Expert Peptic Ulcer Treatment in Bathinda — Dr. Raman Garg

Peptic ulcers (stomach and duodenal ulcers) are open sores that develop on the inner lining of the stomach, upper small intestine, or oesophagus due to damage from stomach acid. They affect millions of people in India and, if left untreated, can lead to serious complications. Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda provides accurate endoscopic diagnosis and complete medical management of peptic ulcers, with surgical backup for complicated cases.

Types of Peptic Ulcers

• Gastric ulcer: In the stomach lining. More common in older patients and NSAID users. Pain typically worsens with eating.
• Duodenal ulcer: In the upper part of the small intestine (duodenum). More common overall, often related to H. pylori. Pain typically occurs 2–3 hours after eating or at night, relieved by food or antacids.
• Oesophageal ulcer: In the oesophagus, often from severe GERD.
• Stress ulcer: In critically ill patients in ICU.

Causes of Peptic Ulcer

• Helicobacter pylori (H. pylori) infection: The most important cause. H. pylori bacteria infect the stomach lining, disrupting the mucus layer and allowing acid to cause ulcers. Responsible for approximately 80% of duodenal ulcers and 60% of gastric ulcers.
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Ibuprofen, diclofenac, aspirin — these inhibit prostaglandins that protect the stomach lining. Long-term NSAID use is the second most common cause.
• Excess acid production: Zollinger-Ellison syndrome — rare tumour causing massive acid overproduction.
• Smoking and alcohol: Delay ulcer healing and increase recurrence risk.
• Stress: Psychological stress alone rarely causes ulcers but worsens symptoms and healing.

Symptoms of Peptic Ulcer

• Burning or gnawing pain in the upper abdomen (epigastrium) — most common symptom
• Pain that comes and goes — often related to meals
• Nausea and vomiting
• Loss of appetite and weight loss
• Belching and bloating
• Feeling of fullness after small meals
• Dark, tarry stools (melaena) — sign of bleeding ulcer
• Vomiting blood or coffee-ground material — emergency
• Sudden severe abdominal pain (perforation) — surgical emergency

Complications of Peptic Ulcer

• Bleeding (haemorrhage): Most common complication. Upper GI endoscopy is both diagnostic and therapeutic — bleeding stopped by injection, electrocoagulation, or clipping.
• Perforation: Ulcer erodes through the stomach or duodenal wall — causes sudden severe pain (peritonitis). Emergency laparoscopic surgery is required.
• Gastric outlet obstruction: Scarring from repeated ulcers blocks the passage from stomach to duodenum — causes severe vomiting and weight loss. Requires endoscopic dilation or surgery.
• Malignant transformation: Rarely, gastric ulcers can become cancerous — all gastric ulcers need endoscopic follow-up.

Peptic Ulcer Diagnosis

• Upper GI Endoscopy: Gold standard — direct visualisation of the ulcer, biopsy for H. pylori and cancer. Read more →
• H. pylori tests: Rapid urease test (biopsy), urea breath test, stool antigen test, serology
• Barium swallow X-ray: Older technique, less accurate

Peptic Ulcer Treatment

Medical Treatment

• H. pylori Eradication (for H. pylori-positive ulcers): Triple therapy (PPI + amoxicillin + clarithromycin, 10–14 days) or quadruple therapy (PPI + bismuth + two antibiotics). Eradication achieves permanent cure in most patients — ulcers rarely recur if H. pylori is eliminated.
• Proton Pump Inhibitors (PPIs): Omeprazole, pantoprazole, rabeprazole — reduce stomach acid dramatically. Used for 4–8 weeks to heal ulcer.
• H2 Blockers: Famotidine — milder acid reduction
• Antacids: For immediate symptom relief
• Sucralfate: Forms protective layer over ulcer
• Stop NSAIDs: Switch to paracetamol for pain. If NSAIDs cannot be stopped — use PPI for gastric protection.
• Stop smoking and alcohol

Endoscopic Treatment (For Bleeding Ulcers)

If an ulcer is actively bleeding or has signs of recent bleeding, Dr. Raman Garg performs therapeutic endoscopy:

• Adrenaline injection to stop bleeding
• Electrocoagulation (heater probe or argon plasma coagulation)
• Mechanical clipping of the bleeding vessel

Surgical Treatment (For Complications)

• Perforated ulcer: Emergency laparoscopic repair (Graham patch closure)
• Refractory bleeding: If endoscopic treatment fails — open or laparoscopic surgery
• Gastric outlet obstruction: Laparoscopic gastrojejunostomy (bypass)

Frequently Asked Questions — Peptic Ulcer Treatment Bathinda