reappear immediately upon discontinuation of medication, making it difficult to achieve the desired "cure." Therefore, dietary and lifestyle modifications may be more important than medication alone.
However, it is essential to note that long-term severe GERD can increase the risk of esophageal cancer, making regular endoscopic surveillance necessary for patients with GERD.

Reply Date: 2002/08/09

More Info

Chronic gastric ulcers and esophageal reflux disease (GERD) are common gastrointestinal conditions that can significantly impact a person's quality of life. Understanding these conditions, their causes, and management strategies is crucial for effective treatment.

What is Chronic Gastric Ulcer?
A chronic gastric ulcer is a sore that develops on the lining of the stomach. It is characterized by a persistent inflammation that can lead to erosion of the stomach lining. Chronic ulcers can be caused by several factors, including:
1. Helicobacter pylori Infection: This bacterium is a common cause of gastric ulcers. It can damage the stomach's protective lining, making it more susceptible to acid.

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Long-term use of NSAIDs can irritate the stomach lining and lead to ulcer formation.

3. Excessive Alcohol Consumption: Alcohol can erode the stomach lining and increase acid production.

4. Smoking: Tobacco use can impair the healing of existing ulcers and increase the risk of developing new ones.

5. Stress: While stress alone does not cause ulcers, it can exacerbate symptoms and delay healing.

Chronic gastric ulcers can be classified as benign or malignant. Benign ulcers are non-cancerous and can often be treated effectively with medication and lifestyle changes. Malignant ulcers, on the other hand, may indicate stomach cancer. A biopsy is typically performed during endoscopy to determine the nature of the ulcer. If your father's biopsy results did not indicate malignancy, it is likely that the ulcers are benign.

What is Esophageal Reflux?
Esophageal reflux, or gastroesophageal reflux disease (GERD), occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and chest pain. The primary causes of GERD include:
1. Lower Esophageal Sphincter (LES) Dysfunction: The LES is a muscle that acts as a valve between the esophagus and stomach. If it weakens or relaxes inappropriately, acid can escape into the esophagus.

2. Hiatal Hernia: This condition occurs when part of the stomach pushes through the diaphragm into the chest cavity, which can contribute to reflux.

3. Obesity: Excess weight can put pressure on the stomach, pushing acid into the esophagus.

4. Dietary Factors: Certain foods and beverages, such as spicy foods, caffeine, and alcohol, can trigger reflux symptoms.

5. Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can lead to GERD.

Relationship Between GERD and Gastric Ulcers
While GERD and gastric ulcers are distinct conditions, they can be interrelated. Chronic acid exposure from reflux can lead to inflammation of the esophagus (esophagitis) and may contribute to the development of ulcers in the stomach. Conversely, the presence of gastric ulcers can exacerbate GERD symptoms due to increased acid production and irritation.

Management Strategies
1. Medications: Proton pump inhibitors (PPIs) such as omeprazole or esomeprazole are commonly prescribed to reduce stomach acid production and promote healing of ulcers. Antacids and H2-receptor antagonists may also be used for symptom relief.

2. Lifestyle Modifications: Encouraging your father to avoid hot, spicy foods, alcohol, and smoking can help manage symptoms. Eating smaller, more frequent meals and avoiding lying down immediately after eating can also be beneficial.

3. Stress Management: Since stress can exacerbate both conditions, incorporating stress-reducing techniques such as mindfulness, yoga, or counseling may be helpful.

4. Regular Follow-Up: Continuous monitoring through endoscopy may be necessary to assess the healing of ulcers and the status of GERD.

Conclusion
Chronic gastric ulcers and esophageal reflux are manageable conditions with appropriate medical intervention and lifestyle adjustments. It is essential to follow up with healthcare providers for regular assessments and to discuss any concerns regarding symptoms or treatment efficacy. If your father experiences persistent or worsening symptoms, further evaluation may be warranted to ensure optimal management.

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