What is an Ulcer? Symptoms, Diagnosis, and Treatment

Just as wounds can develop on the outside of the body, it is also normal for wounds to occur inside the body.

Just as wounds can develop on the outside of the body, it is also normal for wounds to occur inside the body. These wounds often cause pain and can occur in other internal organs, especially the stomach.

What is an Ulcer?

An ulcer is an open sore that forms on the inner surface of the digestive system. It can develop in the stomach lining, the upper part of the small intestine, or the esophagus. Ulcers occur when digestive juices damage the walls of the stomach and intestines. This type of ulcer is called a peptic ulcer. Ulcers rarely heal on their own, but if left untreated, they may recur. Overgrowth of the Helicobacter pylori bacteria in the digestive system can cause peptic ulcers. Peptic ulcers form as a result of damage or erosion to the protective lining of the digestive system. Although Helicobacter pylori infection does not cause symptoms in most people, it can sometimes irritate the inner lining of the digestive system, leading to a peptic ulcer. While open sores can occur in various areas such as the mouth, stomach, legs, and intestines, the term "ulcer" is most commonly used to refer to ulcers that occur in the stomach and duodenum.

What Are the Symptoms of an Ulcer?

The stomach and duodenum are protected by a mucosal lining, but this lining can wear away over time, particularly depending on diet. While there may be some differences in symptoms between duodenal and gastric ulcers, the symptoms are often similar. The most common complaint is a burning pain in the stomach. Certain foods, in particular, may worsen ulcer-related symptoms. Some people with peptic ulcers may not experience any symptoms at all. The pain frequently associated with ulcers sometimes improves after eating. Generally, ulcer symptoms include:

• Dizziness
• Weight loss
• Blood in the stool
• Vomiting
• Difficulty breathing
• Heartburn

Who Gets Ulcers?

People with a family history of ulcers are at a higher risk of developing them. Additionally, certain foods, stress, and various diseases can contribute to the formation of ulcers. The causes of ulcers include:

• Helicobacter Pylori Bacteria: Helicobacter pylori is a type of bacteria that can be found in the stomach. When it overgrows, it begins to break down the stomach lining and forms an ulcer.
• Medications: Other common causes of ulcer formation include prolonged use or high doses of nonsteroidal anti-inflammatory drugs (NSAIDs). If the blood does not clot effectively, ulcers may bleed more. Other medications that can cause ulcers include chemotherapy drugs and medications used for osteoporosis.
• Zollinger-Ellison Syndrome: Zollinger-Ellison syndrome is a rare condition that causes tumors to develop in the pancreas and small intestine. These tumors release a hormone called gastrin, which stimulates the production of stomach acid. Excess acid can lead to ulcer formation.
• Crohn's Disease: Crohn's disease can also increase sensitivity, leading to stomach and duodenal ulcers.

How is an Ulcer Diagnosed?

The symptoms of ulcers often resemble those of other conditions such as gallstones or gastroesophageal reflux disease, making an accurate diagnosis very important. Initially, the doctor will inquire about the patient's medical history and current medications. They may also request a blood, stool, or breath test to check for signs of H. pylori infection. The following tests are commonly used:

• H. pylori Tests: There are several tests used to diagnose an infection caused by H. pylori. A stool test is commonly used, where a stool sample is sent to a laboratory for analysis. Since H. pylori produces an enzyme called urease, a high urease level may indicate an infection. If a breath test is used, patients are given a radioactive carbon substance to ingest, and then their breath is collected in a bag for analysis.
• Esophagogastroduodenoscopy (EGD): EGD is a type of endoscopy, also known as upper endoscopy. With the help of a camera, the doctor can view ulcers in the stomach or small intestine. During this test, biopsies may be taken for laboratory analysis.
• Upper Gastrointestinal System X-ray: This is a type of X-ray used to view the upper digestive system. The procedure involves drinking a substance called barium sulfate. Since barium sulfate does not react with the body, it passes through the digestive system, helping to visualize the internal organs in an X-ray. Multiple X-rays are taken as the barium sulfate moves through the esophagus, stomach, and small intestine. This can help detect abnormalities such as ulcers.

What Are the Types of Ulcers?

Ulcers are slow-healing, painful open sores that can recur. They primarily occur in the stomach and duodenum, under the term peptic ulcer. However, they can rarely develop in other areas such as the mouth or legs. These include:

• Gastric Ulcer: Also known as a stomach ulcer, this is the most common type of ulcer. It forms as open sores on the stomach lining, typically presenting as a burning sensation.
• Duodenal Ulcer: These ulcers occur in the first part of the small intestine, the duodenum. Their symptoms and treatment are often similar to those of gastric ulcers.
• Mouth Ulcers: These are open sores that occur inside the mouth. They are commonly known as canker sores. Mouth ulcers typically heal on their own without treatment. If they become painful, medications prescribed by a doctor or dentist can help manage the pain.
• Venous Ulcers: These open sores typically occur on the legs, below the knee, and on the inner ankle. They are caused by poor blood flow from the heart, resulting from damage to the veins. Venous ulcers usually do not cause pain. Treatment focuses on improving blood flow to the affected area.
• Arterial Ulcers: These open sores primarily develop on the outer parts of the lower legs, ankles, feet, toes, and heels. Arterial ulcers are caused by a lack of blood flow to the tissue due to damage to the arteries, and healing can take a long time.
• Genital Ulcers: These open sores occur on the genitalia and surrounding areas. They can be caused by sexually transmitted diseases but may also result from trauma or inflammatory diseases.

What Are the Dangerous Consequences of an Ulcer?

If left untreated, ulcers can lead to several complications, some of which can cause life-threatening symptoms. The potential complications caused by ulcers include:

• Bleeding: An untreated ulcer can lead to serious bleeding. Symptoms to watch for include blood in the stool, dark-colored stools, or severe pain.
• Perforation: Perforation refers to holes in the organ lining within the digestive system. Although rare, it can be serious and lead to complications.
• Narrowing and Obstruction: If ulcers occur in the pylorus, the exit part of the stomach, they can cause narrowing and block the stomach outlet. If the ulcer is in the part of the duodenum where it connects to the stomach, inflammation can block the passage of food. Duodenal ulcers can also cause narrowing in the small intestine. Symptoms include vomiting, bloating, early fullness (feeling of satiety), and pain.

Ulcer Treatment Methods

The treatment depends on the underlying cause of the ulcer. Various medications are available to treat stomach ulcers. Treatment often requires the use of medications that either reduce the amount of acid in the stomach or protect the stomach and duodenum. A common type of medication used to treat ulcers is called proton pump inhibitors. These medications prevent the formation of stomach acids that can lead to ulcers. Additionally, the bacteria causing the ulcer can be treated with antibiotics. Other factors that support treatment include lifestyle changes. In severe cases, surgical methods may be used to repair the digestive system lining. Surgery is not commonly performed, but it may be necessary if there are complications such as bleeding or perforation. In ulcers caused by Zollinger-Ellison syndrome, surgery may be used to remove tumors, which can also prevent the spread of the tumors to other parts of the body.

What Should Be Done to Prevent Ulcers?

Ulcer sores can be prevented in some people through lifestyle changes. The following measures can help prevent ulcers:

• Quit smoking
• Reduce triggers that can harm the stomach, such as fried foods and spicy foods
• Ensure there is at least a 2-hour gap between eating and sleeping

What Helps Relieve Ulcer Pain?

Overeating, gas, and indigestion can worsen ulcer pain. Therefore, aside from doctor-prescribed painkillers, the following nutrients can help prevent mild pain:

• Probiotics do not kill the bacteria causing the ulcer, but they can help treat ulcers by restoring the balance of good bacteria in the digestive system. Consuming yogurt and fermented products can help maintain gut health.
• Flavonoids may help prevent the growth of H. pylori, the bacteria commonly associated with stomach ulcers. This property acts as a protective agent by increasing stomach mucus. Particularly, colorful fruits are rich in flavonoids.
• Chamomile tea may help relax mild intestinal spasms, reduce inflammation, and relieve pain.