What is this Condition?

Peptic ulcers are sores that develop in the mucous lining of the lower esophagus, stomach, and sections of the intestine called pylorus, duodenum, and jejunum. They are most common in the following circumstances:

• About 80% of all peptic ulcers are duodenal ulcers, which affect part of the small intestine and most often strike men between ages 20 and 50.

• Gastric ulcers, which affect the stomach lining, are most common in middle-aged and elderly men, especially in chronic users of some anti-inflammatory drugs or alcohol.

• Duodenal ulcers usually follow a chronic course, with remissions and flare-ups, but 5% to 10% of sufferers develop complications that reqUire surgery.

>What Causes it?

Though the precise cause is not known, peptic ulcers are thought to develop when the mucous lining becomes weakened, gets inadequate blood flow, or is defective. Recent research findings include the following:

• Stress may stimulate long-term overproduction of gastric secretions that can erode the stomach, duodenum, or esophagus.

• Backup of stomach acid through a lining damaged by chronic gastritis or irritants, such as aspirin or alcohol, is a likely cause of gastric ulcers.

• In elderly people, the pylorus begins to malfunction, permitting bile to back up into the stomach – a common cause of gastric ulcers in this age-group. For unknown reasons, these ulcers often strike people with type A blood and become malignant more often than duodenal ulcers.

• Too much acid secretion, possibly caused by an overactive vagus nerve, contributes to the formation of duodenal ulcers. These ulcers tend to afflict people with type 0 blood, Duodenal ulcers may persist for life. If they do heal, they usually leave scars that can later break down and ulcerate again.

What are its Symptoms?

Heartburn and indigestion usually signal the start of a gastric ulcer attack. Eating a large meal can stretch the person’s stomach, causing pain and a feeling of fullness and bloating. Other typical effects include weight loss and repeated episodes of digestive tract bleeding.

Duodenal ulcers produce heartburn and pain in the middle of the stomach that is relieved by food. The person gains weight (eating to relieve discomfort) and feels a peculiar sensation of hot water bubbling in the back of the throat. Attacks usually occur about 2 hours after meals, whenever the stomach is empty, after taking aspirin, or after drinking orange juice, coffee, or alcohol. Attacks recur several times a year. Vomiting and other digestive disturbances are rare.

Other Symptoms and Complications

Any of these ulcers may be symptom-free or may penetrate the pancreas and cause severe back pain. Other complications of peptic ulcers include perforation, hemorrhage, and obstruction of the opening between the stomach and the small intestine.

How is it Diagnosed?

Upper digestive tract X-rays show abnormalities in the mucous lining. The doctor can analyze stomach secretions for evidence or use a scope to see the ulcers. Stools may test positive for traces of blood.

How is it Treated?

If you have a peptic ulcer, the doctor will probably treat you with an antibiotic at least once to wipe out a bacterium called Helicobacter pylori because it can infect ulcers even with other causes. He or she may prescribe a familiar drug such as Achromycin or Amoxil. People who take anti-inflammatory drugs may use a drug called Cytotec to reduce ulceration. A coating agent also may be administered to a person with duodenal ulcers. Mostly, the doctor treats your symptoms with drug therapy and rest, starting with antacids.

If you have a bleeding ulcer, the doctor begins emergency treatment with insertion of a nasal tube to bathe the ulcer with iced salt water, possibly containing norepinephrine. A scope can be used to see the bleeding site and a laser or cautery to control bleeding. If the ulcer perforates or persists, or if malignancy is suspected, surgery will be recommended.