A peptic ulcer is the erosion of a circumscribed area (equal to or more than 0.5cm) of the tissues in the walls of the gastrointestinal tract that is accessible to gastric secretions. The ulcer penetrates the mucus and may invade the underlying sub mucosal and muscular tissues. Or peptic ulcer has the erosion of the lining of the walls of the stomach.
The most frequent site of ulcer is the stomach (gastric ulcer) due to the presence of hydrochloric acid and pepsin, and proximal portion of the duodenum (duodenal ulcer). The esophagus, jejunum or any other part of the gastrointestinal mucosa may be susceptible if the surface comes into contact with gastric secretions.
How Peptic Ulcer Occurs
The stomach produces hydrochloric acid and pepsin for the breakdown of food. Although the acid is very strong, the stomach and the duodenum are protected by the protective mucosal lining. But if the mucosal lining of the stomach and duodenum are eroded or damaged, the tissues are no longer protected and are exposed to hydrochloric acid.
The hydrochloric acid and pepsin erode the tissues, causing ulcer. An ulcer is therefore caused by an imbalance between hydrochloric acid and pepsin secretions and the body’s natural defenses, that is the hydrochloric acid and pepsin produced is more than the protective mechanism.
Causes Of Peptic Ulcer
1. Recent findings indicate that a bacterium called Helicobacter pylori is the leading cause of peptic ulcer disease. These bacteria get into the body through contaminated food, water or mouth to mouth contact.
2. Certain illness such as pancreatitis (inflammation of the pancreas), hepatic (liver) disease and pre-existing gastritis also cause ulcers.
3. Blood type: for unknown reasons, gastric (stomach) ulcer commonly affects people with blood group ‘A’ and duodenal ulcer tends to affect people with blood group ‘O’.
4. Studies also show that there is a tendency for peptic ulcer disease to occur or run in families.
5. Cigarette smoking and high alcohol intake can also dispose one to peptic ulcer disease.
6. The reflux of bile and pancreatic enzymes into the stomach due to an incompetent pyloric sphincter may lead to gastric (stomach) ulcer. The bile salt damages the gastric mucosa predisposing it to ulceration.
Types Of Peptic Ulcer Disease According To Location
1. Gastric (Stomach) Ulcer
In this type of peptic ulcer, the erosion occurs in the lining of the stomach. The ulcer is superficial, round, oval or cone-shaped and has smooth margins. The ulcer is usually located predominantly in the antrum, but can also be found in the body and fundus of the stomach. Gastric secretions are either normal or decreased. Helicobacter pylori cause about 50% to 70% of stomach ulcer. It is also caused by hydrochloric acid and pepsin.
It occurs most commonly in middle-aged and elderly women between the ages of 50% to 60%. It also occurs in people with incompetent lower esophageal sphincter and bile reflux.
Symptoms Of Gastric (Stomach) Ulcer
Burning sensation, pain in the high left epigastrium, and upper abdomen radiating to the back. The pain occurs 1-2 hours after meals. The pain is aggravated by food and is relieved by the antacid. There is a loss of appetite and loss of weight, feeling of fullness and distention after meals, tenderness in the epigastrium, nausea and vomiting when pain is severe and melena stool.
2. Duodenal Ulcer
The erosion in duodenal ulcer occurs in the lining of the duodenum. The ulcer is located at the first 1-2cm of the duodenum. The ulcer is penetrating and usually heals with a deformity. Gastric secretion is increased and helicobacter pylori causes about 90% to 95% of cases.
It occurs in men between the ages of 20-50 years but increasing in women, especially postmenopausal women between 35-45 years. It is increased with psychological stress associated with certain diseases such as chronic renal failure, pancreatic disease and chronic obstructive pulmonary disease (COPD).
Symptoms Of Duodenal Ulcer
Sharp mid-epigastric pain, cramping, gnawing, burning or pressure like in nature. The pain appears 2-4 hours after meals, mid-morning, mid-afternoon, midnight and it is periodic and episodic. Pain is relieved with antacid and sometimes by food which neutralizes and dilutes the hydrochloric acid. Because eating often reduces the pain of duodenal ulcer, the person gains weight.
Nutritional Management of Peptic Ulcer
If you are an ulcer patient,
1. Limit or avoid the intake of hot, spicy foods and pepper, alcohol carbonate beverages, tea, coffee etc.
2. Foods high in roughage such as raw fruits, salads, and vegetables may also imitate an inflamed mucosa.
3. Develop the habit of taking blank diet (eg. porridge). And always eat on time.
4. Avoid eating citric fruits on empty stomach.
5. Stop smoking and avoid the intake of alcohol because it increases the production of acid.
6. Avoid aspirin-containing drugs, ibuprofen, indomethacin, and phenylbutazone because they irritate the gastric mucosa.