What Is Peptic Ulcer And Can You Highlight Its Causes And Symptoms
What is Peptic ulcer ? Peptic Ulcer is a sore resulting from the mucosal erosion of the wall of the stomach or that of the duodenum, due to the action of strong digestive acids and enzymes or due to infections.
- Helicobacter pylori infection and drugs which irritate the stomach and intestinal lining may cause peptic ulcers.
- Stomach pain and discomfort are the usual symptoms, which appear intermittently.
- The characteristic symptoms of the disease help in diagnosis. Endoscopic examination of the stomach can confirm it.
- Treatment focuses on reducing the acidity in the stomach. Antibiotics are used to treat Helicobacter pylori infection.
Ulcers can form as a result of gastritis. They can grow deep into the stomach lining or into the lining of the part of small intestine called duodenum. According to the location of the ulcer and the reason for its origin, different names are given to peptic ulcers.
Those ulcers which develop in the duodenum are called duodenal ulcers; they are the most frequently occurring peptic ulcers. Usually duodenal ulcers are restricted to the first two or three inches of the small intestine.
Gastric ulcers form inside the stomach, usually on the upper curve, but they are not as common as the duodenal ulcers. When partial gastrectomy is done, ulcers may form where the rest of the stomach joins the intestine and they are called marginal ulcers.
Stress ulcers resulting from acute stress gastritis, due to severe burns or prolonged illness or traumatic injury, can develop not only in the stomach, but also in the duodenum or in both at the same time.
Causes Of Peptic Ulcer
Bacterial infections and certain drugs act as irritants and disrupt the normal tissue repair and renewal process of the lining of stomach and the small intestine. This weakens the protective mucous lining and makes it susceptible to the damaging action of the strong digestive acids and enzymes.
Helicobacter pylori which survive in the highly acidic environment of the stomach and upper part of the small intestine, is found to be a major cause of peptic ulcer. Prior to the development of antibiotics to tackle Helicobacter pylori, the incidence of this bacterial infection used to be as high as 90% in people having ulcers in the duodenum. The new treatments available have significantly lowered it down to around 50%.
Regular use of aspirin and frequent use of other NSAIDs such as ibuprofen and the use of corticosteroids are known to cause irritation to the protective layer of mucous which lines the inner wall of the digestive tract. When the mucous lining is damaged, the strong acids and enzymes produced by the digestive glands eat into the wall of stomach and small intestine causing ulcers. Not everyone who takes these drugs get peptic ulcer; some people are at a greater risk of developing it due to their inherent nature. Those in the higher risk group are advised to take NSAIDs belonging to the group called COX-2 inhibitors or coxibs instead of the other NSAIDs which are known irritants. But the greater risk of stroke and heart attack associated with coxibs make them unsuitable for long term use. As an alternative to coxibs, especially for those have other risk factors for stroke and heart attack, the usual NSAIDs along with a proton pump inhibitor which prevents the production of stomach acids can be taken.
Smoking is found to have an adverse effect on gastric health; not only that smokers are more prone to developing ulcers, but that their ulcers take longer to heal also.
Emotional stress is not considered a risk factor for developing peptic ulcer even though it is known to enhance the production of stomach acids.
Zollinger Ellison syndrome is a rare cancerous condition which results in the increased production of stomach acids and the development of ulcers due to it. These ulcers may be cancerous and the usual treatment for noncancerous peptic ulcers may not work for them even though the symptoms may appear similar.
Symptoms Of Peptic Ulcer
The symptoms of peptic ulcer appear intermittently because the ulcers keep appearing ad disappearing. There may be pain free periods in between episodes of painful flare ups. Peptic ulcers in older people as well as in children may be asymptomatic till other complications due to the ulcers start appearing.
Some people have the characteristic symptoms of duodenal ulcers such as a burning or soreness felt right below the breastbone. The steady pain felt by some people may be severe or mild but others may have a feeling of hunger or an empty feeling instead. Pain may not be felt early in the morning but gradually develops as the day progresses. Often temporary relief may be achieved by food and drink, especially milk, which neutralizes the acids or by taking antacids. The pain may return after a few hours, though. Occasionally, pain may be severe enough to wake a person up at night. After a period of pain and discomfort, the symptoms may disappear completely without any treatment, only to return after several weeks to a few years later. Many people with the disease can often predict when a flare up can happen. Episodes are usually more frequent in spring as well as in fall. Periods of stress, either physical or emotional, also may trigger an episode. But half the people with duodenal ulcer may not have any of these symptoms.
No characteristic pattern can be observed in the symptoms produced by gastric ulcers or marginal ulcers. Stress ulcers also do not have any typical symptoms. Food intake may either bring relief or make the pain worse. If edema due to gastric ulcers extends into the duodenum, it may obstruct the passage of food from the stomach, resulting in nausea and vomiting after a meal. Persistent bleeding or rupture of the peptic ulcers may cause fainting or light headedness as a consequence of the low blood pressure precipitated by the severe loss of blood.
Peptic Ulcer Video Summary
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Yasser Elnahas
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Four times as many peptic ulcers arise in the duodenum—the first part of the small intestine, just after the stomach—as in the stomach itself. About 4% of gastric ulcers are caused by a malignant tumor, so multiple biopsies are needed to exclude cancer. Duodenal ulcers are generally benign.-.^`
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While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has persuasively demonstrated that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers.