Peptic Ulcer

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Last Medical Review: March 26, 2020
Medically Reviewed by Dr. David Costa Navarro
Peptic Ulcer (March 26, 2020)

What is peptic ulcer?

Peptic ulcer is a lesion of the internal lining tissue (mucous membrane) of the stomach (gastric ulcer) or, more frequently, of the duodenum (duodenal ulcer). It is a very common pathology. At any one or two out of one hundred people have a gastric or duodenal ulcer. The disease occurs in cycles in which, after a period of exacerbation, a more or less long period of apparent healing follows. The disease is favored by certain factors such as: smoking (which should be avoided as much as possible), genetic factors (more frequent among subjects with blood group 0), age (more frequent in the elderly) and sex (more frequent in men). Some medications, such as aspirin and anti-inflammatories, promote the formation of an ulcer and may increase the risk of bleeding from an existing ulcer.

What are the causes

Gastric juice, made up of hydrochloric acid and pepsin, has the potential ability to “digest” the mucosa with which it is in contact, in the same way it digests food. An ulcer is formed when the protective factors of the mucous membrane, such as the production of a slimy lining mucus and the natural tissue repair processes can no longer counteract the aggression of the gastric juice. Peptic ulcers are so called because they are determined by the action of pepsin on the mucous membrane. The causes of the breakdown of the balance between defense mechanisms of the mucosa and damaging factors in favor of the latter are complex and not yet fully known. Lately, medical research has come to the important discovery of the role of a bacterium (Helicobacter pylori) as the cause of the ulcer.

How it manifests itself

Many ulcer patients may have no symptoms and the ulcer can heal spontaneously. The main symptom is a burning pain in the upper middle part of the abdomen. It is an intermittent pain, which comes and goes, sometimes described as a sense of soreness, pressure, heaviness or a feeling of emptiness or hunger. There are some differences between the pain caused by a gastric ulcer and that of a duodenal ulcer.   Generally speaking, it can be said that gastric ulcer pain:

  • it is often stronger during the day;
  • it is not relieved by food intake;
  • may worsen after a short time from food intake.

Duodenal ulcer pain:

  • night comes more intensely;
  • is relieved by taking food or milk;
  • it reappears two or three hours after the meal.

Nausea and vomiting are common symptoms of the two types of ulcer.

What are the risks

Complications of the ulcer often occur during relapses and always require immediate referral to a medical center. The most frequent are:

  • Hemorrhage. It can present with vomiting of bright blood or of material similar to coffee grounds, emission of dark stools, with a tarry appearance. Blood test anemia may be present.
  • Pyloric or duodenal obstruction. It is due to the narrowing of the lumen of the stomach due to the healing of an ulcer or the spasm and swelling associated with an active ulcer. It is manifested by abundant vomiting and requires surgery.
  • Drilling. It occurs when the ulcer penetrates through the entire wall of the stomach or duodenum, and can only be treated with surgery. It occurs with sudden, intense pain that spreads through the abdomen and can be reported in extra-abdominal locations (back, shoulders).

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