Peptic ulcers (from the Greek word “peptikós”, meaning “digestive”) are lesions of the digestive canal which may interest the internal part (mucosa) of the stomach (gastric ulcers) or the upper part of the small intestine, the duodenum (duodenal ulcer). The aggression by digestive enzymes causes the wound; this occurs when the protective features of the mucous membrane are lost due to chronic inflammation or to the action of irritants. The most frequent cause is an infection cause by a bacteria called Helicobacter pylori (Hp).
- Duodenal ulcer is the most common ulcer (65% of cases); it appears in younger subjects (it usually first appears in subjects aged between 30 and 50) and it is more common among men.
- Gastric ulcers are less frequent, they appear in older subjects (over 60) and are usually associated with atrophic chronic gastritis.
Do not mistake ulcers with gastritis, which is an inflammation of the stomach walls which can lead to ulceration over time.
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Symptoms
What are the most common symptoms? The most common symptom of an ulcer is a dull pain in the abdomen (in the area between the navel and the sternum), lasting from a few minutes to several hours, sometimes defined as a sense of swelling, heaviness or a feeling of hunger.
Pain worsens when the stomach is empty and it can be temporarily relieved by eating certain foods that limit stomach acidity or medications that help reduce acidity.
The pain can be accompanied by nausea, vomit, loss of appetite, and weight loss.
In other cases, patients have no signs of pain or vomit, but they have anaemia, caused by chronic and microscopic bleeding from the ulcer.
Finally, some patients can show complications of this conditions very early on: haemorrhage, perforation, penetration to adjacent organs, strictures of the digestive system. Changes in pain patterns often indicate complications: pain that becomes constant and radiates towards the back may be a symptom that the ulcer has penetrated the pancreas; pain accentuated by food and accompanied by vomiting may indicate an obstruction of the digestive tract; sudden and generalized abdominal pain may indicate a perforation of the bowel in the abdominal cavity.
In alcuni casi a questo dolore sono associati nausea, vomito, mancanza di appetito e calo di peso.
In altri casi, invece, i pazienti sono asintomatici per dolori o vomito, ma presentano anemia, dovuta alla perdita cronica e microscopica di sangue dall’ulcera.
Infine, in alcuni pazienti possono presentarsi, anche da subito, le complicanze della malattia: emorragia, perforazione, penetrazione in organi adiacenti, restringimenti dell’apparato digerente. I cambiamenti delle caratteristiche del dolore spesso indicano la presenza di complicanze: un dolore che diventa costante e si irradia posteriormente può essere espressione di una penetrazione al pancreas; un dolore accentuato dal cibo e accompagnato da vomito può indicare un processo ostruttivo dell’apparato digerente; un dolore addominale improvviso e generalizzato può indicare una perforazione delle viscere in cavità addominale.
What is it?
Peptic ulcers (from the Greek word “peptikós”, meaning “digestive”) are lesions of the digestive canal which can affect the internal part (mucosa) of the stomach (gastric ulcers) or the upper part of the small intestine, the duodenum (duodenal ulcer). The wound is caused by an aggression by digestive enzymes; this occurs when the protective features of the mucous membrane are lost due to chronic inflammation or to the action of irritants.
• Duodenal ulcer is the most common ulcer (65% of cases); it appears in younger subjects (it usually first appears in patients between the ages of 30 and 50) and it is more common among men.
• Gastric ulcers are less frequent, they appear in older subjects (over 60) and they are usually associated with atrophic chronic gastritis.
Ulcers must not be mistaken for gastritis; the latter is an inflammation of the stomach walls which can lead to ulceration over time.
Risk factors
What are the causes and risk factors? The most common cause of peptic ulcers is Helicobacter pylori (Hp), a type of bacteria that lives and multiplies in the mucous layer that lines and protects stomach and small bowel walls. This bacteria does not normally cause problems, but in some cases it can attack the mucosa and cause a lesion.
Other causes or aggravating factors of peptic ulcer include:
• regular use of certain pain relievers (nonsteroidal anti-inflammatory drugs – NSAID) can irritate or inflame the mucosa.
• smoking: nicotine contained in tobacco increases the volume and concentration of gastric acids, increasing the risk of developing an ulcer. Smoking can also slow down the healing process of a treated ulcer.
• alcohol abuse: alcohol can irritate and corrode the gastric mucous lining causing inflammation and bleeding.
• stress: it can worsen symptoms of peptic ulcer and, in some cases, slow down the healing process.
Treatment options
Can peptic ulcer be treated?
Treatment for peptic ulcer is aimed at reducing the level of acids in the digestive tract to help the ulcer heal. Particularly, protonic pump inhibitors (PPIs) reduce stomach acid by blocking the “pumps” located inside acid-secreting cells. These medications can usually resolve the condition in a few weeks.
In patients who are positive for Hp infection, antibiotic therapy is also used to neutralize the bacteria.
Are there ulcers that fail to heal?
Peptic ulcers that don’t heal with treatment are called refractory ulcers. Surgery is only needed if the ulcer does not respond to an aggressive pharmacological treatment. An ulcer can fail to heal for several reasons:
• not taking medications according to directions
• the presence of a strain of H. pylori that is resistant to antibiotics
• regular consumption of tobacco and alcohol
• regular use of anti-inflammatory drugs
Lifestyle changes
When ulcers are healing, it is particularly important to keep an eye on food and on your stress levels. Acidic or spicy foods can increase the pain; the same goes for stress, which can cause an increase in acidity. These are some useful rules for people suffering with ulcers:
• don’t smoke
• limit alcohol
• avoid nonsteroidal anti-inflammatory drugs
• keep acid reflux under control (avoid spicy and fatty foods, do not lie down immediately after meals, use extra pillows and try to maintain a healthy weight).
Diagnosis
How are ulcers diagnosed?
The presence of ulcers is confirmed through endoscopy and x-rays. Endoscopy (gastroscopy) is usually the first approach chosen, as the direct observation of the ulcers allows medical professionals to assess its size and shape and to collect a sample (biopsy).
• Gastroscopy consists in passing a long, thin tube equipped with a camera down your throat: this tube goes down into your oesophagus, stomach and duodenum, so that the doctor can see the upper tract of the digestive system and check for the presence of ulcers.
• X-rays of the upper gastric tract is performed after drinking a white, metallic-tasting fluid (it contains barium), which will cover the internal mucous membrane of the digestive tract, making ulcers visible.
• Biopsy can detect the presence of Hp inside the gastric mucous membrane.
The main methods used to diagnose the presence of Helicobacter pylori are:
• Esophagogastroduodenoscopy (EGDS): using an endoscope, your doctor will examine the oesophagus, stomach and duodenum from the inside, and collect biopsy samples for culture and histological testing.
• Blood tests searching for anti-Hp antibodies.
• Breath test uses a radioactive isotope of carbonium to show the presence of Hp in a sample of exhaled air.
• Stool tests searching for an antigen of Hp (HpSA).
