Ulcers, digestive

Encyclopedia of Alternative Medicine, Apr 06, 2001 by Belinda Rowland

An ulcer is an eroded area of skin or mucous membrane. In common usage, however, ulcer usually refers to disorders in the upper digestive tract. The terms ulcer, gastric ulcer, and peptic ulcer are often used interchangeably. Peptic ulcers can develop in the lower part of the esophagus, the stomach, the first part of the small intestine (the duodenum), and the second part of the small intestine (the jejunum).

It is estimated that 2% of the adult population in the United States has active digestive ulcers, and that about 10% will develop ulcers at some point in their lives. There are about 500,000 new cases in the United States every year, with as many as 4 million recurrences. The male/female ratio for digestive ulcers is 3:1.

The most common forms of digestive ulcer are duodenal and gastric. About 80% of all digestive ulcers are duodenal ulcers. This type of ulcer may strike people in any age group but is most common in males between the ages of 20 and 45. The incidence of duodenal ulcers has dropped over the past 30 years. Gastric ulcers account for about 16% of digestive ulcers. They are most common in males between the ages of 55 and 70. The most common cause of gastric ulcers is the use of nonsteroidal anti-inflammatory drugs, or NSAIDs. The current widespread use of NSAIDs is thought to explain why the incidence of gastric ulcers in the United States is rising.

There are three major causes of digestive ulcers: infection, certain medications, and disorders that cause oversecretion of stomach juices.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are painkillers that many people use for headaches, sore muscles, arthritis, and menstrual cramps. Many NSAIDs are available without prescriptions. Common NSAIDs include aspirin, ibuprofen (Advil, Motrin), flurbiprofen (Ansaid, Ocufen), ketoprofen (Orudis), and indomethacin (Indacin). Chronic NSAID users have 40 times the risk of developing a gastric ulcer as nonusers. Users are also three times more likely than nonusers to develop bleeding or fatal complications of ulcers. Aspirin is the most likely NSAID to cause ulcers.

Consumption of high-fat or spicy foods are not significant risk factors.

• Hypersecretory syndromes, including Zollinger-Ellison syndrome, secrete excessive amounts of digestive juices into the digestive tract. Fewer than 5% of digestive ulcers are due to these disorders.
• Smoking increases a patient's chance of developing an ulcer, decreases the body's response to therapy, and increases the chances of dying from complications.
• Blood type. Persons with type A blood are more likely to have gastric ulcers, while those with type O are more likely to develop duodenal ulcers.
• Attitudes toward stress, rather than the presence of stress, puts one at risk for ulcers.

Not all digestive ulcers produce symptoms; as many as 20% of ulcer patients have so-called painless or silent ulcers. Silent ulcers occur most frequently in the elderly and in chronic NSAID users.

The symptoms of gastric ulcers include feelings of indigestion and heartburn, weight loss, and repeated episodes of gastrointestinal bleeding. Ulcer pain is often described as gnawing, dull, aching, or resembling hunger pangs. The patient may be nauseated and suffer loss of appetite. About 30% of patients with gastric ulcers are awakened by pain at night. Many patients have periods of chronic ulcer pain alternating with symptom-free periods that last for several weeks or months. This characteristic is called periodicity.

The symptoms of duodenal ulcers include heartburn, stomach pain relieved by eating or antacids, weight gain, and a burning sensation at the back of the throat. The patient is most likely to feel discomfort two to four hours after meals, or after having citrus juice, coffee, or aspirin. About 50% of patients with duodenal ulcers awake during the night with pain, usually between midnight and 3 A.M. A regular pattern of ulcer pain associated with certain periods of day or night or a time interval after meals is called rhythmicity.

Between 10-20% of peptic ulcer patients develop complications at some time during the course of their illness. All of these are potentially serious conditions. Complications are not always preceded by diagnosis of or treatment for ulcers; as many as 60% of patients with complications have not had prior symptoms.

Bleeding is the most common complication of ulcers. It may result in anemia, vomiting blood, or the passage of bright red blood through the rectum. The mortality rate from ulcer hemorrhage is 6-10%.

About 5% of ulcer patients develop perforations, which are holes through which the stomach contents can leak out into the abdominal cavity. The incidence of perforation is rising because of the increased use of NSAIDs, particularly among the elderly. The signs of an ulcer perforation are severe pain, fever, and tenderness when the doctor touches the abdomen. Most cases of perforation require emergency surgery. The mortality rate is about 5%.

Ulcer penetration is a complication in which the ulcer erodes through the intestinal wall without digestive fluid leaking into the abdomen. Instead, the ulcer penetrates into an adjoining organ, such as the pancreas or liver. The signs of penetration are more severe pain without rhythmicity or periodicity, and the spread of the pain to the lower back.