Stomach Ulcer Definition
A stomach ulcer involves an erosion in a person's gastrointestinal tract. An ulcer may also be referred to as a, 'Peptic Ulcer.' The most common form of ulcer is a duodenal ulcer which occurs within the first foot of a person's small intestine, just beyond their stomach. Ulcers which form in a person's stomach are referred to as, 'Gastric Ulcers.' Ulcers are neither cancerous, or contagious; duodenal ulcers are nearly always benign, and stomach ulcers may become malignant. Stomach ulcer disease affects millions of citizens in America each year. The size of the ulcer a person may experience ranges from between an eight of an inch to three-quarters of an inch.
Stomach ulcers can be a symptom of other conditions or disease, and are common in mastocytosis. Bleeding from stomach ulcers can cause a person to experience iron deficiency anemia. Children may also develop stomach ulcers. Approximately twenty-million Americans develop at least one stomach ulcer during their lifetime. Greater than forty-thousand Americans have surgery due to persistent problems or symptoms related to ulcers each year, while approximately six-thousand Americans die every year from stomach ulcer related complications.
A person's stomach is a bag of muscle which mixes and crushes food with pepsin and hydrochloric acid. Should the lining of the person's stomach or duodenum experience damage, the pepsin and acid work on the lining of their stomach in the same manner as they would food, breaking the lining down as they would to digest it. Too much pepsin and acid may damage the lining of the person's stomach, causing an ulcer. Damage may also come from other causes, making the person's stomach more susceptible to what might otherwise be ordinary levels of gastric acid.
Persons who remain untreated for ulcer could experience a bleeding ulcer. A bleeding ulcer is one that has eaten into the person's blood vessels, causing the person's blood to seep into their digestive tract. The person may also experience a perforated ulcer, a form of ulcer that has essentially eaten a hole in the wall of their stomach or duodenum, allowing partially digested food and bacteria into the hole, causing inflammation. Persons with untreated ulcers may also experience an obstruction or narrowing of their intestinal opening which prevents food from leaving their stomach and entering their small intestine.
Peptic ulcers are directly caused by the destruction of either the intestinal or gastric lining of a person's stomach by hydrochloric acid, a form of acid that is present in the digestive juices of the stomach. An infection, caused by the Helicobacter Pylori bacterium, is believed to play a role in causing both duodenal and gastric ulcers. The bacterium can be transmitted from person to person via food that has been contaminated, as well as through water.
An injury to the gastric mucosal lining, in combination with a weakening of the person's mucous defenses, can also cause a gastric ulcer. Excessive secretion of hydrochloric acid, psychological stress, as well as genetic predisposition, are contributing factors to either the formation or worsening of duodenal ulcers. Chronic use of anti-inflammatory medications, as well as cigarette smoking, can worsen duodenal ulcers, or cause treatment to fail.
A person's stomach defends itself from pepsin and hydrochloric acid through the creation of a mucus coating which shields their stomach, production of bicarbonate, and circulation of blood to their stomach lining in order to assist in both cell renewal and repair. Should any of these functions which protect a person's stomach experience impairment, an ulcer may form. Caffeine stimulates the secretion of acid in a person's stomach, aggravating pain associated with an existing ulcer. Non-steroidal anti-inflammatory medication, such as ibuprofen, aspirin, naproxin, or piroxicam, can interfere with the stomach's ability to produce both bicarbonate and mucus, as well as affecting the flow of blood to a person's stomach, hindering cell repair and causing the stomach's defense mechanisms to fail.
Alcoholic cirrhosis has been linked to increased risk of ulcers, while heavy drinking has been shown to delay the healing of ulcers. While emotional stress may not cause ulcers, people who have ulcers report that emotional stress has increased the pain they experience in association with ulcers. Physical stress increases a person's risk of developing gastric ulcers.
The main symptoms related to an ulcer include burning and a gnawing sensation in the stomach which last anywhere from thirty minutes to several hours. The pain associated with an ulcer is often interpreted as indigestion, hunger, or heartburn. Some persons experience the symptoms right after eating; others may not experience symptoms until several hours later. Persons with ulcers may have pain that awakens them at night. Some people experience pain for weeks, followed by weeks where they do not have pain at all.
A stomach ulcer affects the nerves which surround it. The nerves that are affected become agitated, causing the person pain. Stomach ulcers may cause hemorrhages due to erosion of a major blood vessel, or a tear in the wall or the person's intestine or stomach. The result may be peritonitis or an obstruction of the person's gastrointestinal tract due to either swelling or a spasm in the area of the person's ulcer. The risks of developing an ulcer can include:
Persons who have an ulcer may or may not experience any symptoms. Symptoms associated with an ulcer can include:
A doctor has a number of options available to them in order to diagnose an ulcer. Endoscopic and X-ray examinations are among these options, as well as testing for the H. Pylori bacterium. Endoscopy involves use of a fiber-optic endoscope that a doctor uses to illuminate and examine the person's esophagus, stomach, and duodenum. The doctor is able to look for inflammation, ulcerated or infected areas, as well as malformations and growths.
Should the doctor suspect an ulcer, they may order an upper GI series of X-rays of the person's esophagus, stomach and duodenum. The person swallows a liquid containing barium. Barium makes ulcers visible on an X-ray.
Another test a doctor can order is a, 'Gastroscopy,' which involves insertion of a flexible tube into the person's throat. The tube assists the doctor in seeing ulcers, as well as obtaining tissue samples for examination under a microscope to find out if the person's ulcer is cancerous.
Confirmation of the presence of the H. Pylori bacterium can help a doctor to eliminate it, curing the person's ulcer. The bacterium can be detected through tissue, breath, or blood testing. The Meretek UBT Breath Test requires the person to drink a liquid, or swallow a capsule containing an amount of protein, then blow through a straw into a balloon. A lab technician then checks the air the person has exhaled for evidence of the bacterium.
Treatment for ulcers involves several things, to include modification of the person's lifestyle and reduction of the amount of stress they experience. A doctor can treat duodenal and gastric ulcers with a number of types of medicines, to include H2-blockers, mucosal protective agents, and proton-pump inhibitors. To treat H. Pylori, these medications are used in conjunction with antibiotics. Should medications prove ineffective, or should complications arise, surgery may become needed.
H2-blockers are used to reduce the amount of acid the person's stomach produces. Examples of H2-blockers include Ranitidine, Cimetidine, Nizatidine, and Famotidine. The person usually takes a single dose at bedtime in order to start healing a duodenal ulcer over a four week period of time, and a gastric ulcer in six to eight weeks.
Proton-pump inhibitors, on the other hand, modify the production of acid in the person's stomach by stopping their stomach's acid pump. An example of a proton-pump inhibitor is Omeprazole, which has ten-times the ability to suppress stomach acid than an H2-blocker, healing a duodenal ulcer in two to four weeks.
Mucosal protective agents protect a person's stomach's mucous lining from acid. Examples of this type of medication include Misoprostol, and Sucralfate. Non-prescription forms of these medications include antacids and bismuth subsalicylate.
Antibiotics can be administered to persons who are infected with the H. Pylori bacteria, causing ulcers. Examples of antibiotics that are commonly prescribed include Tetracycline and Metronidazole, although a doctor may substitute amoxicillin or clarithromycin.
Should surgery become necessary because other methods of treatment have failed, there are some common forms of surgery that are available. These forms of surgery include antrectomy, vagotomy, and pyloroplasty. A vagotomy cuts the person's vagus nerve which transmits messages from the person's brain to their stomach, interrupting acid secretions. An antrectomy removes the lower part of a person's stomach called the, 'Antrum.' The Antrum produces a hormone that stimulates the person's stomach to secrete digestive juices. The surgery enlarges the opening into the person's duodenum and small intestine, allowing contents to move more freely from their stomach. A Pyloroplasty involves cutting and re-suturing the pylorus valve at the lower portion of the person's stomach, as well as relaxing and widening its opening into the person's duodenum.