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Diagnosing gastric conditions

More people in Korea than in the West complain of symptoms related to the gastrointestinal system. However, many people tend to dismiss such symptoms and do not see a doctor about it, which can sometimes lead to the progression of serious illnesses, such as gastric cancer.

The best methods to maintain a healthy life is to practice the usual good lifestyle habits and have regular checkups to diagnose conditions early. Here, we will look at gastritis, gastric ulcers and gastric cancer, which are serious conditions.
Illustration by Park Gee-young
Illustration by Park Gee-young


Gastritis and gastric ulcers are common nowadays. If you experience upper abdominal pain, nausea, vomiting or diarrhea within a few hours after meal, acute gastritis may be suspected.

Acute gastritis refers to an inflammatory condition of the gastric walls, in particular, the mucosal layer of the stomach. It is commonly caused by cold or hot foods, salty or spicy foods, and alcohol. In most cases, the condition will improve with temporary fasting and avoidance of spicy or hot foods.

Chronic gastritis is a common condition, and tends to recur often. Previously, it was a diagnosis made after ruling out ulcers or cancer in patients who complained of stomach symptoms, but it is now understood as a chronic infection caused by the bacteria Helicobacter pylori.

The definitive diagnosis is made using biopsies through upper endoscopy, but just because there is inflammation of the stomach wall, it does not always mean that the person will experience symptoms. Some people may experience continuous symptoms even after the treatment of the inflammation, so there is no need for specific treatment if you do not have any discomfort. However, in one particular type of gastritis, called atrophic gastritis, gastric cancer can occur, so the patient will need regular checkups.

Gastric ulcers

This condition is commonly associated with upper abdominal, or umbilical burning pain, and sometimes with vomiting blood (hematemesis) or bloody or black stools. Peptic ulcers, which consist of gastric and duodenal ulcers, refer to the erosion of mucosa or deeper tissue layers of the stomach and the duodenum.

A peptic ulcer is a very common condition; at least 1 in 10-20 people will experience it during their lifetime. The condition also frequently recurs even after treatment. Some people may temporarily feel better with antacids or foods, but it is difficult to diagnose the condition with the symptoms alone, and the diagnosis is confirmed through upper endoscopy. Some people may show symptoms similar to gastric cancer, so this must be ruled out by doing endoscopy and biopsy. Typically, a person with a peptic ulcer will be medically treated for two months, and those with gastric cancer will need another endoscopy after finishing the treatment.

It has recently been found that 80 percent of gastric ulcers and 95 percent of duodenal ulcers are caused by the bacteria H. Pylori, so finding this infection and treating it can significantly reduce the recurrence of ulcers.

Gastric cancer

Unfortunately, gastric cancer is often asymptomatic in its early stages. Symptoms of gastric cancer include discomfort in the upper abdomen, pain, dyspepsia (indigestion), distention following a meal, decreased appetite, and weight loss. However, these symptoms are similar to those with dyspepsia or peptic ulcers. This is why many patients often undergo prolonged treatment with digestive medicines or antacids, and end up missing the timeframe for curative treatment.

Gastric cancer is the most common cancer in Korea, and also has a high mortality rate. In 1998 alone, 11,102 people (23.9 per 100,000 persons, male to female ratio of 1.8:1) died of gastric cancer. It is the fifth-most common cause of death, following cerebrovascular disease, cardiovascular disease, traffic accidents and liver disease.

The exact cause of gastric cancer is not known, but both genetic and environmental factors contribute to it. Some foods associated with gastric cancer include salted foods, burnted meat, and salty and spicy foods. Not eating enough fresh vegetables or fruits, smoking and drinking alcohol also contribute to gastric cancer.

It is most important to diagnose gastric cancer early. Gastric cancer has a high mortality rate, but can be cured if diagnosed and treated early. Those who experience the symptoms listed above should receive a regular check up as well as those without any symptoms from middle age and onwards. The main treatment method is surgery.

Prevention, early diagnosis and treatment

It is difficult to completely prevent gastric conditions, but the risk of developing gastric conditions can be decreased significantly with dietary and lifestyle changes. The stomach is a place where ingested food is stored and digestion started, so a healthy diet is crucial.

It is best to eat regular meals, avoid spicy and hot foods, avoid binge drinking, and stop smoking. It is best to eat lots of fresh fruits and vegetables, and avoid smoked or salty foods. Exercising and sufficient sleep to relieve stress is also helpful.

To diagnose peptic ulcers or gastric cancers, it is important that you avoid self-treatment, and receive appropriate tests and examinations at the hospital. In most cases, an endoscopic examination will be very helpful, which allows both diagnosis and biopsy of the stomach tissue for various conditions, as well as allowing early diagnosis of gastric cancer. Since gastric cancer is very common in Korea, even those without any symptoms should have a regular endoscopy every 1-2 years from middle age and onward.

If you have a family history of gastric cancer, it is very important that you have regular endoscopies. With the recent introduction of conscious sedation endoscopy, the procedure will be much more comfortable than it was previously.
Kim Eun-ran
Kim Eun-ran

By Kim Eun-ran

The author is a doctor at Division of Gastroenterology at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ― Ed.