Gastric (stomach) or duodenal (small intestine) ulcers are lesions that affect the lining of the digestive system. Ulcers can occur in any part of the digestive tract, starting from the mouth, passing through the esophagus and stomach, and ending in the small and large intestines.
Generally, when someone mentions suffering from an "ulcer," they are likely referring to a gastric or duodenal ulcer. These ulcers can result from various factors, with the main ones being infection with the bacterium Helicobacter pylori or the use of medications that harm the stomach lining. Apart from abdominal pain and discomfort, ulcers in the stomach and duodenum can be associated with complications such as bleeding, perforation (formation of a hole in the stomach or duodenum), and more.
What causes gastric and duodenal ulcers?
In the past, it was commonly believed that lifestyle factors like stress, worry, and smoking were the main causes of gastric and duodenal ulcers. However, further research has shown that stomach acids—hydrochloric acid and pepsin—play a role in their development. Nowadays, studies indicate that the majority of ulcers (80% of gastric ulcers and 90% of duodenal ulcers) develop as a result of infection with the bacterium Helicobacter pylori (H. pylori). Despite the contribution of lifestyle factors, acid (pepsin), and H. pylori to ulcer development, H. pylori is considered the primary factor in most cases.
Factors contributing to the development of peptic ulcers:
1. Helicobacter pylori: Research shows that the majority of ulcer development is a result of infection with the bacterium Helicobacter pylori (H. pylori). The bacterium produces substances that weaken the stomach's protective lining, making it more susceptible to acid and pepsin. This leads to an inflammatory process and the eventual formation of an ulcer. It's important to note that the bacterium is present in the stomach in high percentages in many individuals without causing ulcers.
2. Smoking: Studies indicate that smoking increases the likelihood of developing ulcers and slows the healing process of existing ulcers.
3. Caffeine: Caffeine can increase stomach acid secretion, which may worsen the pain of existing ulcers. However, acid irritation in the stomach is not solely attributed to caffeine.
4. Alcohol: While there is no direct proven link between alcohol consumption and gastric ulcers, ulcers are more common in individuals with alcoholic liver disease, a condition often associated with alcohol consumption.
5. Stress: Although emotional stress is no longer considered a direct cause of ulcers, people with ulcers often report that stress exacerbates the pain.
6. Physical stress: Physical stress can increase the risk of developing ulcers, especially in the stomach. For example, individuals with injuries such as severe burns or those who have undergone major surgery often require meticulous treatment to prevent stress ulcers.
7. Gastric acid and pepsin: Hydrochloric acid and pepsin contribute to the formation of ulcers.
8. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These drugs (e.g., aspirin, ibuprofen, naproxen sodium, and indomethacin) increase stomach acid and pepsin secretion. NSAIDs are commonly used without a prescription for treating fever, headaches, minor pain, and general discomfort.
What are the symptoms of gastric and duodenal ulcers?
Not everyone with ulcers experiences symptoms. The most common symptom is a burning or gnawing pain in the upper abdomen, between the chest and belly button. The pain often occurs between meals and in the early hours of the morning, lasting from a few minutes to several hours.
Less common symptoms of ulcers may include:
- Nausea
- Vomiting
- Poor appetite
- Weight loss
- Fatigue and weakness
- Belching
What are some complications of peptic ulcers?
Individuals with gastric or duodenal ulcers may experience serious complications if appropriate treatment is not sought in time. The most common problems include:
- Bleeding: Bleeding can occur when the ulcer is deep or affects blood vessels in the duodenal lining, leading to blood loss that can be severe at times.
- Perforation: Sometimes, an ulcer can cause a hole in the wall of the stomach or duodenum. Bacteria and food particles may leak into the abdominal cavity, causing inflammation of the peritoneum (the lining of the abdomen).
- Obstruction and narrowing: Ulcers located at the outlet of the stomach, near the connection to the duodenum, can cause swelling and scarring, which may narrow or block the passage to the intestines. This obstruction can prevent food from passing from the stomach to the small intestine, leading to vomiting.
How are ulcers diagnosed?
It's essential to diagnose the condition correctly and distinguish between ulcers caused by Helicobacter pylori infection and those not caused by it, as the treatment varies significantly between the two. Several diagnostic options are available for ulcers, as well as testing for the presence of the H. pylori bacterium.
1. Upper gastrointestinal (GI) series (barium swallow): This diagnostic test examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first part of the small intestine). The patient swallows barium (a chemical agent that aids in visualizing the organs on an X-ray) so that they can be displayed on an X-ray.
2. Upper endoscopy (also called gastroscopy or EGD): It is a procedure that allows the doctor to examine the interior of the esophagus, stomach, and duodenum by inserting a flexible tube with a camera (endoscope) through the mouth and throat and then into the stomach and duodenum. Endoscopy enables the physician to see the inner part of this body area and to add devices through the scope for the removal of tissue samples for biopsy if necessary.
3. Blood tests, breath tests, and stomach tissue tests: These tests are used to detect the presence of Helicobacter pylori. It should be noted that tests for H. pylori may occasionally yield false-positive or false-negative results, especially in individuals who have recently taken antibiotics.