24/05/2025
*ALL YOU NEED TO KNOW ABOUT ULCER*
An ulcer is an open sore that develops on the skin or on a mucous membrane, which is the moist inner lining of certain organs, like the stomach, intestines, or mouth. They occur when the protective layer of these tissues is damaged, exposing the underlying sensitive tissue to irritants.
*TYPES OF ULCERS*
While "ulcer" can refer to sores on various parts of the body, the most commonly discussed are peptic ulcers, which affect the digestive tract:
*1. Peptic Ulcers:* These are open sores that form on the lining of the stomach or the first part of the small intestine (duodenum).
*i. Gastric Ulcers:* Located in the stomach.
*ii. Duodenal Ulcers:* Located in the duodenum.
*2. Esophageal Ulcers:* Occur in the lining of the esophagus (the tube connecting the mouth to the stomach).
*2. Mouth Ulcers (Canker Sores/Aphthous Ulcers):* Small, painful sores inside the mouth, on the gums, tongue, or inner cheeks.
*3. Ge***al Ulcers:* Sores on the ge***al area, often related to sexually transmitted infections.
*4. Leg Ulcers:*
*i. Venous Ulcers:* Due to poor blood circulation in the veins, often on the lower legs.
*ii. Arterial Ulcers:* Due to poor blood circulation in the arteries, often on the feet or ankles.
*iii. Diabetic Foot Ulcers:* A common complication of diabetes, often on the feet, due to nerve damage and poor circulation.
This discussion will focus primarily on peptic ulcers, as they are the most common and often what people refer to when they say "ulcer."
*CAUSES OF PEPTIC ULCERS*
Peptic ulcers develop when there's an imbalance between the digestive acids and the protective lining of the stomach or duodenum. The two main causes are:
*A. Helicobacter pylori (H. pylori) infection:* This bacterium can live in the digestive tract and damage the protective mucous layer, making it vulnerable to acid. It's a very common infection, but only some people develop ulcers.
*B. Nonsteroidal Anti-inflammatory Drugs (NSAIDs):* Common pain relievers like ibuprofen, aspirin, and naproxen can reduce the production of prostaglandins, chemicals that protect the stomach lining from acid. Long-term use or high doses of NSAIDs are significant risk factors.
Less common causes include:
*I. Zollinger-Ellison syndrome:* A rare condition that causes the stomach to produce too much acid.
*II. Other medications:* Certain drugs, like corticosteroids, bisphosphonates, and potassium chloride, can increase ulcer risk.
*III. Severe stress (e.g., from major illness, burns, or trauma):* These are sometimes called "stress ulcers."
Misconceptions: It's important to note that while stress and spicy foods can worsen ulcer symptoms, they are generally not direct causes of ulcers. Smoking and excessive alcohol consumption, however, can increase the risk and hinder healing.
*SYMPTOMS OF PEPTIC ULCERS*
The most common symptom of a peptic ulcer is:
*I. Burning or gnawing abdominal pain:* Typically felt in the upper abdomen, between the breastbone and the navel. The pain may:
√ Be worse when the stomach is empty, between meals, or at night.
√ Be relieved by eating certain foods (like milk or antacids), only to return later.
√ Last for minutes to hours.
*II. Other symptoms can include:*
√ Indigestion (dyspepsia)
√ Heartburn and acid reflux
√ Nausea and vomiting
√ Bloating
√ Loss of appetite
√ Unexplained weight loss
√ Feeling full quickly after eating less food than usual
√ Burping
It's important to note that some people with ulcers, particularly older adults, may experience no symptoms or very mild ones until a complication arises.
*DIAGNOSIS*
Diagnosing a peptic ulcer usually involves:
*I. Medical History and Physical Exam:* The doctor will ask about your symptoms, medical history, medications, and family history.
*II. H. pylori Tests:*
*(a) Breath Test:* You drink a special liquid, and your breath is tested for carbon dioxide produced by the bacteria.
*(b) Stool Test:* A sample of your stool is checked for H. pylori antigens.
*(c) Blood Test:* Checks for antibodies to H. pylori.
*(d) Upper Endoscopy (EGD - Esophagogastroduodenoscopy):* This is the most definitive test. A thin, flexible tube with a camera is inserted through your mouth, down your esophagus, into your stomach, and into the duodenum. This allows the doctor to visually inspect the lining, take biopsies (tissue samples) if needed (e.g., to test for H. pylori or rule out cancer), and sometimes even treat bleeding ulcers.
*II. Barium Swallow (Upper GI Series):* Less common now due to endoscopy, but involves drinking a barium solution and then having X-rays taken to visualize the digestive tract.
*TREATMENT*
Ulcer treatment depends on the cause:
*I. For H. pylori infection:*
*(a) Antibiotics:* A combination of two or more antibiotics (e.g., amoxicillin, clarithromycin, metronidazole) is prescribed to eradicate the bacteria.
*(b) Proton Pump Inhibitors (PPIs):* Medications that reduce stomach acid production (e.g., omeprazole, lansoprazole, esomeprazole). This allows the ulcer to heal.
*(c) Bismuth Subsalicylate:* Sometimes included in treatment regimens (e.g., Pepto-Bismol).
*II. For NSAID-induced ulcers:*
*(a) Stop NSAIDs:* The first step is to discontinue NSAID use if possible. Your doctor may recommend alternative pain relievers.
*(b) PPIs:* To reduce acid and allow the ulcer to heal.
*(c) H2-receptor Blockers:* Another class of acid-reducing medications (e.g., ranitidine, famotidine), though PPIs are generally more potent.
*III. Lifestyle Modifications:*
*(a) Avoid trigger foods:* While not a cause, spicy, acidic, or fatty foods, as well as caffeine and alcohol, can worsen symptoms for some people.
*(b) Quit smoking:* Smoking impairs healing and increases recurrence risk.
*(c) Manage stress:* Stress can exacerbate symptoms.
*SURGERY*
Surgery is rarely needed for peptic ulcers now due to effective medications, but may be necessary for severe complications like persistent bleeding, perforation, or obstruction.
*COMPLICATIONS*
If left untreated, ulcers can lead to serious complications:
*(a) Bleeding:* The most common complication. It can be slow and lead to anemia (fatigue, paleness, shortness of breath), or rapid and severe, causing vomiting blood (bright red or resembling coffee grounds) or passing black, tarry stools (melena). Severe bleeding is a medical emergency.
*(b) Perforation:* The ulcer eats a hole through the wall of the stomach or duodenum, allowing digestive juices and food to leak into the abdominal cavity. This causes sudden, severe abdominal pain and is a life-threatening medical emergency requiring immediate surgery.
*(c) Obstruction (Gastric Outlet Obstruction):* Swelling or scarring from the ulcer can block the passage of food from the stomach into the small intestine. Symptoms include persistent bloating, feeling full quickly, recurrent vomiting (often of undigested food), and unexplained weight loss.
*(d) Gastric Cancer:* While most ulcers are benign, chronic H. pylori infection is a risk factor for stomach cancer. It's important to differentiate between a benign ulcer and a cancerous lesion, especially in older individuals.
In summary, ulcers, particularly peptic ulcers, are open sores in the digestive tract often caused by H. pylori infection or NSAID use. While painful, they are treatable with medication. However, prompt medical attention is crucial, especially if symptoms are severe or signs of complications appear, as untreated ulcers can lead to life-threatening conditions.
- Lamba Paul
