Gastritis and gastric ulcers

What is Gastritis?

Gastritis refers to inflammation of the stomach lining, which can lead to a variety of symptoms, ranging from mild discomfort to severe pain. It can be caused by several factors such as infections, medications, excessive alcohol consumption or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Gastritis can be divided into:

• Acute Gastritis – in its early stage, the inflammation is usually temporary and can be treated with medication or lifestyle changes.

• Chronic Gastritis – this condition develops over time, and can lead to more severe damage to the stomach lining.

Certain types of gastritis, such as atrophic gastritis are often related to Helicobacter pylori infection and can develop into stomach cancer.

Meanwhile, gastric ulcers are open sores or lesions that form on the stomach lining, usually because of an imbalance between stomach acids, and the protective mucus layer. These ulcers are typically caused by the same factors that contribute to gastritis, including infection by Helicobacter pylori (H. pylori) bacteria, overuse of certain medications or excessive alcohol consumption. 

Gastric ulcers can cause significant discomfort, especially when they begin to erode deeper into the stomach wall, potentially leading to complications such as bleeding. Chronic ulcers may also develop into cancer.

What causes Gastritis and Gastric Ulcers?

There are several factors that can contribute to the imbalance between stomach acid, and the protective lining of the stomach. Some of these factors are lifestyle-related, while others involve infection or underlying health issues, such as:

• H. pylori – this bacteria is one of the leading causes of both gastritis, and gastric ulcers. H. pylori is a type of bacteria that lives in the stomach, and can damage its protective lining. Once the lining is compromised, stomach acid can irritate the tissues, causing inflammation or even leading to the development of ulcers.

• Diet and Smoking – diets high in spicy, fatty or acidic foods can aggravate existing stomach irritation. Meanwhile, smoking is known to increase stomach acid, delay healing, and reduce the stomach’s ability to protect itself. Both smoking, and an unhealthy diet can worsen or contribute to the development of gastritis and ulcers.

• Excessive alcohol consumption – drinking too much alcohol can directly irritate, and erode the stomach lining. Over time, this can lead to inflammation, weaken the stomach’s protective barrier, and contribute to ulcer formation. In fact, chronic alcohol use is a significant risk factor for both conditions.

• Excessive use of NSAIDs – medications such as ibuprofen, aspiring, and other NSAIDs are widely used for pain relief. However, long-term or high-dose use can weaken the stomach’s defence mechanisms, making the lining more susceptible to acid damage, and increasing the risk of ulcers, and gastritis, especially when taken on an empty stomach.

• Use of corticosteroids - needed to treat certain conditions but can lead to ulcers. These may also be illegally added in health supplements from illicit vendors. 

• Stress and Autoimmune Conditions – while stress alone may not directly cause ulcers, it can worsen symptoms, and contribute to increased acid production. In rare cases, autoimmune gastritis can develop when the immune system mistakenly targets the stomach lining, causing ongoing inflammation, and damage that may lead to ulcers if left untreated.

What are the symptoms of Gastritis and Gastric Ulcers?

While both gastritis, and gastric ulcers can present with similar symptoms, gastric ulcers tend to cause more severe or persistent discomfort.

Common symptoms of Gastritis

• Bloating
• Indigestion
• Loss of appetite
• Nausea
• Upper abdominal pain or discomfort, which is often described as a burning sensation
• Vomiting

Common symptoms of Gastric Ulcers

• Blood in vomit or stool, which is often a sign of bleeding ulcers
• Feeling of fullness or bloating after eating
• Loss of appetite
• Nausea or vomiting
• Sharp or burning pain in the upper abdomen, often occurring between meals or at night
• Unexplained weight loss

Who is at risk of Gastritis and Gastric Ulcers in Singapore?

Both gastritis, and gastric ulcers are common conditions that can affect anyone. However, there are certain factors that make an individual susceptible to developing the conditions, including:

• Age – older adults are more likely to suffer from gastritis or gastric ulcers due to the natural decline in the stomach's protective mechanisms.

• H. pylori infection – this bacterial infection is common, and can increase the likelihood of developing ulcers, and gastritis.

• Chronic use of NSAIDs – individuals who rely on NSAIDs for chronic pain management or inflammatory conditions are at greater risk.

• Use of corticosteroids - often for treatment of certain conditions.

• Excessive alcohol use – drinking in excess over time damages the stomach lining, heightening the risk of both gastritis, and gastric ulcers.

• Smoking – smoking accelerates stomach acid production, which can damage the stomach lining, and increase ulcer risk.

• Stress – high levels of stress, particularly long-term, may contribute to gastritis, and ulcer formation.

What are the complications of Gastritis and Gastric Ulcers?

If gastritis, and gastric ulcers are left untreated, it can lead to serious health issues, such as:

Complications of Gastritis

• Bleeding – persistent inflammation can damage the stomach lining, and cause bleeding. This may result in symptoms such as vomiting blood or passing black, tarry stools. While the blood loss may be slow and unnoticed, it eventually leads to anaemia.

• Chronic Anaemia – ongoing low-grade bleeding from the inflamed stomach lining can lead to iron-deficiency anaemia. As a result, an individual may feel constantly tired, weak or short of breath.

• Atrophic Gastritis – in long-standing cases, the stomach lining may gradually thin out, reducing acid production. This condition, known as atrophic gastritis, can impair digestion, and nutrient absorption, particularly of vitamin B12. Regular surveillance with endoscopy is needed because it can lead to gastric cancer.

• Increased Risk of Stomach Cancer – chronic gastritis, especially when caused by H. pylori infection or autoimmune conditions, may increase the risk of developing gastric cancer over time. In such cases, regular monitoring, and eradication of H. pylori can significantly reduce this risk.

Complications of Gastric Ulcers

• Gastric Outlet Obstruction – chronic ulcers near the outlet of the stomach (pylorus) may lead to swelling or scar tissue formation, narrowing the passage to the small intestine. This can result in bloating, vomiting, and a feeling of fullness even after small meals.

• Increased Risk of Stomach Cancer – similar to gastritis, long-term H. pylori-associated ulcers may increase the risk of developing gastric cancer, especially if not properly treated or monitored.

• Perforation – an ulcer may break through the stomach wall, allowing stomach contents to leak into the abdominal cavity. This causes sudden, intense pain, and is a medical emergency.

• Severe Bleeding – ulcers can erode into blood vessels, causing significant bleeding. This may present as vomiting blood or black stools, and may lead to a life-threatening drop in blood pressure or anaemia.

How are Gastritis and Gastric Ulcers diagnosed?

When gastritis or ulcers are suspected, diagnosis typically involves a comprehensive evaluation that includes a detailed history, physical examination, and specific diagnostic tests. Dr Tan Siong San will perform a careful and detailed assessment to determine the underlying causes, and the most ideal approach to treatment. This may include:

Physical Examination

The initial step in diagnosis includes a thorough physical examination. During this consultation, our doctor will:

• Review your medical history, including the use of medications such as NSAIDs.
• Ask about lifestyle factors, such as alcohol consumption, smoking, and stress levels.
• Discuss your symptoms, including any recent changes in appetite, digestion or bowel habits.
• Gently examine the abdomen to check for tenderness, especially in the upper middle or left area.

Diagnostic Tests

In the event the clinical assessment suggests gastritis or gastric ulcers, further tests may be recommended to confirm the diagnosis, and identify the underlying cause:

• Blood Tests — these may be used to check for anaemia, which may result from chronic bleeding, signs of infection or inflammation. They also help assess your overall health.

• Gastroscopy (Endoscopy) — this is the most definitive test for diagnosing gastritis, and gastric ulcers. A thin, flexible tube with a camera is inserted through the mouth to visualise the stomach lining directly. It allows our doctor to detect inflammation, ulcers, bleeding or any suspicious lesions. Additionally, biopsies may also be taken during the procedure for further analysis.

• Barium Swallow (Upper GI Series) — if an endoscopy is not immediately available, a barium swallow X-ray may be used to visualise the upper digestive tract, and detect ulcers or abnormal shapes in the stomach lining.

• H. pylori Testing — since H. pylori infection is a major cause, tests such as a urea breath test, stool antigen test or biopsy during endoscopy may be conducted to confirm the presence of the bacteria.

• Stool Test — a stool sample may be examined for signs of blood, which could indicate a bleeding ulcer or for the presence of H. pylori antigens.

How are Gastritis and Gastric Ulcers treated?

Treatment is guided by the underlying cause, severity of symptoms, and the patient’s overall health. For most people, non-surgical treatments are highly effective. However, in more severe cases or when complications arise, surgery may be considered.

Non-Surgical Treatment

Non-surgical treatment is often the first line of care for both gastritis, and gastric ulcers. It involves medication, eradication of infections, and meaningful lifestyle changes.

• Proton Pump Inhibitors (PPIs) – these medications reduce the production of stomach acid by blocking the acid-producing cells in the stomach lining. By lowering acid levels, PPIs allow inflamed areas or ulcers to heal more effectively. Some of the common examples include omeprazole, and esomeprazole.

• H2-Receptor Antagonists –  H2 blockers work by reducing the amount of acid the stomach produces. Though slightly less potent than PPIs, they are still effective, particularly in mild cases. Famotidine, and ranitidine are typical examples.

• Antibiotics – if an H. pylori infection is identified as the cause, a combination of antibiotics, which is usually given alongside PPIs, will be prescribed to eliminate the bacteria. Eradicating H. pylori significantly reduces the risk of recurrence, and prevents long-term complications.

• Antacids – antacids offer quick relief by neutralising existing stomach acid. Though not curative, they help ease pain, and discomfort while other medications work to heal the stomach lining.

• Lifestyle Modifications – simple changes in daily habits can go a long way in managing symptoms. and preventing flare-ups:
  • Avoid spicy, fried or acidic foods.

• Eat smaller, more frequent meals.
• Limit alcohol, and caffeine.
• Stop smoking, which worsens acid production, and damages the stomach lining.
• Reduce stress through relaxation techniques, regular sleep, and physical activity.

Surgical Treatment

Surgical treatment is not commonly required, but it may be necessary in serious or emergency cases, especially when ulcers cause complications such as bleeding, perforation or obstruction.

• Partial Gastrectomy – this involves removing the affected portion of the stomach, especially in cases where ulcers recur frequently or complications arise. It also reduces acid production, and eliminates the damaged area.
• Vagotomy – this procedure involves cutting the vagus nerve, which stimulates acid production in the stomach. It is sometimes combined with a partial gastrectomy, and is typically reserved for severe or recurrent ulcers.

Treatment for Gastric Ulcers

In addition to the general treatments above, specific approaches for gastric ulcers include:

• Endoscopic therapy may be used to stop active bleeding from an ulcer.
• Ulcer healing medications such as PPIs, and H2 blockers to promote mucosal recovery.
• Monitoring complications, especially in chronic cases, such as obstruction or perforation.
• Surgical treatment, including gastrectomy or ulcer excision, may be required if there is a risk of malignancy or when ulcers do not heal despite comprehensive medical therapy.

Summary

If you are experiencing persistent stomach discomfort, bloating, heartburn or other signs of gastritis or gastric ulcers, do not wait to seek help. Early diagnosis, and proper treatment can prevent complications, and significantly improve your quality of life.

At Tan Siong San Surgery, we take a patient-centred approach, combining comprehensive diagnostics with personalised care plans tailored to your needs. Whether you require medical management or are concerned about long-term symptoms, our team is here to guide you every step of the way. Schedule your consultation today, and take the first step towards healing.