The ulcer, better known as ” peptic ulcer “, consists of a rounded lesion, which deeply affects the mucous membrane, i.e. the internal lining of the digestive tract. It predominantly affects men, with triple frequency compared to women, presenting itself in two different forms depending on its anatomical location.
In fact, we speak of gastric ulcer if the walls of the stomach are affected , of duodenal ulcer if instead the first section of the intestine, the duodenum , is affected.
The former appears more frequently between the ages of 50 and 60 and in the lower social classes, but it is not clear whether this is linked to particular dietary factors or to risky behaviors such as cigarette smoking, caffeine intake, emotional stress or, more generally, to an incorrect diet or lifestyle.
The second generally occurs above all between the ages of 30 and 40 and its incidence is not influenced by particular socio-economic conditions. In any case, duodenal ulcer is the most frequent form (up to 10 times) and, unlike gastric ulcer, recognizes a familial predisposition although Helicobacter pylori is present in over 85% of cases. Furthermore, due to the anatomical proximity between the duodenum and pancreas, if left untreated, it can lead to inflammation of the pancreas and, consequently, to pancreatitis.
From infections to drugs
Beyond the specific causes, an ulcer is the result of the imbalance between the action of aggressive factors such as the acidity of gastric juices, the proliferation of bacteria or the high consumption of certain drugs, and protective ones, in particular the production of mucus by cells of the gastric mucosa.
In detail, gastric ulcer in most cases is due to:
- Helicobacter pylori infection (50-65% of cases), a Gram-negative bacterium which owes its name to its particular helix shape. It is able to settle and proliferate in the acidic environment of the stomach, triggering an immune and inflammatory reaction, the so-called gastritis , favoring the progressive damage to the walls of the stomach or duodenum and, if left untreated, the ulcer becoming chronic
- abuse of non-steroidal anti-inflammatory drugs ( NSAIDs ) or use of cortisones that reduce the natural protective mechanisms of the stomach lining (mucus production)
- habit of consuming irritants such as coffee, alcohol, carbonated drinks, spices and cigarette smoke
- psychological factors (stress, conflict)
- pre-existing conditions such as Zolliger-Ellison syndrome . Although it is a rare condition, it is characterized precisely by the presence of multiple peptic ulcers due to gastric hyperacidity induced by an excessive release of the hormone gastrin by “gastrinomas”, almost always malignant tumors that can develop in the pancreas and duodenum .
Some more news on Helicobacter
In Western countries, Helicobacter infection affects about 20% of people under the age of 40 and 50% of those over 60. In developing countries, on the other hand, it affects most adults without sparing children.
Man appears to be the main carrier of this microorganism, which is transmitted via the oral-oral or fecal-oral route and is the first cause of slow-moving infection in the world.
Symptomatology
Gastric ulcer gives rise to pain and burning in the stomach, usually between meals, caused by the contact of gastric acids with the area of the lesion. Sometimes these disorders affect a wider abdominal area also reaching the sternum.
The classic symptoms are often associated with:
- a feeling of distension, heaviness or emptiness in the stomach
- nausea and vomiting
- digestive difficulty
- weight loss favored by loss of appetite
- iron deficiency anemia caused by local bleeding if the ulcer is advanced.
Pain from duodenal ulcers also usually occurs after meals (60-120 minutes after) or during an overnight fast. It is appeased by the ingestion of food, which has a buffering effect in this case.
Another characteristic aspect of peptic ulcer, both gastric and duodenal, is its seasonality and variable duration. In fact, it occurs mostly in spring and autumn with attacks that can last a few days or weeks alternating with remission intervals of even several months or years.
Exams to do
It is important that peptic ulcer is recognized and treated promptly because, in addition to creating discomfort, it also involves local damage which, if not properly contained, can lead to sometimes very serious complications over time.
The diagnosis of ulcer is based both on the symptoms reported by the patient (anamnesis) and on instrumental tests. Among the main ones we find:
- X-ray with contrast medium: although not prescribed as much as it used to be, it is based on the administration of barium sulfate which shows if there is any abnormality along the contour of the stomach wall or duodenum
- gastroscopy : an endoscopy technique that allows direct visualization of the ulcer at the gastrointestinal level. In some cases, classic gastroscopy can be associated with a biopsy, i.e. a sample of the mucosa to be subjected to histological examination
- targeted research of Helicobacter: its presence can be documented by the analysis of the tissue sample collected with the biopsy, with a simple blood test, by searching for specific antibodies, with a stool test or through the “Breath test” or “breath test” which consists in the ingestion of urea labeled with carbon 13 and consequent collection of exhaled air in a special test tube after 30 minutes. Examining the breath thus collected, if the quantity of marked carbon dioxide is higher than that present in the pre-ingestion breath, the test is considered positive for Helicobacter infection. This occurs because the bacterium converts labeled urea into carbon dioxide.
Possible complications
Peptic ulcer is a pathology in all respects and, as such, if left untreated it can give rise to various complications:
Complication | Characteristics |
---|---|
Chronicization | Stress, smoking, anti-inflammatory drugs, site and depth of the lesion itself are among the main factors that hinder proper healing. Generally, if after a period of 4 months of treatment there is no healing of the ulcer, it is called a chronic or “untreatable” ulcer. This leads to the appearance of more or less frequent recurrences and with variable pain intensity |
Drilling | It can occur acutely or gradually. In the first case it gives rise to a peritonitis first of an irritative type following the leakage of the material contained in the stomach or duodenum, and subsequently purulent due to the proliferation of bacteria. If it develops more slowly, the symptoms may be masked by the formation of adhesions between the affected site and the surface of nearby organs such as the pancreas or liver |
Hemorrhage | It can occur with slow but continuous bleeding and consequent anemia, or acutely with the emission of blood through vomiting (hematemesis) or tarry stools ( melena ) due to the digestion of the blood itself |
Stenosis (narrowing) | The permanence of an ulcer involves the scarring of the affected area with consequent impairment of functionality |
Involvement of neighboring organs | Even if it is a benign ulcer, organs such as the liver or pancreas can be affected if it grows too large |
neoplastic degeneration | The ulcer, following the persistence of an inflammatory process , can also lead to the malignant transformation of the cells with the subsequent development of cancer . |
That’s how he takes care of himself
The therapy varies according to the severity and characteristics of the individual case and follows the so-called “stepwise” criterion.
Sodium bicarbonate or the common aluminum and magnesium -based antacids are the first effective and quick remedies to buffer the acidity and promote healing of the lesion in its early stages.
If they are not sufficient, it is necessary to resort to drugs which block the histamine H2 receptor and therefore acid secretion, or to proton pump inhibitors which directly intervene on the hydrochloric acid production mechanism.
If, on the other hand, there is a Helicobacter ulcer , the so-called eradication therapy is advisable, which usually lasts for two weeks and is based on antibiotics (amoxicillin, clarithromycin or metronidazole) and a proton pump inhibitor to block the production of stomach acid.
Furthermore, for the most serious cases, especially when they turn into emergencies (hemorrhage, perforation), it is often necessary to resort to surgery to repair the damaged tissues.
At any stage, following an appropriate diet is in any case essential both to enhance the effects of the pharmacological approach and to limit the episodes of recurrence, typical of a pathology that tends to be chronic such as an ulcer.
It is therefore recommended to:
- limit the consumption of difficult-to-digest foods (cured meats, dairy products, dried fruit, peppers, etc.) in order not to accentuate the consequent production of gastric juices
- limit the consumption of salt and condiments
- adopt “gentle” cooking methods, such as steam
- avoid the abuse of irritating substances such as spices, caffeine, carbonated drinks, alcohol
- consume small meals, dividing them throughout the day.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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