Ulcer

"If you guys don't stop yelling, you'll give me an ulcer!"

"There's been so much stress at work lately, I'm sure I'll get an ulcer."

"Don't worry so much. Do you want an ulcer?"

When people talk like this, it sounds like ulcers are easy to give and easy to get. It also sounds like stress is to blame. But is that the real story?

What Is an Ulcer?

An ulcer is a sore, which means it's an open, painful wound.Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum (pronounced: doo-uh-dee-num).Peptic ulcers are actually very common.

What Causes an Ulcer?

For almost 100 years, doctors believed that stress, spicy foods, and alcohol caused most ulcers. Now we know that most peptic ulcers are caused by a particular bacterial infection in the stomach and upper intestine, by certain medications, or by smoking.

In 1982, two doctors — Barry Marshall and Robin Warren — discovered a certain kind of bacteria that can live and grow in the stomach. Both doctors went on to win the Nobel Prize for their discovery. The medical name for these bacteria is Helicobacter pylori (or H. pylori, for short). Today doctors know that most peptic ulcers are caused by an infection from H. pylori.

Experts believe that 90% of all people with ulcers are infected with H. pylori. But strangely enough, most people infected with H. pylori don't develop an ulcer. Doctors aren't completely sure why, but think it may partly depend upon the individual person — for example, those who develop ulcers may already have a problem with the lining of their stomachs.

It's also thought that some people may naturally secrete more stomach acid than others — and it doesn't matter what stresses they're exposed to or what foods they eat. Peptic ulcers may have something to do with the combination of H. pylori infection and the level of acid in the stomach.

The direct cause of peptic ulcers is the destruction of the gastric or intestinal mucosal lining of the stomach by hydrochloric acid, an acid normally present in the digestive juices of the stomach. Infection with the bacterium Helicobacter pylori is thought to play an important role in causing both gastric and duodenal ulcers. Helicobacter pylori may be transmitted from person to person through contaminated food and water. Antibiotics are the most effective treatment for Helicobacter pylori peptic ulcers.

Injury of the gastric mucosal lining, and weakening of the mucous defenses are also responsible for gastric ulcers. Excess secretion of hydrochloric acid, genetic predisposition, and psychological stress are important contributing factors in the formation and worsening of duodenal ulcers.

Another major cause of ulcers is the chronic use of anti-inflammatory medications, such as aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

How Ulcers Form

When H. pylori bacteria do cause ulcers, here's how doctors think it happens:

1. Bacteria weaken the protective coating of the stomach and upper small intestine.
2. Acid in the stomach then gets through to the sensitive tissues lining the digestive system underneath.
3. Acid and bacteria directly irritate this lining resulting in sores, or ulcers.

Although H. pylori are responsible for most cases of peptic ulcers, these ulcers can happen for other reasons, too. Some people regularly take pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, that fight inflammation in the body and are used to treat long-term painful conditions like arthritis. If taken in high daily doses over a long period of time, NSAIDs can cause ulcers in some people.

Smoking also is associated with peptic ulcers. Smoking increases someone's risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more acid. Drinking a lot of alcohol each day for a period of time can also increase a person's risk of ulcers because over time alcohol can wear down the lining of the stomach and intestines.

In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick to eat for a long period of time.

Ulcers occur because of uncontrolled increased acid production in the stomach and changes in the immune system (the body system that fights infection). With any illness where the body's ability to heal is challenged (such as when someone has serious burns from a fire), there is a risk for developing ulcers.

Signs and Symptoms

Stomach pain is the most common symptom of an ulcer. It usually feels like sharp aches between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for awhile.

Other symptoms of ulcers can include:

• loss of appetite
• sudden, sharp stomach pains
• nausea
• frequent burping or hiccuping
• weight loss
• vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)
• bloody or blackish bowel movements (this could indicate a serious problem, so call a doctor right away if you see this)

Anyone who thinks he or she may have an ulcer needs to see a doctor. Over time, untreated ulcers grow larger and deeper and can lead to other problems, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, which can make someone very sick.

Children develop stomach ulcers too.

Stomach Ulcers may be a symptom of another disease or condition. Stomach ulcers are often common in mastocytosis. Bleeding from stomach ulcers may cause iron deficiency anemia.

How Are Ulcers Diagnosed?

In addition to doing a physical examination, the doctor will take a medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. If you have stomach pain or other symptoms of an ulcer, the doctor will perform some tests to help make the diagnosis.

One test is called an upper gastrointestinal (GI) series. This is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a whitish liquid called barium while getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.

Another common procedure to look for an ulcer is called anendoscopy (pronounced: en-dass-kuh-pee). During this test, the doctor uses an endoscope, a skinny, lighted tube with a special camera on the end.

A person getting an endoscopy is given anesthesia and will have no memory of the procedure. For an endoscopy, the doctor gently guides the endoscope into the throat and down into the esophagus, and finally into the stomach and upper intestines. The doctor is able to look at the inner lining of these organs from the camera on a television screen and can even take pictures. Tissue can be removed during an endoscopy and then tested for H. pyloribacteria.

A doctor can also do a blood test for H. pylori bacteria. This may be important if an ulcer is found in the upper GI series. The blood test can be done right in the doctor's office. Sometimes a bowel movement or a person's breath can also be specially tested to check for the H. pylori bacteria.

How Are Ulcers Treated?

Ulcers caused by H. pylori bacteria are generally treated with a combination of medications:

• Usually two antibiotics to kill the H. pylori bacteria are taken every day for about 2 weeks.
• Antacids — acid blockers or proton pump inhibitors — are given for 2 months or longer to lessen the amount of acid in the stomach and help protect the lining of the stomach so the ulcer can heal.

Ulcer Prevention

Doctors are not totally certain how H. pylori bacteria are transmitted from person to person. The bacteria have been found in saliva, so kissing may be one way. They also may be spread through food, water, or contact with vomit (puke) that has been infected with the bacteria.

The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before you eat and to take good care of your body by exercising regularly and not smoking or drinking.

Reviewed by: Michael K. Davis, MD

Foot and leg ulcers

Ulcers are breaks in the layers of the skin that fail to heal. They may be accompanied by inflammation.

Sometimes they don't heal and become chronic. Chronic foot and leg ulcers mainly affect the elderly.

People with diabetes are at special risk of developing foot ulcers, and foot care is an important part of diabetes management.

What causes ulceration?

The most common cause of chronic leg ulcers is poor blood circulation in the legs. These are known as arterial and venous leg ulcers.

Other causes include:

• injuries - traumatic ulcers
• diabetes - because of poor blood circulation or loss of sensation (nerve damage) resulting in pressure ulcers
• certain skin conditions
• vascular diseases (stroke, angina, heart attack)
• tumours
• infections.

Arterial leg ulcers

Approximately 10 per cent of all leg ulcers are arterial ulcers.

Feet and legs often feel cold and may have a whitish or bluish, shiny appearance.

Arterial leg ulcers can be painful. Pain often increases when your legs are at rest and elevated.

You can reduce pain by sitting on the edge of the bed with your feet on the floor. Gravity will then cause more blood to flow into your legs.

What causes arterial leg ulcers?

The used blood, which now contains carbon dioxide and other by-products, is carried via the veins from the tissues back to the heart.Arteries are the tubes that carry blood from the heart to the body's tissues. The tissues receive oxygen and nutrients from the blood.

Arterial leg ulcers are caused by poor blood circulation as a result of narrowed arteries. They are also caused by damage to the small blood vessels from long-standing diabetes.

Diabetes also increases the likelihood of atherosclerosis (narrowing of the arteries). This means people with diabetes have a much increased risk of developing arterial ulcers.

What can trigger or worsen arterial leg ulcers?

• Smoking.
• High blood pressure.
• Diabetes.
• Arthritis (rheumatoid arthritis).
• Old leg ulcers.
• Coronary heart disease, including coronary thrombosis (blood clots in the arteries of the heart).
• Atherosclerosis in the legs.

What can I do to prevent arterial leg ulcers?

Stop smoking and lose weight if you are overweight. Reduce the amount of fat in your diet and eat more fruit and vegetables.

Exercise as much as possible. By exercising, you force your blood vessels to form new branches, improving the blood circulation in your legs.

It's fine if your legs hurt a little when you exercise, but it mustn't make you feel unwell.

Try this exercise while sitting down: move your feet around in circles, then up and down. This activates the venous pump. It's also helps people with venous leg ulcers.

Take good care of your feet:

• make sure shoes fit correctly and are not too small.
• keep your feet warm and try to avoid injuries to your feet and legs.
• examine your feet and legs daily for any changes in colour or the development of sores.
• visit a chiropodist regularly

Apthous Ulcers (Mouth Ulcers)-RAD

Apthous Ulcers (Mouth Ulcers)

Aphthous ulcers are ulcers that form on the mucous membranes of the mouth or oral cavity. Aphthous ulcers are typically recurrent round or oval sores or ulcers that occur inside the mouth .Aphthous mouth ulcers are very painful sores that can occur anywhere inside the mouth. At least 1 in 5 people develop aphthous mouth ulcers at some stage in their life.
There are three types:
• Minor aphthous ulcers are the most common they are small, round, or oval, and are less than 10 mm across. They look pale yellow, but the area around them may look swollen and red. Only one ulcer may develop, but up to five may appear at the same time. Each ulcer lasts 7-10 days, and then goes without leaving a scar. They are painful.
• Major aphthous ulcers these are 10 mm or larger. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months, and then goes but leaves a scar. They can be very painful – eating may become difficult.
• Herpetiform ulcers’, these are tiny, about 1-2 mm across. Many occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts one week to two months. (These are sometimes called but they have nothing to do with herpes or the herpes virus.)
Aphthous ulcers usually first occur at any age. They then recur from time to time. There can be days, weeks, months, or years between each bout of ulcers. The ulcers tend to recur less often as you become older. In many cases, they eventually stop coming back. Some people feel a burning in the mouth for a day or so before an ulcer appears.

Causes of Aphthous ulcers?

The exact reason why aphthous ulcers develop is not yet clearly defined. Current thinking is that the immune system has been disturbed by some external factor and these results in the development of aphthous ulcers. Also, approximately 40% of people who get ulcers have a family history of aphthous ulcers.
Some factors that seem to trigger outbreaks of ulcers include:
• Emotional stress and lack of sleep
• Mechanical trauma, for example self-inflicted bite , improper brushing
• Nutritional deficiencies, particularly vitamins B, iron, and folic acid
• Certain foods including spices, chocolate
• Certain toothpastes and hard tooth brushes
• Smoking, but Some ex-smokers find they develop ulcers only after stopping smoking.
• Changes in hormone levels. Some women find that mouth ulcers occur just before their period. In some women, the ulcers only develop after the menopause.
• Rarely, a food allergy may be the cause.
• A reaction to a medication is a rare cause. For example, anti-inflammatory drugs, and oral nicotine replacement therapy have been reported to cause mouth ulcers in some people.
• Aphthous ulcers are commonly present in certain medical conditions. Many of these conditions are associated with impaired immune systems and include Behcet disease, Crohn disease and inflammatory bowel disease.

Treatments for Aphthous ulcers?

Treatment aims to ease the pain when ulcers occur, and to help them to heal as quickly as possible. (There is no treatment that prevents aphthous mouth ulcers from recurring.)
• No treatment may be needed. The pain is often mild, particularly with the common ‘minor’ type of aphthous ulcer. Each bout of ulcers will go without treatment.
• General measures include:
o Avoid spicy foods, acidic fruit drinks, and very salty foods (such as crisps) which can make the pain worse.
o Use a straw to drink, to by-pass ulcers in the front of the mouth. (Note: do not drink hot drinks with a straw, as you may burn your throat. Only cold drinks.)
o Use a very soft toothbrush.
o If you suspect a medication is causing the ulcers, then a change may be possible.
• Chlorhexidine mouthwash may reduce the pain. It may also help ulcers to heal more quickly. It also helps to prevent ulcers from becoming infected. Chlorhexidine mouthwash is usually used twice a day. It may stain teeth brown if you use it regularly. However, the stain is not usually permanent, and can be reduced by avoiding drinks that contain tannin (such as tea, coffee, or red wine), and by brushing teeth before use. Rinse your mouth well after you brush your teeth as some ingredients in toothpaste can inactivate chlorhexidine.
• Steroid lozenges may also reduce the pain, and may help ulcers to heal more quickly. By using your tongue you can keep a lozenge in contact with an ulcer until the lozenge dissolves. A steroid lozenge works best the sooner it is started once an ulcer erupts. If used early, it may ‘nip it in the bud’, and prevent an ulcer from fully erupting. The usual dose is one lozenge, four times a day, until the ulcer goes. In children, use for no more than five days at a time.
• Steroid paste (gel) is an alternative to a lozenge.
• A painkilling oral rinse, gel, or mouth spray may help to ease pain. For example, benzydamine spray, or choline salicylate gel. However, the effect of each dose does not last very long.
• Steroid -Other treatments may be tried if the above do not help or where the pain and ulceration are severe. For example, a course of steroid tablets, strong steroid mouthwashes, colchicine, tetracycline or doxycycline mouthwashes, and some immunosuppressant drugs.
• Cautery with Silver nitrate under local anesthetic is very effective. It destroy the nerve endings under the ulcer base reducing pain and early healing
• Biopsy to be done if mouth ulcer doesn’t heal after 2-3 weeks, to rule out any malignancy.