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Peptic ulcers

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of stomach and GI ulcers.

Alternative Names

Duodenal ulcers; Gastric ulcers; H. pylori

Introduction

A peptic ulcer is an open sore or raw area that tends to develop in one of two places:

• The lining of the stomach (called gastric ulcers ), or
• The upper part of the small intestine -- the duodenum (called duodenal ulcers ). In the US, duodenal ulcers are three times more common than gastric ulcers.

Ulcers average between one-quarter and one-half inch in diameter. They develop when digestive juices produced in the stomach, intestines, and digestive glands damage the lining of the stomach or duodenum.

The two important digestive juices are hydrochloric acid and the enzyme pepsin . Both substances are critical in the breakdown and digestion of starch, fat, and proteins in food. They play different roles in ulcers:

• Hydrochloric acid. A common misbelief is that excess hydrochloric acid, which is secreted in the stomach, is solely responsible for producing ulcers. Acid output in patients with duodenal ulcers does tend to be higher than normal, but in most patients with gastric ulcers, acid production is usually normal or lower than normal. Some stomach acid, in fact, is important for protecting against H. pylori -- the bacteria that has been the cause of most peptic ulcers. [Note: One exception is ulcers that occur in Zollinger-Ellison syndrome. This is a rare genetic condition in which very high levels of gastrin, a potent acid, are secreted by tumors in the pancreas or duodenum.
• Pepsin. Pepsin is an enzyme that breaks down proteins in food. Since the stomach and duodenum are also composed of protein, however, they too are susceptible to the actions of pepsin. Pepsin is, then, also important in the formation of ulcers.

Fortunately, the body has provided a defense system to protect the stomach and intestine against these powerful substances:

• The mucous layer, which coats the stomach and duodenum, forms the first line of defense.
• Bicarbonate , which the mucous layer secretes, neutralizes the digestive acids.
• Hormone-like substances called prostaglandins help keep the blood vessels in the stomach dilated, ensuring good blood flow and protecting against injury. (Prostaglandins are also believed to stimulate bicarbonate and mucus production.)

Disrupting any of these defense mechanisms makes the stomach and intestine lining susceptible to the actions of acid and pepsin, increasing the risk for ulcers.

• Review Date: 7/14/2006
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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