Ulcers are open sores that can occur inside the body or on its outer surface. The latter are often referred to as pressure ulcers or bedsores, and they occur most often in people who are confined to bed or a wheelchair. The term is commonly used to refer to a peptic ulcer, which is an ulcer in the upper gastrointestinal tract. The two major forms of peptic ulcer are chronic duodenal ulcers, which occur in the part of the small intestine leading out of the stomach, and gastric ulcers, which occur in the upper part of the stomach. Peptic refers to the fact that these ulcers are caused partially by digestive juices, one of which is acid-pepsin.
Ulcers occur in approximately 10% of the population. They are much more common in men than in women. Duodenal ulcers occur four times more often than gastric ulcers. The highest incidence of gastric ulcers is from age 60 to 70, whereas it is highest for duodenal ulcers when a person is in the fifties.
The primary symptom of an ulcer is pain in the area between the navel and the breastbone. The pain may be a burning sensation or a continuous gnawing sensation; some people with ulcers are awakened at night by pain. The pain is often relieved by eating or by taking antacids. Some people with ulcers have no symptoms, or they experience a bloated sensation after eating. Other people with gastric ulcers lose weight because they develop an aversion to food; eating increases their discomfort. In more severe cases, ulcers may cause internal bleeding, which is passed as black, tarry stools or as red blood when bleeding is massive.
Treatment focuses on relieving pain and helping the ulcer heal. The most widely accepted treatment is the administration of medication that inhibits acid secretion. It is also common to give antacids, which are effective and less expensive but may require more frequent dosages. Blood tests may reveal the presence of an organism named Helicobacter pylori in some people with peptic ulcers. When this organism is present, standard antacid treatment is supplemented with a combination of bismuth and antibiotics that cure the H. pylori infection and prevent recurrence in the majority of patients.
Ulcer sufferers are instructed not to take aspirin and not to drink alcohol, since these substances irritate the stomach lining. In addition, drinks containing caffeine, such as coffee and tea, are omitted from the diet because these drinks stimulate the secretion of gastric acid. Greasy or spicy foods may also cause discomfort. Peptic ulcers usually heal within one to three months with active medical treatment. Surgery is indicated when there are complications such as unresponsiveness to medications, obstruction, or when the ulcer perforates and allows stomach acids to pass directly into the abdomen. These complications require immediate medical attention.
People who develop ulcers are often described as hard-driving, successful individuals who have strong needs to please and to receive attention from others. They are also characterized as stressed, tense, and conflicted between needs for dependence and independence. Ulcer sufferers seem to have an overactive digestive system in response to chronic stress. A person who is prone to gastric upset can take preventive action by avoiding aspirin, caffeine, and alcohol and by learning better relaxation and communication skills in order to cope with stress and to meet personal needs more effectively.