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ULCERS (OESOPHAGUS, GASTRIC, DUODENAL)

UNDERSTANDING THE PROBLEM

Peptic ulcers are breaks or wounds in the lining of the parts of the upper gut that are exposed to stomach acid.
They occur in the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer), and in the oesophagus (gullet).

UNDERSTANDING WHO SUFFERS

About 10% of people in the developed world will have an ulcer at some time in their life.

The two most important causes of duodenal and gastric ulcers are:

  • Helicobacter pylori, a germ that lives in the stomach. 70 – 80% of patients with peptic ulceration are infected with Helicobacter pylori. This germ, which is caught in childhood, lives in the stomach and causes inflammation, resulting in increased acid production. Most people with the infection are unaware of the infection and only about 1 in 5 will develop an ulcer.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • NSAIDs are a group of painkilling medications commonly taken for headaches, joint pains and other pain. They include aspirin, ibuprofen and diclofenac amongst many others, but do not include paracetamol which is not associated with peptic ulceration. NSAIDs cause both inflammation and ulceration, particularly if taken in high doses over a long period of time, and more so in the elderly.

Researchers have long suspected that an autoimmune response lies at the root of the disease, but an explanation for why the immune system of people with achalasia responds as it does remains elusive.

POTENTIAL SIGNS AND SYMPTOMS

Although some gastric and duodenal ulcers give no symptoms, the most common problem is abdominal pain. Typical ulcer pain is felt in the centre or left upper abdomen and sometimes in the back. The pain does not always conform to a pattern but is usually made worse or relieved by eating and improved with antacid medicines. However, many people have symptoms just like an ulcer, but do not have one – this is called ‘non-ulcer dyspepsia’.

Other symptoms that may occur are:

  • A gnawing or burning pain in the middle or upper stomach between meals or at night
  • Bloating
  • Heartburn
  • Nausea or vomiting
  • Dark or black stool (due to bleeding)
  • Vomiting blood (that can look like "coffee-grounds")
  • Weight loss
EXAMINATIONS USUALLY REQUIRED
  • Gastroscopy: The most secure way to diagnose or exclude an ulcer is by gastroscopy.
  • Barium Meal x-ray: In the case a gastroscopy is not possible, a barium meal x-ray can detect an ulcer, but cannot sample the gut to check for Helicobacter or stop bleeding.
  • Upper Endoscopy: When severe symptoms occur doctors recommend an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities.
PROPOSING TREATMENT AND WHY AIMIS

If surgery is required, AIMIS offers laparoscopic and da Vinci robotic surgery. The Da Vinci partial or subtotal gastrectomy is a less invasive state-of-the art surgical procedure that enables the procedure to be undertaken through a few tiny incisions. Gastrectomy is defined as partial when a part of the stomach is removed surgically; this is normally the resection of the part of the stomach which has the ulcer.

AIMIS is an expert in Da Vinci Minimal invasive robotic subtotal gastrectomy and provides advanced techniques offering many advantages over standard laparoscopy such as:

  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • Less trauma to the body
  • Shorter hospital stay
  • Return to normal activities in a shorter period of time.

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Ulcers can bleed, which can be very serious. Bleeding ulcers cause vomiting of blood or passage of black tarry stools, known as ‘melaena’. If you have either, you should seek immediate attention. If blood loss is slow it may not be seen in the stool but can cause a reduction in the amount of blood in your circulation, called anaemia. Anaemia makes you look pale and feel tired or lethargic or short of breath.

Helicobacter pylori infection is treated with a combination of antibiotics and an acid suppressing drug, usually a Proton Pump Inhibitor, otherwise known as PPI. PPI’s reduce the acid produced by the stomach.
Eradication of helicobacter cures the ulcer long-term. It is important that the success of the treatment is confirmed 6-8 weeks later with a stool test, a breath test or a repeat gastroscopy.

If the ulcer is related to NSAIDs, they should be stopped and if possible avoided in the future. If they cannot be withdrawn, taking a PPI as well gives quite good protection against ulcers.

PPI tablets will often stop the symptoms of an ulcer and may heal it temporarily, but the ulcer almost always returns when the PPI is stopped. They are most effective treatment for oesophageal ulcers. Oesophageal ulcers associated with severe reflux may sometimes require treatment with a surgical anti-reflux procedure.

Other types of Ulcers may also require surgery.

FURTHER INFORMATION ON INCREASED RISK GROUPS

The stomach normally produces acid to help with the digestion of food and to kill germs (bacteria). This acid is corrosive so some cells on the inside lining of the stomach and the first part of the small intestine (the duodenum) produce a natural mucous barrier. There is normally a balance between the amount of acid made and the mucous defence barrier. An ulcer may develop if there is an alteration in this balance, allowing the acid to damage the lining of the stomach or duodenum. Causes of this include the following:

Infection with Helicobacter pylori (H. pylori) and is the cause in about 19 in 20 cases of duodenal ulcer Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen and many others available by prescription; even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.

  • Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)
  • Excessive drinking of alcohol
  • Smoking or chewing tobacco
  • Serious illness
  • Radiation treatment to the area
  • Family history of ulcers
  • Having another illness such as liver, kidney, or lung disease

Stress and spicy foods may make ulcer symptoms worse but we now know they do not cause ulcers. Peptic oesophageal ulcers are due to severe reflux of acid gastric juice into the oesophagus due to a failure of the lower oesophageal sphincter mechanism, usually associated with a hiatus hernia.

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Upper gastrointestinal (GI) series x-rays - This is a series of X-rays of the stomach and duodenum that helps the doctor locate an ulcer and determine its type and how serious it is.

Helicobacter pylori testing

  • Breath testing is one of the most common techniques (It takes about half an hour. The person being tested swallows a small amount of radio-labelled (but not radio-active) urea. Helicobacter in the stomach metabolises the labelled urea to labelled carbon dioxide. Levels of the label in the carbon dioxide in the breath are measured. High levels indicate the presence of Helicobacter pylori).
  • Stool tests are becoming increasingly accurate and are likely to be the best way of detecting the presence of the bacteria in the future. A single small sample of stool is needed.
  • A gastroscopy by sampling the lining of the stomach. Helicobacter pylori infection is treated with a combination of antibiotics and an acid suppressing drug, usually a PPI. Eradication of helicobacter cures the ulcer long-term. It is important that the success of the treatment is confirmed 6-8 weeks later with a stool test, a breath test or a repeat gastroscopy.

If the ulcer is related to NSAIDs, they should be stopped and if possible avoided in the future. If they cannot be withdrawn, taking a PPI as well gives quite good protection against ulcers.PPI tablets will often stop the symptoms of an ulcer and may heal it temporarily, but the ulcer almost always returns when the PPI is stopped. They are most effective treatment for oesophageal ulcers.
Oesophageal ulcers associated with severe reflux may sometimes require treatment with a surgical anti-reflux procedure. Other types of Ulcers may also require surgery.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Upper Gastrointestinal Problems including:
Fundoplication Surgery, Minimally Invasive Heller Myotomy Surgery, Subtotal Gastrectomy Esophageal Stent Placement, Esophageal Surgical Repair, Esophagectomy, Esophagus Replacement and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Upper Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • High patient satisfaction
  • Minimal pain
OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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