To determine treatment, the physician must first diagnose precisely the condition of the stomach and the position of the ulcer. The most common procedure to detect an ulcer is by barium X-ray. If an ulcer is not evident in an X-ray, the doctor uses a fibre optic endoscope to view the inner surfaces of the digestive tract.
Analysis of stomach juices and biopsies of cells can determine the possibility of malignancy. The physician sometimes orders a second gastroscopy six to eight weeks after treatment to check that the ulcer has healed, and be sure that no cancerous growth was missed. The physician may prescribe histamine blocking drugs such as cimetidine or ranitidine, except during pregnancy, which are powerful inhibitors of stomach acid and pepsin secretion. These can relieve pain and promote ulcer healing within a few weeks, and may also be used for long-term therapy to prevent recurrent ulcers or if patients prefer not to have an operation.
For short-term treatment of duodenal ulcers, up to eight weeks, the drug sucralfate acts directly on the ulcer site by coating the ulcer and protecting the area from further acid damage. Anticholinergic drugs such as atropine, belladonna and the newer synthetics are also used occasionally which decrease the action of the acid producing cells, and change gastric motility.
Most ulcers heal successfully in response to these medications. But if an ulcer won’t heal, the physician may decide on an operation, either removing the lower portion of the stomach where gastrin is produced, or cutting the vagus nerve which connects the brain to the stomach. A refined variation of this latter operation is called a selective vagotomy in which the procedure concentrates on cutting only those parts of the vagus nerve that go to the acid-secreting cells in the stomach wall.
Alternatively, the doctor may treat a bleeding ulcer by passing an electric current through the tissue to stop blood flow or by using a heated aluminium cylinder.