Ulcers

  • Basics

    An ulcer within the digestive tract, also known as a peptic ulcer, is a sore in the lining of the stomach or the upper portion of the small intestine (duodenum) Figure 01, Figure 02.During digestion, the stomach secretes juices that aid in digestion. These fluids are as caustic as car battery acid. Normally, other substances produced in the body protect the lining of the stomach from its highly acidic environment. Ulcers develop when aggressive factors overwhelm protective mechanisms.

    Click to enlarge: Anatomy of the Digestive System

    Figure 01. Anatomy of the Digestive System

    Click to enlarge: Stomach and Duodenal Ulcers

    Figure 02. Stomach and Duodenal Ulcers

    Until recently, doctors thought peptic ulcers resulted from stress and diet. Now they know many ulcers are due to a Helicobacter pylori (H. pylori) bacterial infection.

    About 90% of duodenal ulcer and 70% of stomach ulcer patients are infected with H. pylori bacteria.

    Many people are unaware that most ulcers are an infectious disease, and that hand washing is a means of protecting against it.Like many other bacteria, H. pylori can be passed from person to person, probably through ingestion of bacteria that have been eliminated from another human body through either vomit or stools. Eating food touched by someone who has not washed his or her hands after a bowel movement may be one way in which the H. pylori passes from one person to another.

    Stomach ulcers (gastric ulcers) are also connected to the use of pain medications called nonsteroidal anti-inflamatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil, Motrin, and Aleve).Most NSAIDs are over-the-counter drugs that are taken for fever, aches, and pains. Prescription strength NSAIDs are used to treat arthritis. NSAIDs contribute to the formation of stomach ulcers because they damage the three defenses that the stomach has against digestive juices. The defenses include: the stomach’s mucus lining, which acts as a physical barrier to the acid, the bicarbonate (a component of the baking soda) produced by the stomach that counteracts (neutralizes) the acid; and the blood circulation to the stomach lining, which promotes cell repair.

  • Causes

    Most peptic ulcers result from an infection with H. pylori bacteria or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Both bacterial infection and NSAIDs interfere with the normal balance of digestive fluids. The fluids include acid, enzymes such as pepsin, and protective mechanisms that guard the lining of the stomach from the strong acids. An ulcer may develop when the fluids become unbalanced. If the fluid becomes too acidic (either through overproduction or the protective mechanisms are lost), it irritates the stomach lining resulting in inflammation, erosions and ultimate development of ulcers.

    NSAIDs interfere with protective elements normally present in the stomach. Because NSAIDs such as aspirin and ibuprofen interfere with the stomach’s defense mechanisms against acid and pepsin (the main enzyme in gastric juice), the risk of ulcer increases when a person takes these drugs. The stomach protects itself against the strong acid and enzymes needed to digest food in three ways: a mucus lining that coats the inside of the stomach, the production of bicarbonate to neutralize acid, and blood flow to the stomach that promotes cell repair. Ulcers develop when damage to these mechanisms exceeds the stomach's ability to repair itself.

    Approximately 70% to 90% of all peptic ulcers are caused by H. pylori, but doctors are not sure how these bacteria cause ulcers. The H. pylori bacteria have a spiral shape that may allow them to burrow into the stomach lining and damage it. H. Pylori bacteria produce a chemical that changes the acidity (pH) that surrounds them and causes inflammation.

    H. pylori infection is common in developing countries and among people older than age 60 in the U.S., about half of whom harbor the bacteria. However, most people who are infected with the bacteria do not develop stomach ulcers. Scientists do not yet understand why H. pylori cause ulcers to develop in some individuals but not in others. Theories currently being studied include characteristics of the infected person, including genetics and diet, and the characteristics of different types of H. pylori.

    Physical stress, such as surgery or disease, can cause the development of an ulcer. Emotional stress may aggravate the lining of the stomach, but it does not cause ulcers. However, it may serve as a trigger. Radiation treatment, alcohol abuse, and physical trauma, such as major surgery or severe burns, also can lead to ulcer development.

    The genetic disorder Zollinger-Ellison syndrome (ZES) is responsible for some ulcers. Zollinger-Ellison syndrome is a rare disorder in which tumors secrete large amounts of the hormone gastrin. This hormone causes the stomach to produce excess acid which attack the lining of the stomach and cause ulcers. These ulcers tend to be more painful and are harder to treat than other stomach ulcers. Scientists think that an abnormal tumor suppressor gene causes Zollinger-Ellison syndrome. The disease most often occurs in people between the ages of 30 and 60 years of age.

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