The peptic ulcers are small injuries or sores difficult to close, which have the form of open craters, circular or oval forms which are in the internal wall of the stomach or the small intestine (and no so frequent in the esophagus). The peptic ulcers of the stomach are called gastric ulcers; when they are formed in the intestine, they are called duodenal ulcers. Both ulcers, gastric and duodenal are peptic ulcers because they are developed inside the digestive system and they are in contact with the enzyme pepsin. The pepsin is an enzyme which works together with the chlorhydric acid produced by the gastric mucous to digest the foods, especially the proteins. The peptic ulcers are found more frequently on the minor curvature of the stomach and in the duodenal tube. It’s calculated in the world that the 10% of the population, in any moment, has one or more ulcers. Its more frequent occurrence, in the case of gastric ulcers, is in patients between 50 and 60 years, and for the duodenal ulcers between 40 and 50 years. When the ulcer is little deep receives the name of erosion.
The duodenal ulcer is the most common type of peptic ulcer. It’s produced in the duodenum, in the first centimeters of the small intestine, just next to the stomach. The gastric ulcers, which are the less frequent, generally are located in the high part of the stomach’s curvature. The repetitive regurgitation of acid coming from the stomach to the low part of the esophagus can cause inflammation (esophagitis) and esophageal ulcers. The ulcers which appear as a consequence of stress derivate of a severe disease, burns or traumatisms are called ulcers of stress.
The duodenal ulcer is more frequent in the man y seems to be that in the last two decades have increased in the feminine sex. The gastric ulcer is presented more often in patients who take anti-inflammatories non steroids. The acid and the pepsin, cause ulcer only when the mechanism of the mucous defense, reparation and healing are alterated by the presence of the Helicobacter Pylorus or the ingestion of anti-inflammatories non steroids. The mechanism is the acid hypersecretion, as well as a series of factors like: familiars, psychological, hormonals, physiologics, gastronomes, locals, the presence of Helicobacter Pylorus and non steroids anti-inflammatories.
A) CAUSES:
The causes of ulcers are several but the gastroenterologists sustain that are tour the causes of the peptic ulcers:
1) Hereditary factor:
In people who have the protector mucous membranes very thin or weak that recover the stomach and the duodenum allowing that gastric juices form sores.
2) Infection:
Due to the presence of bacteria type Helicobacter Pylorus in the stomach, which live in the gastric mucous. It affects the 95% of the patients by duodenal ulcer, and the 70% of patients by gastric ulcer.
3) By the use of anti-inflammatory medicaments, Analgesics:
Those which are used by many patients for: headache, muscular pain, arthritis and menstrual spasms.
The gastric ulcers are differenced of the duodenals due to they tend to be developed later and they are generated mainly by the use and abuse of some drugs; particularly the aspirin, ibuprofen, flurbiprofen, ketoprofen and indometacine, and other non steroids anti-inflammatories, which cause erosions and ulcers in the stomach, especially in elderly people (men of 55 to 70 years) of the developed countries. Such erosions and ulcers tend to be healed when it’s interrupted the treatment with drugs. The recurrence is less probable, unless it’s reinitiate the same treatment. Finally, the last cause is that which is produced by disorders that generate hypersecretion of gastric juices (acid hypersecretion), which can attack and form sores in the gastric mucous, or act on the weak or thin gastric mucous and generate also sores or injuries.
Also there are other risk factors; like the consumption of tobacco, have blood type A (gastric ulcer) or blood type O (duodenal ulcer), and, finally, it’s the patient attitude in front of the stress problems.
B) SYMPTOMS
The typical ulcer tends to be healed and to turn. The symptoms can vary according the localization and age of the individual. Children and elderly people can’t present the usual symptoms or even any type of symptom. On these circumstances, the ulcers are discovered only when complications are developed.
The symptoms of peptic ulcers not always are visible. The most frequent symptoms in old men and patients with chronic ulcers.
1) Gastric Ulcers:
In this type of ulcers; it’s presented persistent heartburn (pyrosis) after foods, indigestion, nauseas, vomitings, lost of weight, lost of appetite, sometimes the pain awakes you at mid night and recurrent episodes of gastrointestinal hemorrhage; the pain is deaf and similar to a crisis of hunger.
2) Duodenal Ulcers:
In the duodenal ulcers there is pyrosis, stomachs ache and lost of weight. The patient suffers discomfort after 2 – 4 hours after foods, citrics, coffee and aspirin. One of each two patients wakes up in the night, between 1:00 am to 2:00 am, for the headaches.
The complications of the ulcers are the bleeding stated by vomiting with blood and black evacuations, the perforation that is presented like a violent picture of abdominal pain and attack to the general state, and, the critical narrowness of the pyloric canal. These complications generally require surgery; the laparoscopic boarding is the ideal.
Penetration of ulcer:
When the ulcer goes through the muscular wall of stomach or from duodenum and penetrates towards a solid organ like the liver or pancreas, this causes intense and persistent pain. In case that this penetrates towards the pancreas, then it generates back pain.
Perforation of ulcer:
It occurs when the ulcer goes through the wall and arrives to the abdominal free space, generating a sudden, intense and constant pain that can be extended for the whole abdomen. Here, the patient can have pain in one or both shoulders. This requires immediate surgery.
Hemorrhage:
It’s a frequent complication of ulcers, which is evident by vomitings of vomitings of blood red brilliant or coffee color, by feces of black color or bloody. The gastroenterologist will have to do endoscopy to determine if it’s a peptic ulcer.
Obstruction:
It’s the swelling of the inflamed tissues around the ulcer. It can make narrow the way-outs of the stomach or duodenum, generating very repetitive vomitings. A symptomatology is fullness in the stomach or absence of appetite.
C) Diagnosis of the peptic ulcer
The physician suspects the presence of an ulcer when the person presents a characteristic pain in the stomach. It can be necessary to realize tests to check the diagnosis, given that the gastric cancer can produce similar symptoms. In the same way, when the ulcers are resistant to the treatment, particularly if there are several or if the ulcers are located in less habitual zones, the physician can suspect of other underlying processes that take to an excess of production of gastric acid by the stomach. To help the diagnosis of the ulcers and identify its origin, the physician can make use of an endoscopy, X-rays with barium mush, to analyze the gastric juice and to effect blood tests.
There’s too much information about ulcers in books and texts of gastritis and ulcers; also information of ulcers and gastritis in Internet that the patient can use to understand his/her problem. Furthermore, there are many books about treatments, medicines, medicaments, natural remedies and drugs to try to heal the ulcers. Once the patient has determined its situation, should go to the clinic and check with the gastroenterologist to do the respective endoscopy and determine the degree of disease the patient has and the remedies, medicines or medicaments that the patient should use.
