The stomach plays crucial roles in digestion and acid production, making it susceptible to various disorders that can significantly impact digestive health and overall wellbeing.

• Peptic Ulcer Disease and Gastritis

Understanding Peptic Ulcers

Peptic ulcer disease involves the formation of open sores in the lining of the stomach (gastric ulcers) or duodenum (duodenal ulcers). These ulcers develop when the protective mucous layer is compromised, allowing stomach acid to damage the underlying tissue.

Causes

The primary causes include Helicobacter pylori infection, which accounts for approximately 60% of gastric ulcers and 90% of duodenal ulcers, and prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs). Less common causes include Zollinger-Ellison syndrome, Crohn’s disease, and severe physiological stress.

Symptoms

Classic symptoms include burning or gnawing epigastric pain, often related to meal timing. Gastric ulcer pain may worsen with eating, while duodenal ulcer pain typically improves with food intake. Additional symptoms may include nausea, vomiting, loss of appetite, and weight loss. Complications can cause severe pain, vomiting blood, or black, tarry stools.

Diagnosis

Gastroscopy provides definitive diagnosis and allows assessment of ulcer characteristics, ruling out malignancy, and testing for H. pylori infection. Non-invasive H. pylori testing includes urea breath tests, stool antigen tests, and serology. Imaging studies may be used when endoscopy is contraindicated.

Treatment

Treatment addresses underlying causes through H. pylori eradication when present and discontinuation of NSAIDs where possible. Acid suppression with proton pump inhibitors promotes healing and symptom relief. Complicated ulcers may require extended treatment or surgical intervention.

• Functional Dyspepsia

Disease Characteristics

Functional dyspepsia encompasses persistent or recurrent symptoms of epigastric pain, burning, postprandial fullness, and early satiety in the absence of structural abnormalities that could explain the symptoms.

Symptoms

Patients typically experience upper abdominal discomfort, bloating, nausea, and altered appetite. Symptoms may be triggered or worsened by specific foods, stress, or meal patterns. The chronic nature of symptoms significantly impacts quality of life and daily activities.

Diagnosis

Diagnosis requires careful symptom assessment and exclusion of organic causes through appropriate investigation, often including gastroscopy. Rome IV criteria provide standardised diagnostic guidelines based on symptom patterns and duration.

Treatment

Management involves acid suppression therapy, prokinetic agents to improve gastric emptying, and dietary modifications. Some patients benefit from low-dose tricyclic antidepressants or psychological interventions addressing the gut-brain axis.