Ulcers - Symptoms and Diagnostic Studies

Small, open craters or sores that develop in the lining of the stomach or small intestine are commonly referred to as ulcers. (Less often, ulcers form in the esophagus, especially in the lower portion that may be exposed to stomach acids.) Technically, however, those that develop in the stomach are gastric ulcers, and those that form in the section of small intestine just below the stomach are duodenal ulcers. Doctors usually add the term peptic because such ulcers develop only in the areas of the digestive system that come in contact with pepsin, an enzyme that breaks down proteins. At one time, researchers thought that an overabundance of pepsin and other digestive juices was the cause of ulcers, but studies have since shown that most ulcer patients do not have this problem. Indeed, many have lower than normal levels of stomach acid.

Doctors theorize that hereditary factors, such as a thin or overly fragile protective mucous membrane lining the stomach and duodenum, may be involved. In addition, research has linked the presence of a bacterium called Helicobacter pylori to the incidence of ulcers. Whatever the cause, ulcers can be exacerbated by poor dietary habits, excessive stress, caffeine, smoking, and heavy drinking. They are also worsened by aspirin and other nonsteroidal anti inflammatory drugs. Studies reveal that I in 10 persons will develop one or more ulcers at some point. They can occur at any age, but duodenal ulcers typically develop between ages 40 and 50, and gastric ulcers between ages 50 and 60. Many ulcers heal within a year, often without any special treatment or without even making their presence known. Symptoms vary considerably. Some patients experience abdominal burning or a gnawing sensation, usually just under the breastbone. This type of ulcer pain typically occurs when the stomach is empty. Other sufferers complain of feeling bloated or nauseated after eating, and still others describe a feeling of persistent hunger.

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Often, an acute episode of bleeding is the initial tip off. This may manifest itself as vomiting fresh, bright red blood or material that resembles coffee grounds. The stools may be bloody, maroon, or tarry and black, also indications of intestinal bleeding. Severe bleeding can lead to shock, a medical emergency characterized by a drop in blood pressure, rapid heartbeat, and cold, clammy skin. Chronic loss of small amounts of blood can result in anemia . The ulcer may perforate the stomach or intestinal wall, allowing the contents to spill into the abdominal cavity. The first sign of a perforation is sudden, in tense, unrelenting abdominal pain. This also is a medical emergency, as it can lead to peritonitis, a life threatening inflammation of the abdominal lining. Intestinal obstruction is still another complication of ulcers, usually the result of accumulated scar tissue that narrows the passage between the stomach and duodenum. Symptoms include distended stomach, intense pain, and vomiting of partially digested foods.

Diagnostic Studies And Procedures

Endoscopy, a procedure in which a long, thin, flexible viewing instrument is inserted into the stomach or duodenum by way of the mouth and esophagus, is the major diagnostic tool. This examination allows a doctor to view the lining of these organs, take pictures of suspicious areas, and collect samples of tissue and intestinal fluids. An upper GI series is another diagnostic procedure. It entails taking X-rays after the patient has swallowed barium, a chalky substance that makes the intestines more visible on film.

Ulcers - Symptoms and Diagnostic Studies

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