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Ulcers (Digestive)

Ulcers (Digestive)

Definition

In general, an ulcer is any eroded area of skin or a mucous membrane, marked by tissue disintegration. In common usage, however, ulcer usually is used to refer to disorders in the upper digestive tract. The terms ulcer, gastric ulcer, and peptic ulcer often are used loosely and interchangeably. Peptic ulcers can develop in the lower part of the esophagus, the stomach, the first part of the small intestine (the duodenum), and the second part of the small intestine (the jejunum).

Description

It is estimated that 2% of the adult population in the United States has active peptic ulcers, and that about 10% will develop ulcers at some point in their lives. There are about 500,000 new cases of peptic ulcer in the United States every year, with as many as 4 million recurrences. The male/female ratio for ulcers of the digestive tract is 3:1.

The most common forms of peptic ulcer are duodenal and gastric. About 80% of all ulcers in the digestive tract are duodenal ulcers. This type of ulcer may strike people in any age group but is most common in males between the ages of 20 and 45. The incidence of duodenal ulcers has dropped over the past 30 years. Gastric ulcers account for about 16% of peptic ulcers. They are most common in males between the ages of 55 and 70. The single most common cause of gastric ulcers is the use of nonsteroidal anti-inflammatory drugs, or NSAIDs. The widespread use of NSAIDs is thought to explain why the incidence of gastric ulcers in the United States is rising.

Causes and symptoms

Causes of peptic ulcers

There are three major causes of peptic ulcers: infection, certain types of medication, and disorders that cause oversecretion of stomach juices.

HELICOBACTER PYLORI INFECTION. Helicobacter pylori is a rod-shaped gram-negative bacterium that lives in the mucous tissues that line the digestive tract. Infection with H. pylori is the most common cause of duodenal ulcers. About 95% of patients with duodenal ulcers are infected with H. pylori, as opposed to only 70% of patients with gastric ulcers.

USE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS). Nonsteroidal anti-inflammatory drugs, or NSAIDs, are painkillers that many people use for headaches, sore muscles, arthritis, menstrual cramps, and similar complaints. Many NSAIDs are available without prescriptions. Common NSAIDs include aspirin, ibuprofen (Advil, Motrin), flurbiprofen (Ansaid, Ocufen), ketoprofen (Orudis), and indomethacin (Indacin). Chronic NSAID users have 40 times the risk of developing a gastric ulcer as nonusers. Users also are three times more likely than nonusers to develop bleeding or fatal complications of ulcers. Aspirin is the NSAID that is most likely to cause ulcers.

MISCELLANEOUS SYNDROMES AND DISORDERS. Fewer than 5% of peptic ulcers are due to these disorders. They include Zollinger-Ellison syndrome, a disorder in which small tumors, called gastrinomas, secrete a hormone (gastrin) that stimulates the production of digestive juices. Because of this excess secretion, these disorders are sometimes called hypersecretory syndromes.

OTHER RISK FACTORS. Smoking is an important risk factor that increases a patient's chance of developing an ulcer, decreases the body's response to therapy, and increases the chances of dying from ulcer complications. Blood type appears to be a predisposing factor for ulcer location; people with type A blood are more likely to have gastric ulcers, while those with type O are more likely to develop duodenal ulcers. The role of emotional stress in ulcer development is currently debated. Present research indicates that an individual's attitudes toward stress, rather than the amount of stress by itself, is a better predictor of vulnerability to peptic ulcers. Preferences for high-fat or spicy foods do not appear to be significant risk factors.

Symptoms

GASTRIC ULCERS. The symptoms of gastric ulcers include feelings of indigestion and heartburn, weight loss, and repeated episodes of gastrointestinal bleeding. Ulcer pain often is described as gnawing, dull, aching, or resembling hunger pangs. The patient may be nauseated and suffer loss of appetite. About 30% of patients with gastric ulcers are awakened by pain at night. Many patients have periods of chronic ulcer pain alternating with symptom-free periods that last for several weeks or months. This characteristic is called periodicity.

DUODENAL ULCERS. The symptoms of duodenal ulcers include heartburn, stomach pain relieved by eating or antacids, weight gain, and a burning sensation at the back of the throat. The patient is most likely to feel discomfort two to four hours after meals, or after having citrus juice, coffee, or aspirin. About 50% of patients with duodenal ulcers awake during the night with pain, usually between midnight and three a.m. A regular pattern of ulcer pain associated with certain periods of day or night or a time interval after meals is called rhythmicity.

Not all digestive ulcers produce symptoms; as many as 20% of ulcer patients have so-called painless or silent ulcers. Silent ulcers occur most frequently in the elderly and in chronic NSAID users.

Complications

Between 10-20% of peptic ulcer patients develop complications at some time during the course of their illness. All of these are potentially serious conditions. Complications are not always preceded by diagnosis of or treatment for ulcers; as many as 60% of patients with complications have not had prior symptoms.

HEMORRHAGE. Bleeding is the most common complication of ulcers. It may result in anemia, vomiting blood (hematemesis), or the passage of bright red blood through the rectum (melena). About half of all cases of bleeding from the upper digestive tract are caused by ulcers. The mortality rate from ulcer hemorrhage is 6-10%.

PERFORATION. About 5% of ulcer patients develop perforations, which are holes in the duodenal or gastric wall through which the stomach contents can leak out into the abdominal cavity. The incidence of perforation is rising because of the increased use of NSAIDs, particularly among the elderly. The signs of an ulcer perforation are severe pain, fever, and tenderness when the doctor touches the abdomen. Most cases of perforation require emergency surgery. The mortality rate is about 5%.

PENETRATION. Ulcer penetration is a complication in which the ulcer erodes through the intestinal wall without digestive fluid leaking into the abdomen. Instead, the ulcer penetrates into an adjoining organ, such as the pancreas or liver. The signs of penetration are more severe pain without rhythmicity or periodicity, and the spread of the pain to the lower back.

OBSTRUCTION. Obstruction of the stomach outlet occurs in about 2% of ulcer patients. It is caused by swelling or scar tissue formation that narrows the opening between the stomach and the duodenum (the pylorus). Over 90% of patients with obstruction have recurrent vomiting of partly digested or undigested food; 20% are seriously dehydrated. These patients also usually feel full after eating only a little food, and may lose weight.

Diagnosis

Physical examination and patient history

The diagnosis of peptic ulcers should rarely be made on the basis of a physical examination alone. However, a 2003 report showed that many ulcer diagnoses made based solely on physical exams actually are only dyspepsia, or upper adnominal pain and discomfort not caused by ulcers. The only significant finding may be mild soreness in the area over the stomach when the doctor presses (palpates) it. The doctor is more likely to suspect an ulcer if the patient has one or more of the following risk factors:

  • male sex
  • age over 45
  • recent weight loss, bleeding, recurrent vomiting, jaundice, back pain, or anemia
  • history of using aspirin or other NSAIDs
  • history of heavy smoking
  • family history of ulcers or stomach cancer

Endoscopy and imaging studies

An endoscopy is considered the best procedure for diagnosing digestive ulcers and for taking samples of stomach tissue for biopsies. An endoscope is a slender tube-shaped instrument that allows the doctor to view the tissues lining the stomach and duodenum. Duodenal ulcers are rarely malignant. If the ulcer is in the stomach, however, the doctor will take a tissue sample because 3-5% of gastric ulcers are malignant. Radiological studies are sometimes used instead of endoscopy because they are less expensive, more comfortable for the patient, and are 85% accurate in detecting malignancies.

Laboratory tests

BLOOD TESTS. Blood tests usually give normal results in ulcer patients without complications. They are useful, however, in evaluating anemia from a bleeding ulcer or a high white cell count from perforation or penetration. Serum gastrin levels can be used to screen for Zollinger-Ellison syndrome.

TESTS FOR HELICOBACTER PYLORI. It is important to test for H. pylori because almost all ulcer patients who are not taking NSAIDs are infected. Noninvasive tests include blood tests for immune response and a breath test. In the breath test, the patient is given an oral dose of radiolabeled urea. If H. pylori is present, it will react with the urea and the patient will exhale radiolabeled carbon dioxide. Invasive tests for H. pylori include tissue biopsies and cultures performed from fluid obtained by endoscopy.

Treatment

Medications

Most drugs that are currently given to treat ulcers work either by lowering the rate of stomach acid secretion or by protecting the mucous tissues that line the digestive tract.

ANTISECRETORY DRUGS. Medications that lower the rate of stomach acid secretions fall into two major categories: proton pump inhibitors, which bind an enzyme that secretes stomach acid, and H2 receptor antagonists, which work by reducing intracellular acid secretion. The proton pump inhibitors include omeprazole (Prilosec) and lansoprazole (Prevacid). The H2 receptor antagonists include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). Both types of drugs have few serious side effects and appear to be safe for long-term use.

PROTECTIVE DRUGS. The drugs that are currently used to protect the stomach tissues are sucralfate (Carafate), which forms a pastelike substance that clings to the mucous tissues and prevents further damage from stomach acid; and bismuth preparations. A third type of protective drug includes misoprostol (Cytotec), which is often given to patients with ulcers caused by NSAIDs.

Surgery

Surgical treatment of ulcers is generally used only for complications and suspected malignancies. The most common surgical procedures that are used are vagotomies, in which the connections of the vagus nerve to the stomach are cut in order to reduce acid secretion; and antrectomies, which involve the removal of a part of the stomach (the antrum).

Eradication of Helicobacter pylori

Most doctors presently recommend treatment to eliminate H. pylori in order to prevent ulcer recurrences. Without such treatment, ulcers recur at the rate of 80% per year. A 2003 report showed that eradication H. pylori alone usually prevents recurring bleeding ulcers. The usual regimen used to eliminate the bacterium is a combination of tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol).

Alternative treatment

Alternative treatments can relieve symptoms and promote healing of ulcers. A primary goal of these treatments is to rebalance the stomach's hydrochloric acid output and to enhance the mucosal lining of the stomach.

KEY TERMS

Duodenum The first of the three segments of the small intestine. The duodenum connects the stomach and the jejunum. Most peptic ulcers are in the duodenum.

Helicobacter pylori A gram-negative rodshaped bacterium that lives in the tissues of the stomach and causes inflammation of the stomach lining.

Zollinger-Ellison syndrome A disorder characterized by the presence of tumors (gastrinomas) that secrete a hormone (gastrin), which stimulates the production of digestive juices.

Food allergies have been pointed to as a major cause of peptic (stomach) ulcers. An elimination/challenge diet can help identify the allergenic food(s) and continued elimination of these foods can assist in healing the ulcer. People with ulcers should not take aspirin. They also should stop smoking, since smoking irritates the mucosal lining of the stomach. Antacids should be avoided by anyone with an ulcer, because they can cause a rebound effect of increasing gastric acid secretion, as well as deplete vital nutrients necessary for healing. Stress reduction is also important for ulcer sufferers.

Botanical medicine offers a variety of remedies that may be helpful in ulcer treatment. Deglycyrrhizinated licorice or DGL, in a chewable or powder form, can help heal the mucous membranes and increase mucous so that it mixes with saliva to protect the membranes. Raw cabbage juice, high in glutanic acid, is very effective in healing an ulcer (one quart per day in divided doses). Soothing herbs, such as plantain (Plantago major ), marsh mallow (Althaea officinalis ), and slippery elm (Ulmus fulva ); astringent herbs, such as geranium (Pelargonium odoratissimum ); and the anitmicrobial herb goldenseal (Hydrastis canadensis ) can all be effective. Nutritionists advise taking antioxidant nutrients, including vitamins A, C, and E, zinc, and selenium.

Prognosis

The prognosis for recovery from ulcers is good for most patients. Very few ulcers fail to respond to the medications that are currently used to treat them. Recurrences can be eliminated completely or cut to 5% by eradication of H. pylori. Most patients who develop complications recover without problems even when emergency surgery is necessary.

Prevention

Strategies for the prevention of ulcers or their recurrence include the following:

  • eradication of H. pylori in patients already diagnosed with ulcers
  • giving misoprostol to patients who must take NSAIDs
  • avoiding unnecessary use of aspirin and NSAIDs
  • giving up smoking
  • cutting down on alcohol, tea, coffee, and sodas containing caffeine.

Resources

PERIODICALS

"Many Peptic Ulcer Diagnoses Based on Symptoms Alone." AORN Journal August 2003: 210.

Worcester, Sharon. "Eradicating H. Pylori May Prevent Bleeding Ulcers: No [Histamine. Sub2] Blockers Needed." Internal Medicine News September 15, 2003: 33.

ORGANIZATIONS

American College of Gastroenterology. 4900-B South Thirty-First St., Arlington, VA 22206-1656. (703) 820-7400. http://www.acg.cgi.gi.org/acghome/html.

Digestive Health Initiative. 7910 Woodmont Ave., #914, Bethesda, MD 20814. (800) 668-5237. http://www.gastro.org./dhi.html.

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Frey, Rebecca; Odle, Teresa. "Ulcers (Digestive)." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved September 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601681.html

Ulcer Surgery

Ulcer Surgery

Definition

Ulcer surgery is a procedure used to cure peptic ulcer disease when medications have failed.

Purpose

Ulcer surgery is used to relieve a present peptic ulcer disease and to prevent recurrence of it.

Surgery is usually required if the ulcer is in one of the following states:

  • perforated and overflowed into the abdomen
  • scarred or swelled so much that the bowel is obstructed
  • acute bleeding
  • defied all other types of treatment

The need for ulcer surgery has diminished greatly over the past 20-30 years due to the discovery of two new classes of drugs and the presence of the causal germ Helicobacter pylori in the stomach. The drugs are the H2 blockers such as cimetidine and ranitidine and the proton pump inhibitors such as omeprazole. These effectively arrest acid production. H. pylori can be eliminated from most patients with a combination of antibiotics and bismuth.

Precautions

There is a tumor of the pancreas that produces a hormone called gastrin. Gastrin causes ulcers by stimulating acid production. If this diseaseZollinger-Ellison syndromedoes not respond to medical treatment, either the tumor or the entire stomach must be removed.

Description

The two primary goals of ulcer surgery, elimination of the current problem and prevention of future problems bring with them a third problemto perpetuate the normal function of the bowel. The vagus nerves relax the pylorus, allowing the stomach to empty. Cutting the vagus nerves, while reducing the stomach's acid production, also prevents stomach emptying. Therefore, the procedures described must guarantee stomach emptying along with their other goals.

Total gastrectomy

Removing the entire stomach is done only for resistant Zollinger-Ellison syndrome or extensive cancers.

Antrectomy

The lower half of the stomach makes most of the acid and gets all the peptic ulcers above the duodenum. Removing it leaves little place for ulcers to form and little acid to produce them.

Vagotomy

Cutting the vagus nerves can be done in three ways:

  • the main nerves can be cut completely as they enter the abdomen from the chest
  • the branches that go to the stomach can be cut as they leave the main nerves
  • the tiny branches that stimulate acid production can be cut on the surface of the stomach

Pyloroplasty

Opening up the valve at the outlet of the stomach guarantees that the stomach can empty, even without vagus nerve stimulation. Pyloroplasty is ordinarily done by cutting across the muscle that surrounds the outlet. It can also be done by passing a balloon down from the mouth and inflating it forcefully to stretch out the pylorus (opening from the stomach to the intestine).

Close perforation

For some patients all that can be done is to close the hole in the bowel and wait for the patient to recover before initiating corrective surgery.

Billroth I and II

After removing a piece of the stomach, the remainder must be reattached to the rest of the bowel. Simply joining the upper stomach back to the duodenum is called a Billroth I or gastroduodenostomy. It is sometimes better to attach the stomach with another piece of bowel (the jejunum), creating a "y" with the bile drainage and the duodenum forming the second branch of the "y." This part of the procedure is called a gastrojejunostomy. A gastroenterostomy is a more general term for connecting the stomach with any piece of bowel.

A selective vagotomy can be done alone. A complete vagotomy requires either a pyloroplasty or antrectomy. An antrectomy must be reconnected with either a Billroth I or a Billroth II.

Some of these procedures are now being done through a laparoscope.

Risks

All of these procedures carry risks, generally in proportion to their benefits. The more extensive surgeries such as vagotomy and antrectomy with Billroth II reconnection have the highest success rate and the highest complication rate.

Complications include:

  • Diarrhea after a meal
  • Dumping syndrome occurring after a meal and characterized by sweating, abdominal pain, vomiting, lightheadedness, and diarrhea
  • Hypoglycemia after a meal
  • Alkaline reflux gastritis marked by abdominal pain, vomiting of bile, diminished appetite, and irondeficiency anemia
  • Recurrence of an ulcer
  • Malabsorption of necessary nutrients, especially iron, in patients who have had all or part of their stomachs removed

Resources

BOOKS

Moody, Frank G., et al. "Stomach." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, edited by Mark Feldman, et al. Philadelphia: W. B. Saunders Co., 1998.

KEY TERMS

Gastrin A type of hormone that produces gastric juice.

Hypoglycemia An abnormal decrease in blood sugar level.

Jejunum Section of the small intestine.

Laparoscope A pencil-thin telescope that allows surgery to be done through half-inch incisions.

Pylorus The opening from the stomach to the intestine.

Vagus nerve Cranial nerves that supply the internal organs (viscera).

Zollinger-Ellison syndrome A syndrome marked by peptic ulcers and gastrinomas in the pancreas.

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Polsdorfer, Ricker. "Ulcer Surgery." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved September 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601679.html

ulcer

ulcer, open sore or circumscribed erosion, usually slow to heal, on the skin or mucous membranes. It may develop as a result of injury; because of a circulatory disturbance, e.g., in varicose veins or after prolonged bed rest; or in association with such diseases as tuberculosis, syphilis, or leprosy. Corneal ulcers, which result from infection, allergy, or foreign objects in the eye, can cause visual impairment if not treated promptly. Some ulcers may develop into cancer. The underlying cause must be treated as well as the ulcerous lesion.

Peptic ulcer occurs in the mucous membrane of the intestinal tract. An estimated 90% of peptic ulcers are caused by infection with a bacterium, Helicobacter pylori, strains of which promote the formation of ulcers by causing an inflammtory response in the cells of the stomach wall, making it more susceptible to the hydrochloric acid secreted by the stomach. Most commonly, it occurs in the stomach (gastric ulcer) or at the beginning of the small intestine (duodenal ulcer, the most common form) and causes abdominal pain, especially between meals.

Infection with the H. pylori bacterium, which is also associated with some stomach cancer, is very common, but not all strains promote the formation of ulcers. Approximately 50% of those over 60 in developed countries are infected; in developing countries the infection rate is much higher, and infection usually occurs earlier in life. Experts are as yet uncertain how the bacterium is spread. Around 20% of those infected develop ulcers. Peptic ulcer is found more frequently in men. Heavy aspirin or ibuprofen use and smoking increase the risk of ulcer development.

The connection of H. pylori infection with peptic ulcer was made in the early 1980s by Australian scientists Barry J. Marshall and J. Robin Warren. It previously was believed that peptic ulcers were caused by emotional stress, though since the early 1900s researchers had reported finding curved bacteria in the stomachs of dead patients with ulcers more often than in those without ulcers. Marshall and Warren were awarded the Nobel Prize in physiology or medicine in 2005 for their work. Treatment changed accordingly and now typically consists of antibiotics (such as clarithromycin or amoxicillin) plus metronidazole (Flagyl) and bismuth subsalicylate (e.g., Pepto-Bismol). For the relief of symptoms, drugs such as ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), and omeprazole (Prilosec) may also be used. Hemorrhage or perforation of peptic ulcers requires emergency medical treatment.

The full set of genes (genome) of H. pylori was determined in 1997. This achievement will help researchers design new drugs to treat and prevent diseases caused by the bacterium.

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ulcer

ulcer An erosion of an epithelial surface — the skin, or any of the internal linings (mucous membranes) that are in continuity with the skin at the body orifices. Damage may be physical, chemical, due to failure of blood supply or to infection. Peptic ulcer may be gastric or duodenal — affecting the mucous membrane of the stomach or of the duodenum, attributed to the effects of stomach acid, either when it is in excess, or when the normal defences against damage from it are lacking; now known to be linked with infection by Helicobacter pylori. Oesophageal ulcer is related to reflux of stomach contents. Underlying blood vessels can be eroded, with consequences that can be either insidious, or catastrophic in the case of peptic ulcers; bleeding is readily evident if blood is vomited (haematemesis), but less immediately so if it moves on down the gut to appear (in an altered state) in the faeces (melaena). Less dramatic bleeding can be detected by a test for occult blood in the stool. At worst erosion may penetrate right through the wall — most commonly of the duodenum — causing a perforated ulcer, and escape of gut contents leads to peritonitis.

Ulceration of the skin can occur on the legs as a complication of varicose veins, or of poor circulation due to arteriosclerosis. Bedsores are ulcers caused by prolonged pressure and immobility. Some types of skin cancers or other skin diseases can form ulcers. Aphthous ulcers are small painful erosions of the mucous membrane in the mouth. Without the protection of an intact surface, ulcers from any cause can become deeper due to injury or infection.

Sheila Jennett

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Ulcers

ULCERS

DEFINITION


An ulcer is any break in the skin or in a mucous membrane. Mucous membrane is a thin tissue that lines the interior surface of body openings. The term ulcer is used most commonly to refer to ulcers that occur in the upper part of the digestive system, such as peptic ulcers. At one time, doctors believed that ulcers were caused by too much stress. However, it is now known that bacterial infection accounts for more than three-quarters of all peptic ulcers.

DESCRIPTION


Experts estimate that about 2 percent of the adult population in the United States have active ulcers and that about 10 percent of all adults will have an ulcer at some point in their lives. Males have about three times as many ulcers as females.

Ulcers are sometimes classified according to the part of the digestive system in which they occur. Gastric ulcers occur in the stomach. Duodenal ulcers occur in the duodenum. The duodenum (pronounced doo-uh-DEE-nuhm) is the upper part of the small intestine, adjacent to the stomach.

A peptic ulcer is one that occurs in the upper digestive tract, in which the break in the mucous membrane is exposed to gastric acidic secretion. About 80 percent of all peptic ulcers occur in the duodenum. They are most common among males between the ages of twenty and forty-five. Gastric ulcers account for about 16 percent of all peptic ulcers and are most common in males between the ages of fifty-five and seventy.

CAUSES


There are three major causes of peptic ulcers: infection, certain types of medications, and other medical problems that cause the release of too much stomach juices.

Ulcers: Words to Know

Duodenum:
The upper part of the small intestine, joined to the lower part of the stomach.
Endoscope:
An instrument consisting of a long, narrow tube that can be inserted down the patient's throat to study the health of the patient's digestive system.
Helicobacter pylori :
A bacterium that lives in mucous membrane and is responsible for the development of ulcers.
Nonsteroidal anti-inflammatory drugs (NSAIDs):
A group of drugs used to treat pain and fever, including aspirin, ibuprofen, and acetaminophen.
Peptic ulcer:
A general name referring to ulcers in any part of the digestive system.

Helicobacter pylori is a bacterium that lives in mucous membranes in the digestive system. It causes about 95 percent of all duodenal ulcers and 70 percent of all gastric ulcers.

The use of nonsteroidal anti-inflammatory drugs (NSAIDS) also tends to cause ulcers. Nonsteroidal anti-inflammatory drugs are painkillers. People use these drugs for headaches, sore muscles, menstrual cramps, and similar complaints. Some common NSAIDS are aspirin, ibuprofen (pronounced i-byoo-PRO-fuhn, trade names Advil, Motrin), and acetaminophen (pronounced uhsee-tuh-MIN-uh-fuhn, trade name Tylenol). People who use NSAIDS on a regular basis are forty times more likely to get ulcers than those who do not. Aspirin is the NSAID most likely to cause ulcers. Aspirin should not be given to children because of the risk of Reye's syndrome (see Reye's syndrome entry).

Some medical problems can increase the risk of ulcers. For example, Zollinger-Ellison syndrome causes an unusually large release of digestive juices in the stomach and this excess secretion can create ulcers.

Other factors may also increase a person's risk for ulcers. For example, smokers are more likely to develop an ulcer and are also more likely to die from the complications of an ulcer. People with blood type A are more likely to have gastric ulcers, while those with type O are more likely to develop duodenal ulcers.

Scientists are still debating the role of stress in the formation of ulcers. Stress is no longer regarded as a primary cause of the disorder. But some specialists think that it may be a contributing factor.

SYMPTOMS


The symptoms of gastric ulcers include feelings of indigestion and heartburn, weight loss, and repeated cases of bleeding in the stomach. Ulcer pain is sometimes described as gnawing, dull, aching, or similar to hunger pangs. Patients may experience nausea or appetite loss. In many cases, ulcer pain comes and goes over long periods of time.

The primary symptoms of duodenal ulcers include heartburn, stomach pain, weight gain, and a burning feeling at the back of the throat. A patient is most likely to feel discomfort two to four hours after meals.

About 20 percent of all people with peptic ulcers experience no symptoms. This form of the condition is called painless or silent ulcers. Between 10 to 20 percent of all peptic ulcer patients develop complications at some time in their illness. All of these complications can be very serious. In many cases, complications appear without any other signs of an ulcer. Some common complications include:

  • Hemorrhage. Bleeding is the most common complication of ulcers. If bleeding continues, a patient may become anemic. Anemia (see anemias entry) is a condition that develops when a person does not have enough red blood cells. It can lead to extreme tiredness, weight loss, and, in the worst cases, death. About 6 to 10 percent of all patients with a bleeding ulcer die of the problem.
  • Perforation. A perforation is a hole in the wall of the stomach or intestine. The hole allows stomach fluids to leak out into the abdominal cavity. These fluids are very acidic and can cause serious damage to body tissues. The signs of perforation include severe pain, fever, and tenderness of the abdomen. About 5 percent of patients with a perforated ulcer die of the condition.
  • Penetration. Penetration occurs when an ulcer spreads to some organ adjacent to the digestive system. It may affect the liver or pancreas, for example. Signs of penetration include severe pain that spreads to the lower back.
  • Obstruction. Over time, ulcers can form scar tissue. In some cases, this scar tissue can block the opening between the stomach and the duodenum. Food is not able to move all the way through the digestive system. The most common symptom of an obstruction is vomiting. The vomiting is caused by undigested food expelled from the stomach. Obstruction occurs in about 2 percent of all ulcer patients.

DIAGNOSIS


The first indication of an ulcer is likely to be a patient's complaint about one or more of the described symptoms. When a patient visits a physician for diagnosis, a physical examination alone is not enough. A doctor will look for certain factors in the patient's history that may suggest the presence of an ulcer. These factors include:

  • If the patient is male
  • Age over forty-five
  • Recent weight loss, bleeding, repeated episodes of vomiting, back pain, or anemia
  • History of using aspirin or other NSAIDs
  • History of heavy smoking
  • Family history of ulcers or stomach cancer

Endoscopy (pronounced en-DOS-kuh-pee) is one of the best ways to diagnose an ulcer. An endoscope consists of a long, narrow tube that can be inserted down the patient's throat. The tube contains a light and a tiny camera at one end. The doctor can actually look at the interior walls of the stomach and duodenum. If necessary, tiny scissors may also be attached to the endoscope. The scissors can be used to cut off a small sample of mucous membrane, which can be examined for the presence of stomach cancer. About 5 percent of ulcers develop into stomach cancer.

Imaging techniques can also be used to diagnose ulcers. These techniques are not as reliable as endoscopy but they are more comfortable for the patient. Imaging requires the patient to drink a fluid containing a substance that is opaque, or nontransparent, to X rays. An X-ray photograph is then taken of the patient's digestive system. The opaque substance appears as a white patch on the photograph and shows any abnormal structures, such as an ulcer, that may be present.

Blood tests are usually not very helpful in diagnosing ulcers. However, they may indicate when a patient has become anemic because of a bleeding ulcer.

The most important laboratory tests to perform are those that detect the Helicobacter pylori bacterium. One such test is a breath test. A patient is given a drink containing a radioactive substance that the bacterium will react with if it is present. The patient is then asked to breathe into a mechanism that determines whether the patient's breath is radioactive. If it is, that means the bacterium is present. This kind of test is important since the vast majority of people with ulcers are infected with Helicobacter pylori.

TREATMENT


Many symptoms of ulcers can be treated with over-the-counter medications. These medications may relieve the pain, nausea, and general discomfort caused by ulcers. However, they do not cure the disorder.

Two other types of medications are designed to reduce the symptoms of ulcers. Antisecretory drugs are drugs that reduce the amount of acid produced in the stomach. Acid attacks mucous membranes and can produce ulcers, so by lowering the amount of stomach acid released, the risk of ulcer formation can be reduced.

Protective drugs are also used to treat ulcers. A protective drug is a substance that forms a thin lining over mucous membranes, which protects the mucous membranes from attack by stomach acid.

Surgery is generally not used to treat ulcers. However, some of the complications caused by ulcers may require surgery. For example, doctors may cut the vagus nerve to the stomach. The vagus nerve (pronounced VAY-guhss) controls the release of stomach acid. After the cut, less stomach acid will be released, thus reducing the risk of ulcer formation.

One direct method for treating ulcers is to kill the bacteria that is responsible for most the vast majority of deaths caused by ulcers. Unless these bacteria are eliminated from the digestive system, ulcers will come back again and again. The drug used to kill Helicobacter pylori is the antibiotic tetracycline (pronounced tet-ruh-SI-kleen).

Alternative Treatment

Herbalists believe that a variety of natural products can help heal ulcers. For example, they recommend raw cabbage juice to help heal an ulcer. Some herbs that may soothe the symptoms of ulcers include plantain, marsh mallow, slippery elm, geranium, and goldenseal. Nutrition experts recommend taking certain vitamins and minerals, including vitamins A, C, and E, and the minerals zinc and selenium.

PROGNOSIS


The prognosis for recovery from ulcers is good for most patients. Nearly all ulcers respond to the medications now used to treat them. The rate of recurrence of ulcers can be cut to 5 percent through the elimination of the Helicobacter pylori bacterium.

PREVENTION


Methods for preventing ulcers include the following:

  • Elimination of the Helicobacter pylori bacterium
  • Avoiding unnecessary use of aspirin and other NSAIDs
  • Giving up smoking
  • Cutting down on alcohol, tea, coffee, sodas, and other products that contain caffeine

FOR MORE INFORMATION


Books

Ostrov, Rikki. Ulcers: A Guide to Diagnosis, Treatment and Prevention. Thorsons Publications, 1996.

Thompson, W. Grant. The Ulcer Story: The Authoritative Guide to Ulcers, Dyspepsia, and Heartburn. New York: Plenum Press. 1996.

Organizations

American College of Gastroenterology. 4900-B South 31st Street, Arlington, VA 22206-1656. (703) 820-7400.

American Gastroenterological Association. 7910 Woodmont Avenue, #914, Bethesda, MD 20814. (800) 668-5237. http://www.gastro.org.

International Foundation for Functional Gastrointestinal Disorders. PO Box 17864, Milwaukee, WI 53217. (888) 964-2001.

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ulcer

ulcer (ul-ser) n. a break in the skin or in the mucous membrane lining the alimentary tract that fails to heal and is often accompanied by inflammation. arterial u. a skin ulcer due to inadequate arterial blood supply, usually seen on the feet of patients with severe atheromatous narrowing of the arteries in the legs. decubitus u. see bedsore. rodent u. see basal cell carcinoma. venous (or hypostatic or varicose) u. the most common type of skin ulcer, occurring on the legs and caused by increased venous pressure. It most commonly affects older women. See also aphthous ulcer, dendritic ulcer, duodenal ulcer, gastric (ulcer), peptic (ulcer).

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ulcer

ulcer A crater‐like lesion of the skin or a mucous membrane resulting from tissue death associated with inflammatory disease, infection, or cancer. Peptic ulcers affect regions of the gastro‐intestinal tract exposed to gastric juices containing acid and pepsin: gastric in the stomach and duodenal in the duodenum. Usually treated with antagonists of histamine receptors or inhibitors of gastric acid secretion. Often caused by infection with Helicobacter pyloris.

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DAVID A. BENDER. "ulcer." A Dictionary of Food and Nutrition. 2005. Encyclopedia.com. 28 Sep. 2016 <http://www.encyclopedia.com>.

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ulcer

ul·cer / ˈəlsər/ • n. an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal. ∎ fig. a moral blemish or corrupting influence: he's a con man with an incurable ulcer called gambling. DERIVATIVES: ul·cered adj.ul·cer·ous / ˈəls(ə)rəs/ adj.

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"ulcer." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. 28 Sep. 2016 <http://www.encyclopedia.com>.

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ulcer

ulcer Any persistent sore or lesion on the skin or on a mucous membrane, often associated with inflammation. Ulcers may be caused by infection, chemical irritation or mechanical pressure.

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ulcerative gingivitis

ulcerative gingivitis (Vincent's angina) n. acute painful inflammation and ulceration of the gums associated with infection by the microorganisms Fusobacterium and Bacteroides.

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ulcer

ulcer XIV. — (O)F. ulcère or — L. ulcus, ulcer-, rel. to Gr. hélkos wound, sore.
So ulcerate (-ATE3) XV, ulceration XIV, ulcerous XVI. — L.

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T. F. HOAD. "ulcer." The Concise Oxford Dictionary of English Etymology. 1996. Encyclopedia.com. 28 Sep. 2016 <http://www.encyclopedia.com>.

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ulcer

ulceranorexia nervosa, bulimia nervosa, curiosa, Formosa, grocer, samosa, Via Dolorosa •coaxer, hoaxer •greengrocer •rejoicer, voicer •Abu Musa, Appaloosa, babirusa, inducer, introducer, juicer, producer, reducer, rusa, seducer, sprucer, traducer •discusser, fusser, trusser •propulsor, Tulsa, ulcer •oncer • conveyancer • piercer •influencer • Odense • balancer •silencer • grimacer • trespasser •harasser • remembrancer •licenser, licensor •traverser • canvasser • sequencer •bursar, converser, curser, cursor, disburser, mercer, purser, rehearser, reverser, vice versa

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