Gallstones are hardened deposits of cholesterol and bile that form in the gallbladder. The gallbladder is a small organ on the right side of the abdomen that sits just under the liver. Its main role is to store bile (a digestive juice formed in the liver).
Stomach (“peptic”) ulcers are localised areas of damage to the lining of the stomach that resemble small craters. While ulcers are most commonly found in the stomach they also frequently occur in the duodenum (start of the small bowel).
While in the past we believed stress was the cause of stomach ulcers, we now know there are two main causes:
(i) A long-term infection with the ‘Helicobacter pylori’ bacteria can cause widespread damage, or inflammation, to the lining of the stomach. This damage can progress over time to form an ulcer. This was an Australian discovery in which Dr. Barry Marshall and Dr. Robin Warren from Perth first showed that H. pylori causes ulcers. They won the Nobel Prize for Medicine in 2005 in recognition of this discovery.
(ii) The second most common cause of stomach ulcers is overuse of anti-inflammatory medications. These medications (e.g. aspirin, ibuprofen, naproxen, diclofenac) have the unwanted side effect of impairing the way the stomach protects itself against gastric acid
Additional risk factors for ulcers include: older age, using steroid medication, blood-thinning medications, smoking, autoimmune diseases, viral infections and having another chronic health condition.
While stomach ulcers can cause symptoms, they are also frequently ‘asymptomatic’ meaning that a person may not be aware they have an ulcer. When symptoms are present, they usually include upper abdominal pain / discomfort, nausea or vomiting, loss of appetite and loss of weight.
The most serious complications of ulcers are:
(i) Bleeding – this usually presents with a patient vomiting blood-stained stomach contents or passing a black tar-like bowel motion (melaena).
(ii) Perforation (a hole in the stomach) – this usually results in severe stomach pain and the patient becoming extremely unwell.
Both complications can be life threatening and require emergency treatment in hospital.
Stomach ulcers are best diagnosed during a gastroscopy. During the procedure tiny accessories can be passed down the camera’s operating channel to take biopsies of the stomach and/or treat the ulcer if required.
Stomach ulcers that have not caused bleeding or a perforation can be successfully treated by
(i)removing the underlying cause i.e. stopping anti-inflammatory medications or treating helicobacter pylori infection
(ii) taking an ‘acid suppressing’ medication for 4-8 weeks which allows the lining of the stomach to heal without further damage. Dietary changes can also enhance the healing process and help minimize the need for medication in the long-term.
It is important that a follow up gastroscopy be performed to check that a stomach ulcer has healed completely and that there is not an alternative factor contributing to the ulcer.
Bleeding ulcers can be treated with a variety of techniques including: lasers (Argon), clips, endoscopic sutures, pro-coagulant powders, local adrenaline injections, and/or gold probe thermal therapy.
For patients who require long term aspirin or another anti-inflammatory medication an ‘acid suppressing’ medication is sometimes prescribed as well to prevent further ulcers.