Ulcer: Causes, Symptoms, Remedies.
A peptic ulcer is a round or oval lesion that occurs after gastric or duodenal mucosal destruction by gastric acid or digestive juices.
Ulcers penetrate the lining of the stomach or duodenum (the first part of the small intestine).
Gastritis can evolve to peptic ulcer. The names of the different types of ulcers indicate their anatomical location and the circumstances in which they occurred.
The duodenal ulcer, the most common type of peptic ulcer, occurs in the duodenum, in the first centimetres of the small intestine, immediately distal to the stomach. Marginal ulcers may occur when a part of the stomach has been surgically removed in the place where the stomach has been united with a thin intestine.
As with acute stomach gastritis, in the event of overuse of the body caused by severe illness, burns or trauma, stress ulcer may occur. This type of ulcer can occur both in the stomach and duodenum.
Ulcers occur when the lining of the stomach or duodenum is inflamed chronically or when exposed to irritating agents such as excess acid and gastric enzymes (pepsin). Each person secretes acid in the stomach, but only one in 10 people develop stomach ulcers at some point in their lifetime. Each person generates a different amount of gastric acid, and the type of individual acid secretion usually persists for life. People who normally have more acid secretion (acid hypersecretion) are at greater risk of making peptic ulcer than those who are less secretive (hyposecretion).
However, other factors other than acid secretion contribute to the development of the ulcer since most people with gastric hypersecretion do not develop a peptic ulcer, and some people with gastric hypoaesthesia make ulcers. Also, ulcers are more common in the elderly, even though with age advancing, acid secretion decreases.
- Helicobacter pylori infection and administration of certain drugs (especially aspirin, other non-steroidal anti-inflammatory drugs and corticosteroids) that irritate the gastric mucosa and cause ulceration.
- Smokers are more prone to peptic ulcer compared to non-smokers because the ulcerations that appear are healing more slowly.
- Although psychological stress can increase gastric acid production, no association has been found between it and the appearance of peptic ulcers.
- The presence of cancer (a rare cause, but there are situations when the symptoms of cancerous ulcers are very similar to those of benign ulcers).
Usually, peptic ulcer heals and then reactivates. Thus, pain is present for several days or weeks, and then it is attenuated or disappeared.
Symptoms vary depending on the location of ulceration and the age of the person. Children and elderly people usually do not have the usual symptoms of the disease or can be completely asymptomatic (in these situations, ulcers are only discovered if complications occur). Only 50% of people with duodenal ulcer have typical symptoms, i.e. pain with burning or deafening pain, local discomfort, empty stomach and hunger.
The pain is constant and has moderate or moderately severe intensity, usually located immediately below the sternum.
In many people with duodenal ulcer, pain is absent when awakening from sleep, but occurs in the morning.
Milk intake or antacids usually relieves pain, but it reappears after 2-3 hours. Often, pain awakens the person at night. It is common for patients to experience painful pain once or several times a day for a period of one to several weeks, and then the pain disappears even without treatment.
Symptoms of gastric, marginal and stress ulcers, unlike those of duodenal ulcers, do not have a specific evolution. Ingestion of food may relieve pain temporarily or aggravate pain.
Gastric ulcer sometimes produces tissue swelling (edema) from the level of communication between the stomach and the small intestine so that food can not be discharged normally from the stomach. This obstruction can cause bloating, nausea or vomiting after a meal. Complications of peptic ulcers such as haemorrhage or gastric wall rupture are accompanied by symptoms that indicate a decrease in blood pressure such as dizziness and fainting.
Most ulcers heal without complications, but in some situations, they produce potentially fatal complications such as penetration, perforation, bleeding and obstruction.
- Penetration. The ulcer can destroy the muscular wall of the stomach or duodenum, penetrating a neighbouring organ such as the liver or pancreas. In this situation, the patient experiences a very persistent, stabbing pain, sometimes located away from the affected region. The intensity of pain increases when the person changes their position. If the ulcer is not cured by medical treatment, surgery should be performed.
- Perforation. Ulcers located on the anterior wall of its duodenum or, more rarely, gastric ulcers, can perforate the digestive tract wall, thus creating an opening to the free space in the abdominal cavity. The pain that occurs is sudden, intense and constant. It spreads rapidly throughout the abdomen. The affected person feels pain in one or both of the shoulders, which intensifies during breathing. Changing the position aggravates the pain, so patients are usually still. The abdomen is sensitive to the touch, and the pain gets worse when the doctor exerts pressure by hand and then suddenly releases the pressure. Symptoms may be less intense in the elderly, in those taking corticosteroids or in very sick patients. Fever indicates the presence of an infection in the abdominal cavity. If the disease is not treated promptly, the patient may get shocked. This emergency requires immediate surgical intervention and intravenous antibiotic administration.
- Haemorrhage. Haemorrhage is a common complication of ulcers, even when the pain is absent. It can be manifested by the removal of light red blood or partially digested blood, which is brownish brown (like coffee grounds), or by removing black and soft faeces. Haemorrhage can also be caused by other digestive diseases other than ulcers, but doctors start evaluating the patient by first researching the stomach and duodenum. If the bleeding is not massive, an endoscopy is performed. If endoscopy shows hemorrhagic ulcer disease, the endoscope can be used to cauterize it (i.e. local heat application that destroys tissues). The doctor can also use the endoscope and inject substances that produce local coagulation. If the source of haemorrhage can not be identified and haemorrhage is not severe, treatment includes the administration of ulcer medications such as histamine type 2 blockers or proton pump inhibitors. The patient also receives intravenous fluids and does not consume anything orally so that the digestive tract is at rest. If these measures do not stop bleeding, surgical intervention is indicated.
- Obstruction. Swelling of inflamed tissue around the ulcer lesion or fibrosis caused by repeated ulcer changes can lead to narrowing of the stomach and duodenum. Patients with this type of obstruction repeatedly vomit - often regurgitating large amounts of food consumed a few hours earlier. The symptoms of stomach obstruction are the feeling of fullness, bloating and lack of appetite. Over time, vomiting can lead to dehydration and damage to electrolyte balance. Ulcer treatment improves obstruction in most cases, but in case of severe obstruction, endoscopic or surgical intervention is required.
The doctor suspects the presence of an ulcer when the patient experiences characteristic pain. Sometimes the person is treated for the ulcer, following the symptoms, which suggests that the patient had an ulcer that healed. It may be necessary to use specific procedures to confirm the diagnosis of ulcer, especially when the symptoms do not disappear after a few weeks of treatment because gastric cancer can produce similar manifestations.
Also, when there are severely resistant ulcers, especially if the patient has multiple ulcerations or is located in unusual regions, the doctor should try to identify the underlying disease that causes acidic gastric hypersecretion.
To diagnose ulcers and determine their cause, endoscopy or radiography after barium administration (a contrast substance that is deposited on the walls of the digestive tract so that they become visible) can be used. Using the endoscope, a biopsy can be performed (taking a tissue sample for microscopic examination) to determine if it is a benign or malignant gastric ulcer, and to identify Helicobacter pylori bacteria. The endoscope is also used to stop acid bleeding and reduce the risk of gastric ulcer bleeding. Bariatric transduction of the stomach and duodenum helps determine the severity and size of an ulcer, which sometimes can not be fully observed during endoscopy.
Since Helicobacter pylori infection is a major cause of ulcers, patients often receive antibiotics.
Neutralization or reduction of gastric acidity with drugs that directly inhibit acidic gastric production promotes healing of peptic ulcers regardless of their cause. For most people, treatment is continued for 4-8 weeks.
There is no evidence to support the idea that uncooked diets hurry or prevent recurrence of ulcers, although these diets contribute to reducing gastric acid production.
However, patients are advised to avoid foods that aggravate their pain and bloating.
It is also important to avoid gastric irritants, such as nonsteroidal anti-inflammatory drugs, alcohol and smoking.
These are the medicines most commonly used in ulcer treatment:
- Antacids (sodium bicarbonate, calcium carbonate, aluminium hydroxide, magnesium hydroxide) relieve symptoms of ulcers by neutralizing gastric acidity. Their efficacy varies according to the amount administered and the amount of acid the patient will produce. Almost all antacids can be purchased without the need for a medical prescription, available as tablets or liquids. But keep in mind that long-term treatment can have unpleasant side effects (nausea, headache, weakness, loss of appetite).
- Drugs that decrease gastric acid secretion (cimetidine, famotidine, nizatidine and ranitidine) relieves the symptoms of the disease and promote ulcer healing by reducing gastric acid production. These very effective drugs are given once or twice a day. Although most do not produce side effects, cimetidine may confuse, especially among the elderly. Also, it may interfere with the elimination of certain drugs in the body, such as those for the treatment of asthma (theophylline), warfarin (anticoagulant) and phenytoin (anticonvulsant).
- Sucralfate - acts by forming a protective coating at the ulcer, thus favouring healing (it can cause constipation).
- Misoprostol - to reduce the risk of duodenal or gastric ulcer in people taking non-steroidal anti-inflammatory drugs (it causes diarrhoea, digestive disorders, spontaneous abortion).
Surgery - is rarely needed today, by medication, ulcers heal very well, and through endoscopic intervention can stop active bleeding. Surgical intervention is primarily involved in the treatment of peptic ulcer complications such as perforation, the obstruction that does not respond to medication or recurrent obstruction, the existence of two or more episodes of ulcer haemorrhage, suspicion of malignant gastric ulcer or severe cases and recurrences frequent peptic ulcers. Several types of surgical procedures may be used to treat these problems, but each one produces specific complications such as weight loss, digestive disorders and anaemia.