Actually it is an ulcerated, or eroded, area of the mucous membrane that lines all the digestive organs. It occurs most frequently in the lower end of the stomach, first part of the duodenum, or lower end of the oesophagus. All factors involved are still not known. But ulcers almost never occur in patients with low levels of hydrochloric acid in the stomach. The stronger the acid, the greater the likelihood of an ulcer. Emotional tensions, such as those brought on by family arguments, seem to play a large part in the development of ulcers.
What are the causes of peptic ulcers?
The usual cause of peptic ulceration is an imbalance between the rate of secretion of gastric juice and the degree of protection afforded by the gastro duodenal mucosal barrier as well as the neutralization of the gastric acid by duodenal juices.
Therefore, a peptic ulcer can be caused in either of two ways:
- Excess secretion of acid and pepsin by the gastric mucosa or
- Diminished ability of the gastro duodenal mucosal barrier to protect against the digestive properties of the acid-pepsin complex.
Within the past 5 years, at least 75 percent of peptic ulcer patients have been found to have chronic infection of the terminal portions of the gastric mucosa and initial portions of the duodenal mucosa by the bacterium Helicobacter pylori.
In addition to bacterial infection and excess secretion of gastric juices, other factors that are responsible for ulcers include 1) Smoking, presumably because of increased nervous stimulation of the stomach secretory glands, 2) Alcohol, because it tends to break down the mucosal barrier and 3) Aspirin, which also has a strong propensity for breaking down this barrier.
Signs and symptoms of peptic ulcer
The most important symptom of an ulcer is pain. It is usually sharp and severe. In a few cases there is also a steady aching or gnawing sensation in the upper abdomen. The patient can always put his finger on the sore spot.
In duodenal ulcers the pain comes on when the patient is hungry; it may even be severe enough to awaken him at night. In many cases the pain is relieved by eating food, but is made worse by taking alcohol, condiments, and coffee.
Patients with stomach ulcers may feel worse after taking food. Sometimes the ulcer may not be noticed for several weeks or months, only to flare up again under emotional strain or after taking alcohol.
Another symptom often associated with an ulcer is heartburn, or inflammation of the oesophagus. Because of the spasm the stomach cannot empty itself properly, so that the highly concentrated hydrochloric acid spills up into the oesophagus, perhaps even forming an ulcer there to aggravate the situation.
The most important thing is to heal the ulcer and prevent it from coming back. This means a period of both mental and physical rest to allow the stomach to heal. For large ulcers in the stomach, the patient should remain in bed for several weeks, preferably in hospital.
Large duodenal ulcers are also treated in hospitals during the acute stage, particularly if bleeding has occurred. Following this, bed rest at home for two or three weeks may bring the ulcer under control.
Diet is most important in the treatment of ulcers. During the acute stage it may be necessary to take a liquid diet every one to two hours foe a few days. Milk is best for this purpose, for it provides both protein and calcium in adequate quantities to aid healing and support the whole system. As the patient improves other foods such as bland cereals, mashed potatoes and simple desserts should be added to the diet.
Complications of peptic ulcer
Some ulcer patients, as well as those who have undergone surgery, may be troubled with vomiting of blood and tarry stools, due to the presence of hemorrhagic gastritis. Or perhaps the ulcer has eroded into a blood vessel, causing serious hemorrhage into the stomach or duodenum.
Peritonitis may also occur if the ulcer has eroded clear through, allowing the gastric juices to spill out into the abdomen. Patients with ulcers should always note the condition of the stools. If they appear dark or black, the condition should be immediately consulted with the medical physician.
All ulcer patients, including those who have had surgery for this condition, should follow certain rules of life. They should not smoke. Tobacco is an irritant and always aggravates the digestive organs. They should not use coffee, tea or alcohol. They should avoid fried foods, roughage, chilies, spices, and all hot seasonings. For beverages, it is best to use milk, water, and fruit juices.