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Wednesday, 20 January, 1999, 15:47 GMT
Ulcers
Boris Yeltsin
Boris Yeltsin has a bleeding stomach ulcer
Most ulcers can be easily treated. However, when complications develop they can pose a serious threat to health. Patients can be treated with drugs or through surgery, but there is no firm evidence that this works. Bleeding ulcers can be a sign of general poor health.

What is an ulcer?

An ulcer is a sore or a hole that forms in the lining of the stomach or small intestine (duodenum).

Approximately one in ten people will suffer from an ulcer. Each year about ten per cent of sufferers required surgery because of persistent symptoms. In a small minority of cases patients will die of ulcer-related complications.

Who is at risk?

Ulcers can develop at any age, but they are rare among teenagers and even more uncommon in children. Duodenal ulcers occur for the first time usually between the ages of 30 and 50. Stomach ulcers are more likely to develop in people over age 60.

Duodenal ulcers occur more frequently in men than women; stomach ulcers develop more often in women than men.

What are the symptoms of ulcers?

The most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours and may be relieved by eating or by taking antacids.

Less common ulcer symptoms include nausea, vomiting, and loss of appetite and weight.

Bleeding from ulcers may occur in the stomach and duodenum. Sometimes people are unaware that they have a bleeding ulcer, because blood loss is slow and blood may not be obvious in the stool.

These people may feel tired and weak. If the bleeding is heavy, blood will appear in vomit or stool. Stool containing blood appears tarry or black.

What causes ulcers?

Until recent times doctors believed lifestyle factors such as stress and diet caused ulcers. This is now thought unlikely, although some lifestyle factors, such as smoking and drinking alcohol and caffeine are still suspected of causing problems.

Physical stress is also a factor. For example, people with injuries such as severe burns and people undergoing major surgery often require rigorous treatment to prevent ulcers and ulcer complications.

Scientists later discovered that an imbalance of the digestive fluids hydrochloric acid and pepsin could also cause ulceration.

Both substances are produced by the stomach, and are essential to help break down food in the first stages of the digestive process. However, they may also attack the delicate lining of the stomach and duodenum, particularly if the stomach's natural defence mechanisms break down.

Operation
Surgery may be required
Normally the stomach lining produces a mucus shield. It also releases a chemical called bicarbonate that breaks down the digestive fluids. Regular renewal of the cells of the stomach lining also helps guard against the development of ulcers.

Scientists now believe, however, that the primary cause of most ulcers is infection with the bacterium Helicobacter pylori (H. pylori).

H. Pylori

H. pylori is a spiral-shaped bacterium found in the stomach. It produces an enzyme urease, that neutralises the stomach's acid. This causes the stomach to step up acid production, putting its own lining at greater risk.

The bacteria can also penetrate and weaken the stomach's protective mucous lining, and can attach themselves to stomach cells, further weakening the stomach's defence mechanisms and producing local inflammation.

Within weeks of infection with H. pylori, most people develop gastritis - an inflammation of the stomach lining.

However, most people will never have symptoms or problems related to the infection. Scientists do not yet know what is different in those people who develop H. pylori-related symptoms or ulcers.

The impact of drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) make the stomach vulnerable to the harmful effects of acid and pepsin.

NSAIDs such as aspirin, ibuprofen, and naproxen sodium are present in many non-prescription medications used to treat fever, headaches, and minor aches and pains.

These, as well as prescription NSAIDs used to treat a variety of arthritic conditions, interfere with the stomach's ability to produce mucus and bicarbonate and affect blood flow to the stomach and cell repair.

How are ulcers treated?

Lifestyle changes: No particular diet is helpful for most ulcer patients. People who find that certain foods cause irritation should discuss this problem with their doctor. Smoking has been shown to delay healing and prompt recurrence.

Medicines: Doctors treat stomach and duodenal ulcers with several types of medicines including H2-blockers, acid pump inhibitors, and mucosal protective agents. When treating H. pylori, these medications are used in combination with antibiotics.

When is surgery needed?

People who do not respond to medication or who develop complications may require surgery. While surgery is usually successful in healing ulcers and preventing their recurrence and future complications, problems can sometimes result.

There are three common types of surgery for ulcers:

Vagotomy: This involves cutting the vagus nerve that links the stomach to the brain. This reduces acid secretion.

Antrectomy: Removal of the lower part of the stomach (antrum) that produces a hormone that stimulates the stomach to secrete digestive juices.

Pyloroplasty: Enlargement of the opening into the duodenum and small intestine (pylorus), enabling contents to pass more freely from the stomach.

Complications of ulcers

People with ulcers may experience serious complications if they do not get treatment. The most common problems include bleeding, perforation of the organ walls, and narrowing and obstruction of digestive tract passages.

Bleeding: As an ulcer eats into the muscles of the stomach or duodenal wall, blood vessels may also be damaged, which causes bleeding. If the affected blood vessels are small, the blood may slowly seep into the digestive tract.

Over a long period of time, a person may become anaemic and feel weak, dizzy, or tired.

If a damaged blood vessel is large, bleeding is dangerous and requires prompt medical attention. Symptoms include feeling weak and dizzy when standing, vomiting blood, or fainting.

Perforation: Sometimes an ulcer eats a hole in the wall of the stomach or duodenum. Bacteria and partially digested food can spill through the opening into the sterile abdominal cavity (peritoneum). This causes peritonitis, an inflammation of the abdominal cavity and wall. A perforated ulcer that can cause sudden, sharp, severe pain usually requires immediate hospitalisation and surgery.

Narrowing and obstruction: Ulcers located at the end of the stomach where the duodenum is attached, can cause swelling and scarring, which can narrow or close the intestinal opening. This obstruction can prevent food from leaving the stomach and entering the small intestine. As a result, a person may vomit the contents of the stomach.

This page contains basic information. If you are concerned about your health, you should consult a doctor.

See also:

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