Peptic ulcers
Peptic ulcer is a disruption in the gastric or duodenal mucosa when normal defense mechanisms are overwhelmed or impaired by acid or pepsin. Ulcers are circumscribed lesions that extend through the muscularis mucosa. Ulcers are five times more common on the duodenum.
Duodenal ulcers occur most commonly between ages 30 and 55; gastric ulcers, between ages 55 and 70.
Causes
Researchers recognize three major causes of peptic ulcer disease: infection with Helicobacter pylori, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and pathologic hypersecretory states such as Zollinger-Ellison syndrome.
H. pylori is the cause of the majority of duodenal and gastric ulcers. Following treatment with standard therapies, 70% to 85% of patients have a documented recurrence (by endoscopy) within 1 year.
Other causes include the use of certain drugs, such as salicylates and other NSAIDs, which encourage ulcer formation by inhibiting the secretion of prostaglandins (the substances that suppress ulceration). Certain illnesses— such as pancreatitis, hepatic disease, Crohn’s disease, Zollinger-Ellison syndrome, and preexisting gastritis — are also known causes. Additionally, having a type A personality increases autonomic nervous system effects on the gastric mucosa.
Predisposing factors
Ulcers are more common in smokers and those who regularly use NSAIDs. (Smoking increases the amount of hydrochloric acid in the stomach; nicotine reduces the bicarbonate content of pancreatic secretions and also decreases the degree of acid neutralization.) Diet and alcohol don’t appear to contribute to the development of peptic ulcer disease. It’s unclear whether emotional stress is a contributing factor.
Signs and symptoms
Symptoms vary with the type of ulcer.
Gastric ulcers
Gastric ulcers are usually signaled by pain that becomes more intense with eating. The pain is usually constant because the gastric mucosa is sensitive to acid secretion. Nausea or anorexia may occur.
Duodenal ulcers
Duodenal ulcers produce epigastric pain that’s gnawing, dull, aching, or “hunger-like.” The pain is relieved by food or antacids and typically recurs 2 to 4 hours later. Weight loss or vomiting is typically a sign of malignancy or gastric outlet obstruction.
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