Ulcers are the lesions that can occur anywhere in the gastrointestinal tract of mouth to anus, but can form in the lung and even the kidneys. It is necessary to treat ulcers timely to maintain good life quality of patient and prevent further health problems.
Common Types of Ulcers
Peptic Ulcer: Peptic ulcers are seen in the lining of the stomach or duodenum. They include:
A. Esophageal Ulcer: Occurs in the lower end of your esophagus. They are often associated with a bad case of acid reflux or GERD (Gastro Esophageal Reflux Disease).
B. Gastric Ulcer: It is the same as peptic ulcer, but a gastric ulcer exceptionally occurs in the stomach.
C. Duodenal Ulcer: When the peptic ulcer is present in the duodenum, it is called duodenal ulcer. Duodenal ulcer symptom differs from gastric ulcers, and the most common type of ulcer seen in the Western world.
Mouth Ulcers: Commonly known as canker sores (Aphthous stomatitis), they are typically seen anywhere inside mouth, such as below tongue, inside of lips and cheeks. These mouth ulcers are benign and non-contagious. These ulcers may occur from time to time and heal completely between sessions. Mouth ulcers causes pain in the region, interferes with eating and drinking, and more severe forms may be debilitating and may prevent opening the mouth properly or cause pain during speaking.
Less Common Types of Ulcers
Ulcers can occur in the:
Genitals (in and around): Located on the genital area, caused usually by sexually transmitted disease such as syphilis, genital herpes, chancroid, or chlamydia trachomatis. The syndrome is further classified into penile ulceration for males, and vulval ulceration for females.
Lung: iscontinuity in the lining mucous membrane of the lung parenchyma.
Kidneys: Discontinuity in the lining of the parenchyma or renal capsule.
Foot ulcers: Seen more in diabetic patients.
Corneal ulcer or ulcerative keratitis: Affects the cornea of eyes of humans and animals, is very painful and causes blindness. Seen more in children with vitamin A deficiency.
Skin (decubitus ulcer): Also known as pressure ulcer or bedsores, they are localized injuries to the skin and/or underlying tissue. They usually occur over a bony prominence due to pressure, or with shear and/or friction.
Ulcers and complications of immune system together lead to diseases, such as:
i. Crohn’s disease: Ulcers occurring anywhere in the gastrointestinal tract of mouth to anus.
ii. Ulcerative Colitis: Bleeding ulcers occurring in the large intestine and colon.
Ulcers in animals
Ulcers are seen in pets and animals as well. Corneal ulcer or ulcerative keratitis as mentioned above, is common in dogs, and sometimes seen in cats.
How to know if I have an Ulcer: Symptoms of Ulcers
Different types of ulcers show up with different symptoms. In general, pain is present in the affected region as the condition aggravates, but sometimes ulcers are asymptomatic, which means that the person who has them does not experience any symptoms.
The most common type of Ulcer is the Peptic Ulcer and its main symptom is burning pain in the abdomen area.
The Peptic Ulcer symptoms usually are:
1. Pain: There will be pain in the abdomen somewhere between the breastbone and belly button. It can be present for a couple of minutes to hours, and may vary in severity. It is often felt as a burning, stabbing or aching pain, which gets aggravated between meals and after the stomach empties.
2. Many people report other symptoms, such as
a. Loss of appetite.
b. Weight loss.
c. Increase in intestinal gas and burping.
d. Feeling of fullness
f. Inability to drink a lot of liquids.
g. Mild nausea felt on morning first walk.
h. Tiredness and fatigue, feeling unwell.
i. Feel better with milk or antacid.
People may experience any one of the above symptoms, or any combination of any of them.
4. Diet: Consumption of certain foods, including raw fruits and vegetables, onions, peppermint, chocolate, spicy and high-fat foods, citrus fruits, garlic, and tomatoes or tomato-based products tend to aggravate the symptoms. Drinking beverages, including alcohol, citrus juices, caffeinated drinks, and carbonated drinks also tend to aggravate the symptoms.
Causes of Ulcers
Gastric ulcers are lesions or sores that form on the lining (mucosa) of the stomach. Factors believed to cause gastric ulcers are:
1. Ulcers can be caused or worsened by NSAIDs such as ibuprofen and aspirin.
2. Infection with bacteria called H pylori or Helicobacter pylori.
3. Though rare, but excess acid production from gastrinomas (tumours of the acid-producing cells in the stomach) increase the acid content.
4. Imbalance between stomach acid and the natural defenses of the stomach lining leading to inflammation.
• Chronic gastritis
• Increasing age
• Certain blood clotting problems
• Stress is sometimes associated with ulcers to aggravate the symptoms.
• People regularly taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or naproxen.
• People infected by H. pylori bacterium.
• People having family history of ulcers.
• People who regularly consuming alcohol.
• People having diseases related to kidney, liver or lung.
• People above 50 years of age.
Diagnosis of Ulcers
The gastroenterologist checks for the symptoms present. Initially, the treatment is carried out with acid-suppressing medication. Tests may include checking H. pylori infection and its treatment.
Endoscopy: Endoscopy is done do see inside the stomach using a tube fitted with a camera. The procedure (called diagnostic gastroscopy) involves passing an endoscope (a thin, flexible tube) that has a camera attached to one end, that reaches the stomach and the duodenum through the gullet.
Sigmoidoscopy: Flexible sigmoidoscopy is similar to endoscopy, but the tube with camera passed through the rectum for the medical examination of the colon and large intestine.
The images obtained from the camera usually confirms (or rules out) the presence of ulcers.
Tests for H. pylori bacteria
a. During endoscopy or sigmoidoscopy, the doctor may take a tissue sample from the stomach or duodenum. The sample is tested for H. pylori bacteria.
b. Stool antigen test
c. Blood test
d. Urea breath test: A special drink is given. The breath is analyzed to check for H. pylori infection.
If H. pylori tests are positive, treatment is conducted to clear the infection which can heal the ulcer and prevent it from recurring.
The Treatments: How to get rid of Ulcers?
Treatment of Stomach Ulcers depends whether the cause is NSIADs or H.Pylori or both.
1) Proton pump inhibitors (PPIs): If the stomach ulcer is caused by NSAIDs (and not H. pylori infection), a 1-2 month course of proton pump inhibitors (PPIs) is carried out. Alternative painkiller such as paracetamol, may be advised to substitute for currently continuing NSIADs.
PPIs block the actions of proteins (called proton pumps) that are partly responsible for producing stomach acid. Reducing stomach acid prevents damage to the ulcer, and allows it to heal naturally. Lansoprazole and omeprazole are commonly used PPIs for stomach ulcers.
H2-receptor antagonists blocks the actions of a protein called histamine, also responsible for stimulating the production of stomach acid. Ranitidine is generally used as H2-receptor antagonist for treating stomach ulcers.
2) Eradication therapy: To treat H.Pylori infection, is carried out to kill the bacterium. Commonly used antibiotics include amoxicillin, clarithromycin and metronidazole. Such medications have mild side effects like sickness, diarrhea, metallic taste in mouth, and greyish saliva or greyish stools.
If a combination of both (use of NSAID and H. pylori infection) is suspected, the patient is given a 2 month course of PPIs and antibiotics (eradication therapy).
3) Antacids and alginates: In addition to the above medication, the gastroenterologist may also suggest use of antacids to help neutralise stomach acid and alginates to protect the lining of your stomach.
4) At home relief: Eating bananas are considered quite effective to act against stomach acid and may pre preferred over antacids or alginates by the patient.