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Ulcers

Definition of Ulcer
An ulcer is a lesion that is eroding away the skin or mucous membrane. Ulcers can have various causes depending on their location. Ulcers on the skin are usually due to irritation, as in the case of bedsores, and may become inflamed and/or infected as they grow. Ulcers in the gastrointestinal tract were once attributed to stress but most are now believed to be due to infection with the bacterium Helicobacter pylori. GI ulcers, however, are often made worse by stress, smoking and other noninfectious factors.

What is a peptic ulcer?
A peptic ulcer is a break in the inner lining of the esophagus, stomach or duodenum. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. Peptic ulcers occur when the lining of these organs is corroded by the acidic digestive (peptic) juices which are secreted by the cells of the stomach. A peptic ulcer differs from erosion because it extends deeper into the lining of the esophagus, stomach, or duodenum and excites more of an inflammatory reaction from the tissues that are eroded.

Peptic ulcer disease is common, affecting millions of Americans yearly. Moreover, peptic ulcers are a recurrent problem; even healed ulcers can recur unless treatment is directed at preventing their recurrence. The .medical cost of treating peptic ulcer and its complications runs into billions of dollars annually. Recent medical advances have increased our understanding of ulcer formation. Improved and expanded treatment options now are available.

What are the causes of peptic ulcers?
For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, the emphasis of treatment was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered necessary for the formation of ulcers , the two most important initiating causes of ulcers are infection of the stomach by a bacterium called “Helicobacter pyloricus” (H. pylori) and chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin.Cigarette smoking also is an important cause of ulcer formationas well
as failure of ulcer treatment.

Infection with H. pylori is very common, affecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10% to 15% of those infected.

In the past, H. pylori were found in more than 80% of patients with gastric and duodenal ulcers. With increasing appreciation, diagnosis and treatment of this infection, however, the prevalence of infection with H. pylori as well as the proportion of ulcers caused by the bacterium has decreased; it is estimated that currently only 20% of ulcers are associated with the bacterium.

While the mechanism by which H. pylori causes ulcers is complex, elimination of the bacterium by antibiotics has clearly been shown to heal ulcers and prevent the recurrence of ulcers.

NSAIDs are medications used for the treatment of arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this class of medications. Prostaglandins are substances which are important in helping the linings of the esophagus, stomach and duodenum to resist damage by the acidic digestive juices of the stomach. NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Cigarette smoking not only causes ulcers, but it also increases the risk of complications from the ulcers such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking also is a leading cause of failure of treatment for ulcers.

Definition of Duodenal ulcer

Duodenal ulcer: A crater (ulcer) in the lining of the beginning of the small intestine (duodenum.) Ulcer formation is caused by infection with Helicobacter pylori. Other factors predisposing a person to ulcers include anti-inflammatory medications and cigarette smoking. Ulcer pain may not correlate with the presence or severity of ulceration. Diagnosis is made with barium X- ray or endoscopy. Complications of ulcers include bleeding, perforation and blockage. Treatment involves using antibiotics to eradicate H. pylori, eliminating risk factors and preventing complications.