PEPTIC ULCER
t e r m u s e o f
n o n s t e ro id a l a n ti-in fla m m a to ry
d ru g s
( N S A I D s ) , s m o k i n g , a l c o h o l c o n -
s u m p t i o n , a n d e x c e s s a c i d p r o d u c t i o n c a n
a l s o d a m a g e t h e s t o m a c h l i n i n g . A
s tre ss
u lc e r
i s a p e p t i c u l c e r c a u s e d b y s e v e r e
p h y s i o l o g i c a l s t r e s s , s u c h a s t h a t d u e t o
n e u r o s u r g e r y o r t o b u r n s ( f o r e x a m p l e ,
a
C u rlin g ’s u lc e r ).
P s y c h o l o g i c a l s t r e s s i s
t h o u g h t t o a g g r a v a t e a n e x i s t i n g u l c e r .
F o r f u r t h e r i n f o r m a t i o n o n h o w a n
u l c e r f o r m s a n d t h e s i t e s w h e r e u l c e r s
m a y d e v e l o p , s e e t h e i l l u s t r a t e d b o x .
SYMPTOMS
T h e r e
m a y b e n o s y m p t o m s ,
o r t h e r e
m a y b e b u r n i n g o r g n a w i n g p a i n i n t h e
u p p e r a b d o m e n w h e n
t h e s t o m a c h i s
e m p t y . T h e p a i n o f a d u o d e n a l u l c e r i s
o f t e n
r e l i e v e d
b y
e a t i n g ,
b u t
u s u a l l y
r e c u r s a f e w h o u r s l a t e r . T h e p a i n o f a
g a s t r i c u l c e r m a y b e w o r s e n e d b y f o o d .
O t h e r p o s s i b l e s y m p t o m s o f a p e p t i c
u l c e r i n c l u d e a l o s s o f a p p e t i t e , a b l o a t -
e d
o r
f u l l
f e e l i n g
i n
t h e
a b d o m e n ,
n a u s e a , a n d , s o m e t i m e s , v o m i t i n g .
COMPLICATIONS
T h e m o s t
c o m
m o n
c o m p l i c a t i o n
o f a
p e p t i c
u l c e r
i s
b l e e d i n g
a s
t h e
u l c e r
p e n e t r a t e s
d e e p e r
a n d
d a m a g e s
b l o o d
v e s s e l s . I f s e v e r e , b l e e d i n g m a y r e s u l t i n
h a e m a t e m e s i s ( v o m i t i n g o f b l o o d ) a n d
m e la e n a
( b l a c k f a e c e s ) a n d i s a m e d i c a l
e m e r g e n c y C h r o n i c b l e e d i n g m a y c a u s e
i r o n - d e f i c i e n c y
a n a e m ia .
R a r e l y , a n u l c e r
m a y p e r f o r a t e t h e w a l l o f t h e d i g e s t i v e
t r a c t a n d l e a d t o
p e r it o n it is
( i n f l a m m a -
t i o n o f t h e a b d o m i n a l c a v i t y ’s l i n i n g ) .
SITES AND CAUSES OF PEPTIC ULCER
A peptic ulcer develops in about one in eight people
in the UK at some time in their lives. Some of the
mechanisms that are involved in causing ulcers are
shown below. A peptic ulcer is investigated using
endoscopy, which involves passing a gastroscope
(a type of endoscope) through the mouth to view
the stomach and duodenum. A sample of the stomach
lining may be taken at the same time to look for
evidence of H
e e i c o b a c t e r p y e o r i
infection, the major
cause of peptic ulcers; blood tests (to check for
antibodies against H
e e i c o b a c t e r p y e o r i
) and
b re a th te sts
are also used to confirm its presence.
Stomach
Gastric ulcer
This photograph of an ulcer in the wall ofthe
stomach was taken using a gastroscope passed
through the mouth into the stomach.
Duodenal ulcer
In this gastroscopicview ofthe top ofthe
duodenum, an ulcer is clearlyvisible as a
smooth white area.
Site ofulcers
Peptic ulcers are most common in the first part
ofthe duodenum or lower half ofthe stomach;
oesophageal ulcers also occur.
HOW AN ULCER IS FORMED
Stomach lining irritated by bacteria (mostly
H
e E IC O B A C T E R PYEORI
),
NSAIDs (e.g. aspirin),
bile, alcohol, and caffeine
Protective wall of epithelial
cells broken byacid
Increased
acid secretion
Ulcer
1
Gastric glands in the lining ofthe
stomach secrete acid and the enzyme
pepsin, which help to break down food.
The acid and pepsin would quickly eat
away the stomach and duodenum if other
cells in the lining did not secrete a
protective mucus.
2
Most peptic ulcers are due to bacterial infection
ofthe stomach lining, which damages its
mucous layer (making it vulnerable to acid) and
the cells that control excess acid production.
Ulcers can also be caused by NSAIDs or excess
alcohol combined with excess production of acid.
Smoking is another important irritant factor.
3
If damaging influences overcome the
protective factors in the stomach or
duodenal lining, the mucous layer and
mucus-secreting cells are eroded and an
ulcer forms. Stress is probably not a prime
cause of ulcers but it is possible it may
aggravate an existing ulcer.
P
597
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