What is a stomach or duodenal ulcer?
An ulcer is an open sore, or lesion, usually found on the
skin or mucous membrane areas of the body.
An ulcer in the lining of the stomach or duodenum,
where hydrochloric acid and pepsin are present, is
referred to as a peptic ulcer.
When the ulcer is in the stomach, it is called a gastric
ulcer.
When the ulcer is in the duodenum, it is called a duodenal
ulcer.
What causes gastric and duodenal ulcers?
In the past it was believed lifestyle factors, such as
stress and diet caused ulcers. Later, researchers
determined that stomach acids -- hydrochloric acid and
pepsin -- contributed to ulcer formation.
Today, research shows that most ulcers (80 percent of
gastric ulcers and 90 percent of duodenal ulcers) develop
as a result of infection with a bacterium called Helicobacter
pylori (H. pylori).
It is believed that, although all three of these
factors -- lifestyle, acid and pepsin, and H. pylori --
play a role in ulcer development, H. pylori is considered
to be the primary cause.
Factors in the development of peptic ulcers
Factors suspected of playing a role in the development of
stomach or duodenal ulcers include:
Helicobacter pylori
Research shows that most ulcers develop as a result of
infection with bacterium called Helicobacter pylori
(H. pylori). The bacterium produces substances that
weaken the stomach's protective mucus and make it more
susceptible to the damaging effects of acid and
pepsin, as well as produce more acid.
smoking
Studies show smoking increases the chances of getting
an ulcer, slows the healing process of existing
ulcers, and contributes to ulcer recurrence.
caffeine
Caffeine seems to stimulate acid secretion in the
stomach, which can aggravate the pain of an existing
ulcer. However, the stimulation of stomach acid cannot
be attributed solely to caffeine.
alcohol
Although no proven link has been found between alcohol
consumption and peptic ulcers, ulcers are more common
in people who have cirrhosis of the liver, a disease
often linked to heavy alcohol consumption.
stress
Although emotional stress is no longer thought to be a
cause of ulcers, people with ulcers often report that
emotional stress increases ulcer pain.
Physical stress, however, may increase the risk of
developing ulcers, particularly in the stomach. For
example, people with injuries such as severe burns and
people undergoing major surgery often require rigorous
treatment to prevent ulcers and ulcer complications.
acid and pepsin
It is believed that the stomach's inability to defend
itself against the powerful digestive fluids,
hydrochloric acid and pepsin, contributes to ulcer
formation.
nonsteroidal anti-inflammatory drugs (NSAIDs)
These drugs (such as aspirin, ibuprofen, and naproxen
sodium) make the stomach vulnerable to the harmful
effects of acid and pepsin. They are present in many
non-prescription medications used to treat fever,
headaches, and minor aches and pains.
What are the symptoms of gastric and duodenal
ulcers?
The following are the most common symptoms for ulcers,
however, each individual may experience symptoms
differently.
Although ulcers do not always cause symptoms, the most
common ulcer symptom is a gnawing or burning pain in the
abdomen between the breastbone and the navel. The pain
often occurs between meals and in the early hours of the
morning. It may last from a few minutes to a few hours.
Less common ulcer symptoms include:
belching
nausea
vomiting
poor appetite
loss of weight
feeling tired and weak
The symptoms of stomach and duodenal ulcers may
resemble other digestive conditions or medical problems.
Consult your physician for a diagnosis.
What are some complications from ulcers? People with ulcers may experience serious
complications if they do not get treatment. The most
common problems include:
bleeding
As an ulcer eats into the muscles of the stomach or
duodenal wall, blood vessels may also be damaged,
causing bleeding.
perforation
Sometimes an ulcer eats a hole in the wall of the
stomach or duodenum, and bacteria and partially
digested food can spill through the opening into the
sterile abdominal cavity (peritoneum) and cause
peritonitis, an inflammation of the abdominal cavity
and wall.
narrowing and obstruction
Ulcers located at the end of the stomach, where the
duodenum is attached, can cause swelling and scarring,
which can narrow or close the intestinal opening. This
obstruction can prevent food from leaving the stomach
and entering the small intestine, resulting in
vomiting the contents of the stomach.
How are ulcers diagnosed?
Because treatment protocols may be different for different
types of ulcers, it is important to adequately diagnose
ulcer disease and H. pylori before starting treatment. For
example, for an NSAID-induced ulcer, treatment is quite
different from the treatment for a person diagnosed with
an ulcer caused by the bacterium, H. pylori.
There are a number of options available for diagnosing
ulcers, and for testing for the H. pylori bacterium. These
diagnostic procedures include:
upper GI (gastrointestinal) series - an x-ray of the
esophagus, stomach, and duodenum to locate an ulcer,
which is made visible on the x-ray image by swallowing
a chalky liquid called barium.
endoscopy - a small flexible instrument with a
camera on the end is inserted through the mouth into
the esophagus, stomach, and duodenum to view the
entire upper GI tract.
blood, breath, and stomach tissue tests - performed
to detect the presence of H. pylori. Although, some of
the tests for H. pylori are not approved by the US
Food and Drug Administration (FDA) because they may
occasionally give false positive results, and the
other tests may give false negative results in people
who have recently taken antibiotics, omeprazole, or
bismuth, research shows these tests can be accurate in
detecting the bacteria.
Treatment for stomach and duodenal ulcers:
Specific treatment will be determined by your physician(s)
based on:
your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures,
or therapies
expectations for the course of the disease
your opinion or preference
Recommended treatment may include:
lifestyle changes
In the past, physicians advised people with ulcers to
avoid spicy, fatty, or acidic foods. However, a bland
diet is now known to be ineffective for treating or
avoiding ulcers. No particular diet is helpful for
most ulcer patients. People who find that certain
foods cause irritation should discuss the problem with
their physicians.
Smoking has been shown to delay ulcer healing and has
been linked to ulcer recurrence; therefore, people with
ulcers should not smoke.
medications
Physicians treat stomach and duodenal ulcers with
several types of medications, including:
H2-blockers to reduce the amount of
acid the stomach produces by blocking histamine, a
powerful stimulant of acid secretion.
acid pump inhibitors to more
completely block stomach acid production by stopping
the stomach's acid pump -- the final step of acid
secretion.
mucosal protective agents to shield
the stomach's mucous lining from the damage of acid,
but do not inhibit the release of acid.
When treating H. pylori, these medications are often
used in combination with antibiotics.
antibiotics
The discovery of the link between ulcers and H. pylori
resulted in a probable new treatment option --
antibiotics for patients with H. pylori.
surgery
In most cases, anti-ulcer medicines heal ulcers
quickly and effectively, and eradication of H. pylori
prevents most ulcers from recurring. However, people
who do not respond to medication or who develop
complications may require surgery.
At present, laparoscopic surgery is performed to
treat ulcers. Types include:
vagotomy - a procedure that involves
cutting parts of the vagus nerve (a nerve that
transmits messages from the brain to the stomach) to
interrupt messages sent through it, therefore,
reducing acid secretion.
antrectomy - an operation to remove
the lower part of the stomach (antrum), which
produces a hormone that stimulates the stomach to
secrete digestive juices. Sometimes a surgeon may
also remove an adjacent part of the stomach that
secretes pepsin and acid. A vagotomy is usually done
in conjunction with an antrectomy.
pyloroplasty - a surgical procedure
that may be performed along with a vagotomy, in
which the opening into the duodenum and small
intestine (pylorus) are enlarged, enabling contents
to pass more freely from the stomach.
In the future, laparoscopic methods may become the
standard surgical treatment. A laparoscope is a long
tube-like instrument with a camera that allows the
surgeon to operate through small incisions while
watching a video monitor.
Facts About Stomach and Duodenal Ulcers During normal digestion, food moves from the mouth
down the esophagus into the stomach. The stomach produces
hydrochloric acid and an enzyme called pepsin to digest
the food.
From the stomach, food passes into the upper part of
the small intestine, called the duodenum, where digestion
and nutrient absorption continue.
An ulcer is a sore or lesion that forms in the lining
of the stomach or duodenum where hydrochloric acid and
pepsin are present. These ulcers are referred to as peptic
ulcers: gastric ulcers in the stomach and duodenal ulcers
in the duodenum.
About 1 in 10 Americans develop at least one ulcer
during their lifetimes.
Ulcers affect about 5 million people each year.
More than 40,000 people a year have surgery because
of persistent symptoms or problems from ulcers.
Each year about 6,000 people die of ulcer-related
complications.
Ulcers can develop at any age, but they are rare
among teenagers and even more uncommon in children.
Duodenal ulcers occur for the first time usually
between the ages of 30 and 50.
Duodenal ulcers occur more frequently in men than
women.
Stomach ulcers are more likely to develop in people
over age 60.
Stomach ulcers develop more often in women than men.
