Overview of ulcers
Infections caused by numerous bacterial, viral or fungal pathogens are common in tropical, subtropical or temperate regions of the world that have weather and climatic conditions ideal for the birth and propagation of these causative agents.One common disease affecting the lives of people worldwide is “ulcers”.
It is observed in all age groups and ethnic groups and is manifested in different forms along with associated clinical complications. Ulcers may also arise due to improper dietary habits and unhygienic and unhealthy lifestyles.According to recent epidemiological findings by Center for Disease Control and Prevention, about 5-10% of the global population suffer from this condition at some point in time. Research findings also suggest that ulcers have currently become one of the primary contributors of global mortality cases.
What is an ulcer?
In medical terms, an ulcer is defined as an exposed sore on the outer or inner surface of the body caused by an acute infection at the points of a break in the skin or the mucous membrane lining.
These are commonly manifested as single or aggregated lesions in different parts of the human body that cause severe pain and are in most cases incurable.
Such sores are mainly formed due to bacterial infections that lead to excessive erosion and damage of the epithelial tissues at the sites of infections.
In critical cases, ulcers may be manifested as pus-filled blisters on the inner linings of vital parts of the body.
What causes them?
Ulcers (especially peptic ones) are primarily caused by bacterial infections. The generalized factors causing ulcers are listed below-
- Bacterial infection: Infections mediated by Helicobacter pylori cause peptic ulcers. These bacteria are normally transmitted through infected fecal matters, vomit, saliva, or contaminated food and water. They propagate extensively within the stomach and cause excessive disintegration of the inner linings (mucous membranes) of the stomach.
- Medications: Few harmful medications such as Non-steroidal Anti Inflammatory Drugs (NSAIDs), Corticosteroids, Prednisolone, and Anticoagulants are responsible for gastric and duodenal ulcers. Due to their acidic nature, these drugs cause degeneration of the mucous layers that lead to exposed sores which slowly develop into ulcers.
- Hypercalcemia: Abnormal increase in calcium level in the blood leads to increased secretion of gastric juice which directly affects the mucosal linings of the stomach and causes ulcers.
- Tobacco: Excessive intake of tobacco via smoking predisposes the human body to peptic ulcers since it destroys the immune properties of the gastric mucosa and also facilitates the intrusion of bacteria (Helicobacter pylori) into the body.
- Alcohol: Excessive alcohol consumption can lead to permanent damage of the gastric mucosa (for ethanol content above 10%).
- Diet: Frequent intake of oily and greasy foods and caffeinated beverages increases the risk of gastric ulcers by impeding the normal mechanism of production of gastric juice and pepsin. Dyspepsia also results in such cases which causes acute indigestion and gastric pain.
- Irregularity: Having proper food after long intervals of time cause degeneration of the mucosal layer of stomach and duodenum (due to direct exposure to gastric juice) and cause gastric pain in the initial stages and gastric ulcers at an advanced stage.
- Stress: Excessive emotional stress trigger certain physiological changes such as high pulse rate and high blood pressure that lead to increased secretion of basal acids, gradually giving rise to gastric ulcer tendencies.
- Heredity: Genes play a vital role in developing gastric ulcers. Nearly 20-50% of duodenal ulcer patients have a family history of ulcers.
What are the symptoms?
The signs and symptoms are overlooked in the initial stages when gastric pains are suppressed easily by mild antacids. But when the disease gradually progresses and affects large portions of the gastrointestinal tract, the symptoms are serious and require immediate diagnosis. The commonly observed symptoms of ulcers are as follows-
- Persistent abdominal pain that radiates upwards from middle abdomen to the thoracic region (in women ulcer pains generate immediately below the breastbone)
- Pain starts immediately after a meal
- Feeling of penetration or intrusion of a sharp object in the abdominal region and at times in the back
- Acute stomach pain can cause a person wake up in the middle of the night
- Burning sensation in stomach and chest
- Belching with occasional backwash
- Vomiting with blood
- Dark brown or blackish discoloration of stool (occasionally due to presence of blood)
- Sudden occurrence of heartburn
- Bloated belly (mostly due to generation of gas)
- Abnormal weight loss
- Loss of appetite
What are the different types of ulcers?
Different classifications are made based on different criteria.Based on the location of the lesion, the following classification is adopted-
- Peptic: Peptic ulcers are manifested as painful lesions in the stomach or duodenum and are mediated by the Helicobacter pylori These are mainly caused by hypersecretion of digestive juice (Hydrochloric Acid) and pepsin. Prolonged exposure of the inner mucosal linings to these two cause degeneration of the epithelial tissues.
- Gastric: Peptic ulcers found in the stomach are called gastric ulcers. Their symptoms are more or less similar to peptic ulcers.
- Duodenal: Peptic ulcers formed in the duodenum are called duodenal ulcers. They are normally found in the uppermost portion of the small intestine (inner linings). They exhibit slightly different symptoms than that of gastric and peptic ulcers.
- Esophageal: These ulcers are found in the lowermost portion of the esophagus and in most cases are caused by acid reflux.
Depending on the nature of the lesions they can be classified into three types-
- Bleeding type: This is caused due to internal bleeding from an existing peptic ulcer.
- Refractory type: These are caused by extreme cases of bacterial infection and are often incurable after treatment.
- Stress type: These are manifested as clustered lesions in esophagus, stomach or duodenum, and are caused by excessive emotional stress.
Two other forms of ulcers have also been identified. These are-
- Diabetic foot type: It is characterized by deep sores on the feet and is normally found in Type 2 Diabetes patients.
- Venous type: It is also called stasis type and is characterized by sores in the lower extremities.
What are the potential complications?
These lesions, when left undiagnosed, can lead to the following clinical complications –
- Pyloric outlet obstruction
- A hiatal hernia
- Gastroesophageal reflux disease
- Carcinoma of the stomach
How is it diagnosed and treated?
For diagnosis of gastric ulcers, endoscopy of the upper digestive tract is carried out.
The treatment method used for treating ulcers depends upon the cause of the ulcers – bacterial infection caused by the H.pylori bacteria or otherwise. If it is a bacterial infection, antibiotics are used to eliminate the pathogens and also reduce the acidic content of the stomach. If left untreated, ulcers can worsen over time and damage the linings of stomach. They may lead to internal bleeding and even permanent scaring of tissues. Surgical intervention or endoscopy might be required at this stage to treat the ulcer.
One should refrain from consuming foods that are too greasy or spicy and put a strain on the GI tract. Smoking and drinking should be strictly prohibited. Additionally, it is important to reduce stress in order to prevent recurring ulcers.The steady growth of ulcer cases in the past few years has alarmed global health organizations. Healthy dietary habits need to be formed from childhood to reduce risks in future.
- Long-term or frequent use of NSAIDs (non-steroidal anti-inflammatory drugs) is linked closely to increased episodes of ulcers.
- Around 30%-40% of Americans experience an H.pylori bacteria infection, which may cause the formation of peptic ulcers.
• 1-3 million Americans suffer from decubitus ulcers or bed sores.
• Contrary to popular myth, 90% of ulcers are a result of stress or bacterial infection, and not due to consumption of spicy food.
• 12.5% of the entire global population will experience ulcers in the digestive tract (duodenum or stomach lining) at least once.
• People from every age group develop ulcers, but gastric ulcers are more prevalent in people above 40 years of age.
Dos and Don'ts
- Consume more fresh fruits and vegetables. Ensure that you are chewing the food properly.
- Keep yourself well hydrated.
- Aloe Vera juice has ulcer healing properties. Its high vitamin A content helps in swift healing of ulcers.
- Bring large gaps between meals. Eat at regular intervals.
- Have high spice content in your food and for a few days avoid tea and coffee.
- Consume food items with high amounts of abrasive roughage such as nuts and bran.
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