A peptic ulcer is a sore that develops at the upper portion of your small intestine (known as the duodenum) or inside of your stomach lining. There are two types of peptic ulcers: (1) Gastric ulcer and (2) Duodenal ulcer. Let’s dig out the difference between gastric ulcer and duodenal ulcer.

Gastric ulcer vs Duodenal ulcer

Definition:

Gastric ulcer:

Gastric ulcer is a type of peptic ulcer that is defined as an open sore present on the lining of the stomach. A gastric ulcer is also known as a stomach ulcer.

Duodenal ulcer:

Duodenal ulcer is a type of peptic ulcer that is defined as an open sore that develops at the upper portion of your small intestine (duodenum).

Risk factors:

Risk factors are those factors that increase the risk of certain diseases:

Gastric ulcer:

The following are the risk factors of gastric ulcer:

  • Infection with bacteria are known as Helicobacter pylori (H. pylori) bacteria (common cause)
  • Non steroidal anti inflammatory drugs (NSAIDs) which are taken in heavy doses or for long duration (such as ibuprofen or aspirin)
  • Spicy and pickled food
  • Stress
  • Sex (incidence is same in both males and females)
  • Class (common in lower socioeconomic class)
  • Age (more common in middle age)
  • Common in developing countries

Duodenal ulcer:

The following are the risk factors of duodenal ulcer:

  • Infection with bacteria are known as Helicobacter pylori (H. pylori) bacteria (common cause)
  • Non steroidal anti inflammatory drugs (NSAIDs) (such as ibuprofen or aspirin
  • Cigarette smoking
  • Excess alcohol
  • Stress
  • Spicy and pickled food
  • Steroids
  • Sex (more common in males than females)
  • Age (more common in the elderly)
  • Class (common in higher socioeconomic class)
  • Common in western countries.

Causes:

Gastric ulcer:

Gastric ulcer occur when the lining of the stomach is damaged this happens when the barrier is broken down which protects the lining of the stomach from stomach acid.

Duodenal ulcer:

For the digestion of food and the killing of germs or bacteria stomach forms an acid. To protect from this acid stomach and duodenal cells make a layer from mucus. When this layer (or barrier) is damaged an ulcer is formed.

Sign and symptoms or clinical presentation:

Gastric ulcer:

Following are the sign and symptoms of gastric ulcer:

  • Burning pain in the centre of the abdomen
  • Pain aggravates after eating
  • Heart burning
  • Indigestion
  • Nausea
  • Weight loss
  • Epigastric tenderness
  • Anemia.

Duodenal ulcer:

Following are the sign and symptoms of duodenal ulcer:

  • Abdominal pain
  • Pain relieves after eating
  • Indigestion
  • The feeling of abdominal fullness
  • Bloating after eating
  • Nausea
  • Weight gain
  • Anemia
  • Epigastric tenderness.

Investigations or lab tests:

To diagnose and rule out the cause or/ and site or/ and type of the disease your doctor will suggest some lab tests (investigations).

Gastric ulcer:

The following are the investigations to diagnose gastric ulcer:

  • Complete blood count (CBC)
  • Stool culture
  • Antibodies for H. pylori
  • Endoscopy
  • Breath test.

Duodenal ulcer:

The following are the investigations to diagnose duodenal ulcer:

  • Complete blood count (CBC)
  • Flexible gastro duodenoscopy
  • Stool culture
  • Antibodies for H. pylori
  • Breath test
  • Endoscopy/ gastroscopy
  • Barium meal.

Treatment:

Gastric ulcer:

The following are the treatment options for gastric ulcer:

  • Antacids
  • H2 receptors antagonists
  • Proton pump inhibitors (PPIs)
  • Sucralfate
  • Bismuth chelate
  • Misoprostol
  • Antibiotics (metronidazole, tetracycline, amoxycillin, clarithromicin)
  • NSAIDs (such as paracetamol)
  • Surgery is indicated when there is a failure of medical treatment (Open surgical procedure or Laparoscopic assisted procedure)
  • Partial gastrectomy
  • Subtotal gastrectomy
  • Vagotomy (vagal denervation) (truncal, selective, highly selective)
  • Drainage procedures (pyloro plasty, gastro jejunostomy)
  • Life style changes (stop taking NSAIDs  such as aspirin or ibuprofen, avoid eating spicy food, reduce intake of hot drinks, quit cigarette smoking, avoid drinking alcohol).

Duodenal ulcer:

Following are the treatment options for duodenal ulcer:

  • Triple therapy
  • Antacids
  • H2 receptors antagonists
  • Proton pump inhibitors (PPIs)
  • Sucralfate
  • Misoprostol
  • Surgery is indicated when there is a failure of medical treatment (Open surgical procedure or Laparoscopic assisted procedure)
  • Partial gastrectomy
  • Subtotal gastrectomy
  • Vagotomy (vagal denervation) (truncal, selective, highly selective)
  • Drainage procedures (pyloro plasty, gastro jejunostomy)
  • Life style changes (losing weight if overweight, cessation of cigarette smoking, avoid drinking alcohol, avoid eating fatty food, spicy food, and acidic food, reduce intake of hot drinks).

Complications:

Gastric ulcer:

The following are the complications of gastric ulcer:

  • Hemorrhage (bleeding)
  • Perforation
  • Gastric obstruction (pyloric stenosis)
  • Penetration into neighbouring structures malignancy (gastric cancer).

Duodenal ulcer:

The following are the complications of duodenal ulcer:

  • Hemorrhage (bleeding)
  • Perforation
  • Gastric obstruction (pyloric stenosis)
  • Teapot deformity
  • Gastric cancer.

Conclusion:

A person can have both gastric ulcer and duodenal ulcer at the same time. Peptic ulcers are not curable there is always a chance of recurrence of ulcers, although you can treat the symptoms and take precautionary measures.

By- Dr. Pashmina