Peptic Ulcer: What is it? how it manifests itself, all the causes, and how it is treated

Peptic Ulcer: What is it?

A peptic ulcer is a more or less deep lesion of the most superficial layer of the mucosa of the stomach or duodenum. In rare cases, this erosion can extend into the organ wall and perforate it.

What is Peptic Ulcer?

A peptic ulcer is characterized by a loss of substance from the most superficial layer of the lining of the stomach or duodenum (i.e. the first part of the small intestine). This localized ulcerative lesion can have a round or oval shape.

In some cases, the peptic ulcer progressively worsens, going deep until it reaches the submucosa and the muscular layer, sometimes even perforating the organ.

What are the causes?

Peptic Ulcer: causes

Peptic ulcers occur as a result of a reduction in the normal defensive power of the mucosa from the acidity of gastric juices.

Gastric juices, usually produced by the stomach, are necessary to digest foods and kill pathogens that enter the digestive canal. These acids are very corrosive and, for this reason, some specialized cells produce a layer of mucus to protect the cells of the internal lining of the stomach.

Anything that alters this barrier and hinders the natural tissue repair processes exposes you to the risk of ulcer formation. These “aggressive” factors make the mucous lining more vulnerable to gastric juices, which damage the inner lining of the stomach.

Peptic ulcers can manifest themselves in the form of a simple erosion of the mucosa, which leads to the onset of dull, burning pain in the upper region of the abdomen, shortly after eating. However, various complications can also occur including hemorrhages, perforations, and occlusions due to tissue scarring.

What are the risk factors for Peptic Ulcer?

The causes of the breakdown of the balance between “aggressive” and “protective” factors are complex and not yet fully understood.

Although ulcers are commonly associated with stress, they can occur for other reasons.

A factor of primary importance in the origin of the ulcer is Helicobacter pylori infection, a bacterium unusual in that it develops in the acidic environment of the stomach. This microorganism does not cause the ulcer through direct tissue destruction but determines an immune response that makes the mucous lining more vulnerable to attack by gastric juices. The result is chronic inflammation that can damage both the walls of the stomach and the duodenum. Among the factors that can lead to the development of a peptic ulcer is chronic gastritis; more rarely, however, this condition is an expression of a tumor.

In addition to Helicobacter pylori, there are a number of factors that contribute to the onset of the disease:

• In some cases, peptic ulcers are caused by chronic use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). These gastro-injurious drugs, in fact, inhibit the production of protective factors that are normally able to defend the stomach from the effects of gastric juices. For this reason, during prolonged therapies, they should be taken in combination with a gastroprotective drug.
• Lifestyle also certainly has a great influence, just think of the abuse of coffee, smoking, and an unbalanced diet (especially if too fatty or spicy).
• The risk of ulcers also increases with chronic alcohol abuse or by infiltration of bile from the duodenum into the stomach. Both of these conditions are harmful to the mucosal barrier.

Peptic ulcer: can also involve the esophagus

A peptic ulcer is a localized lesion affecting the mucosa of the digestive system exposed to the action of stomach acid secretions. The most frequent location of the ulcer is at the gastric and duodenal level, but it can also appear in the esophagus, in cases of acid or alkaline reflux from the stomach to the esophagus itself, in the jejunum, after surgery that has removed the lower half of the stomach and the duodenum, in Zollinger-Ellison syndrome (an often familial tumor of the endocrine system, and sometimes also in Mekel’s diverticulum (a diverticulum of the small intestine), due to the presence of gastric mucosa when, normally, this should not be there.

Symptoms

Peptic Ulcer: how does it manifest itself?

The most characteristic symptoms of peptic ulcer are a dull pain, similar to a cramp, and a burning sensation in the upper and central region of the abdomen. The pain is sometimes described as a feeling of aching, pressure, heaviness, or emptiness. Painful cramps last from a few minutes to a few hours.

A peptic ulcer is often associated with difficult digestion, early satiety, and bloating. Sometimes, loss of appetite and weight, belching, nausea, and vomiting are also present.

In other cases, symptoms are completely absent.

Peptic ulcers are intermittent and periodic, that is, they occur in cycles, in which flare-ups are interspersed with temporary periods of apparent healing. For reasons still unknown, symptoms flare up more frequently in spring and autumn than the rest of the year.

Similar symptoms, but at different times

There are two types of ulcers: gastric and duodenal.

• A typical sign of duodenal ulcer is a feeling of painful hunger that appears especially during the night or when you are fasting; this disorder is calmed simply by eating something that buffers excessive gastric acidity, such as a small piece of bread.
• Gastric ulcers also present this type of disorder, but generally, the difference is given by the time the pain appears in relation to the meal: within half an hour for gastric ulcers and after two hours for duodenal ulcers.

Although they share some symptoms, gastric and duodenal ulcers are different from each other in many ways; they are therefore explored separately:

Peptic Ulcer: What are the possible complications?

• Peptic ulcers can be complicated by progressive anemization.
• In more serious cases, however, the damage can cause hemorrhages and occlusions due to tissue scarring. Digestive hemorrhage occurs when the ulcer, becoming sufficiently deep, erodes the nearby blood vessels.
• In extreme, and fortunately rarer, cases, the lesion can extend through the entire thickness of the stomach wall. Perforation of the ulcer is extremely dangerous, as the acidic contents of the stomach can leak into the peritoneal cavity, causing serious damage. Digestive hemorrhage and perforated ulcers always require immediate medical-surgical treatment. Therefore pay attention to warning signs such as the appearance of an intense stabbing pain, similar to a stab in the stomach, sudden and persistent.).

Diagnosis

Tests for the diagnosis of Peptic Ulcer

The diagnosis is suspected on the basis of symptoms and confirmed by tests, such as gastroscopy, correlated with biopsies, and radiographic examination with contrast medium. The simultaneous search for Helicobacter pylori infection is very important.

Investigations intended to confirm the diagnosis are also important to ascertain the real nature of the disorders since stomach and duodenal cancer manifests itself with symptoms similar to those of peptic ulcers.

Gastroscopy is an endoscopic examination that is carried out by introducing a fiber optic tube into the patient’s stomach. This allows you to directly observe the condition of the inner lining of the stomach and duodenum. The same test allows you to take small fragments of tissue to examine them under a microscope. Performing the biopsy, followed by histological examination, allows the presence of Helicobacter pylori or, more rarely, tumor cells to be highlighted. In addition to biopsy, H. pylori infection can be diagnosed by stool analysis and urea breath testing.

Treatment

Most ulcers are successfully treated with drugs that inhibit and suppress gastric acid secretion, thus neutralizing the acidity and giving the mucosa time to regenerate. In more severe cases, surgery may be necessary.

Antiulcer drugs

Ulcer treatment is based on drugs capable of reducing the acidity of gastric juices, such as proton pump inhibitors and histamine H2 receptor antagonists. In the presence of Helicobacter pylori infection, antibiotic therapy capable of eradicating the infection is also associated.

Peptic ulcer: When is surgery necessary?

If despite pharmacological therapies, the peptic ulcer:

• It doesn’t heal
• Repeated digestive bleeding occurs
• perforates or is at risk of doing so

or

• A narrowing of the pylorus has occurred

surgery may be required. This consists of the terminal removal of the stomach, located immediately before the pylorus (antrectomy), or of ¾ of the stomach. The remaining portion of the stomach is then connected to the intestine (gastroenterostomy).

Prevention

Peptic ulcer: Can it be prevented?

To counteract the appearance of peptic ulcer or to alleviate its symptoms, it is best to avoid risky habits, in particular:

• In case of an ulcer, a dietary regimen that excludes drinks and foods that increase acid secretion, such as coffee, tea, chocolate, mint, carbonated drinks, pepper, and other spices, is useful. It is also better to avoid excesses (no overly seasoned foods, too hot or cold) and try to eat meals at regular times.
• The consumption of alcohol should be minimized or avoided, since alcohol, if taken in excessive quantities, can irritate and damage the cells of the gastric mucosa which are no longer protected.
• Also be careful not to abuse anti-inflammatory and analgesic drugs, as they can be harmful to the stomach mucosa.
• Give up cigarettes: Smoking represents one of the risk factors for ulcers, as it can alter the normal vascularization and repair of the gastric mucosa.