Definition of ulcer:y A lesion of the skin or a mucous membrane such as the one lining the stomach or duodenum that

is accompanied by formation of pus and necrosis of surrounding tissue, usually resulting from inflammation or ischemia.

Ulcer: An area of tissue erosion, for example, of the skin or lining of the gastrointestinal (GI) tract. Due to the erosion, an ulcer is concave. It is always depressed below the level of the surrounding tissue. Ulcers can have diverse causes. Ulcers on the skin are often due to irritation, as with bedsores, and they may become infected and inflamed as they grow. Ulcers in the GI tract were once attributed to stress but most are now believed to be due to infection with the bacteria H. pyloridus. GI ulcers, however, may be made worse by stress, smoking and other noninfectious factors. The word "ulcer" traveled across the English Channel from the French "ulcere" which, in turn, came from the Latin "ulcus, ulceris" meaning "sore, sore spot, painful spot, or ulcer."

Definition of Peptic ulcer:

A peptic ulcer is erosion in the lining of the stomach or the first part of the small intestine, an area called the duodenum. if the peptic ulcer is located in the stomach it is called a gastric ulcer.
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Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain. Peptic ulcers that occur on the inside of the stomach are called gastric ulcers. Peptic ulcers that occur inside the hollow tube (esophagus) where food travels from your throat to your stomach are called esophageal ulcers. Peptic ulcers that affect the inside of the upper portion of your small intestine (duodenum) are called duodenal ulcers. SYMPTOMS: Pain is the most common symptom Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may:
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Be felt anywhere from your navel up to your breastbone Be worse when your stomach is empty

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Flare at night Often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication Disappear and then return for a few days or weeks

Other signs and symptoms Less often, ulcers may cause severe signs or symptoms such as:
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The vomiting of blood which may appear red or black Dark blood in stools or stools that are black or tarry Nausea or vomiting Unexplained weight loss Appetite changes

The most common symptom of a peptic ulcer is a gnawing or burning pain in the abdomen between the breastbone and navel. Duodenal ulcers typically cause symptoms 2 to 5 hours after meals, when the stomach is empty, and can be relieved by eating. Gastric ulcers, on the other hand, are classically made worse by eating. You may experience pain soon after meals, and food won't improve symptoms. For each, the duration of pain can be from a few minutes to a few hours.

Symptoms of a Peptic Ulcer That Need Immediate Medical Attention

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Vomiting blood Vomiting food eaten hours or days before Difficulty swallowing Nausea Black or tar-like stool (indication that there is blood in the stool) Sudden, severe pain in the abdominal area Pain that radiates to the back Pain that doesn't go away when you take medication Unintended weight loss Unusual weakness, usually because of anemia

Causes: For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, treatment emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called "Helicobacter pyloricus" (H. pylori). Another major cause of ulcers is the chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

H. pylori bacteria is very common, infecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. While the mechanism of how H. pylori causes ulcers is not well understood, elimination of this bacteria by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence. NSAIDs are medications for arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this class of medications. Prostaglandins are substances which are important in helping the gut linings resist corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach. Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer medication treatment failure. in the past, it was believed stress and diet caused peptic ulcers. Later, researchers stated stomach acids (hydrochloric acid and pepsin) contributed to the majority of ulcer formation. Today, however, research shows that most ulcers develop as a result of infection with a bacterium called Helicobacter pylori.

Helicobacter pylori
Research studies have shown that most ulcers are caused by an infection by a bacteria called Helicobacter pylori -- also referred to as H. pylori. While the other factors listed below can also cause ulcers, H. pylori is now considered the cause of most ulcers. The H. pylori bacterium is found in the stomach, and along with acid secretion, can damage the tissue of the stomach and duodenum, causing inflammation and ulcers.
A bacterium. A common cause of ulcers is the corkscrew-shaped bacterium Helicobacter pylori. H. pylori bacteria commonly live and multiply within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of your stomach or duodenum, producing an ulcer.

Acid and pepsin

These powerful digestive fluids are believed to contribute to the formation of ulcers. In ideal situations, the stomach can protect itself from these fluids in several ways. These are:
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The stomach produces a lubricant-like mucus that coats the stomach and shields stomach tissues. The stomach can produce a chemical called bicarbonate that neutralizes digestive fluids and breaks them down into less harmful substances. Blood circulation in the lining of the stomach, as well as cell renewal and repair, help protect the stomach.

NSAIDs
NSAIDs are non-steroidal anti-inflammatory drugs. The most commonly known NSAIDs are aspirin, ibuprofen and naproxen sodium. Others are prescription NSAIDs used to treat several arthritic conditions. NSAIDs can make the stomach's defense mechanisms to fail in a couple of different ways:
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They can make the stomach vulnerable to the harmful effects of acid and pepsin by interfering with the stomach's ability to produce mucus and bicarbonate. They can affect cell repair and blood flow to the stomach.

Smoking
Studies show that cigarette smoking can increase a person's chance of getting an ulcer. Smoking also slows the healing of existing ulcers and contributes to ulcer recurrence.

Caffeine
Beverages and foods that contain caffeine can stimulate acid secretion in the stomach. This can aggravate an existing ulcer, but the stimulation of stomach acid can't be attributed solely to caffeine.

Alcohol
While a link hasn't been found between alcohol consumption and peptic ulcers, ulcers are more common in people who have cirrhosis of the liver, a disease often linked to heavy alcohol consumption.

Stress
Emotional stress is no longer thought to be a cause of ulcers, but people who are experiencing emotional stress often report increased pain of existing ulcers. Physical stress, however, is different. It can increase the risk of developing ulcers, especially in the stomach. Examples of physical stress that can lead to ulcers are that suffered by people with injuries such as severe burns, and people undergoing major surgery.

Peptic Ulcers Causes

When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.
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The food is partially digested in the stomach and then moves on to the duodenum to continue the process. Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and cause an erosion in the mucosal wall.

The medical community long believed that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.
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Gradually, researchers realized that people with ulcers had an imbalance between, on one hand, acid and pepsin, and on the other, the digestive tract's ability to protect itself from these harsh substances. Research done in the 1980s showed that ulcers are actually caused by infection with a bacterium named Helicobacter pylori, usually called H pylori. Not everyone who gets an ulcer is infected with H pylori. We now know that aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.

While we no longer believe that lifestyle factors cause ulcers, we do believe that they play a role. Some types of medical therapy also can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach. This increases the chances of getting an ulcer and slows healing of existing ulcers.
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Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex]) Alcohol Stress - Physical (severe injuries or burns, major surgery) or emotional Caffeine Cigarette smoking Radiation therapy - Used for diseases such as cancer

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People who take aspirin or other anti-inflammatory medication are at increased risk even if they do not have H pylori infection.
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Elderly people with conditions such as arthritis are especially vulnerable. People who have had ulcers or intestinal bleeding before are also at higher-than-normal risk.

If you take these medications regularly, you should talk to your health care provider about alternatives. This is especially true if you get an upset stomach or heartburn after taking one of these medications.

Ulcers can be linked with other medical conditions.

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People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers. A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.

Classification
By Region/Location
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Stomach (called gastric ulcer) Duodenum (called duodenal ulcer) Esophagus (called Esophageal ulcer) Meckel's Diverticulum (called Meckel's Diverticulum ulcer; is very tender with palpation)

Modified Johnson Classification of peptic ulcers:

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Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistentiae. Type II: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion. Type III: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion. Type IV: Proximal gastroesophageal ulcer Type V: Can occur throughout the stomach. Associated with chronic NSAID use (such as aspirin).

Stomach ulcer disease is common, affecting millions of Americans yearly. The size of a stomach ulcer can range between 1/8 of an inch to 3/4 of an inch.

What does a Stomach Ulcer affect? The main thing that a stomach ulcer affects is the nerves surrounding it. The nerves become agitated and cause a great amount of pain. However, stomach ulcers can cause hemorrhages from the erosion of a major blood vessel; a tear in the wall of the stomach or intestine, with resultant peritonitis; or obstruction of the gastrointestinal tract because of spasm or swelling in the area of the ulcer. Stomach ulcer statistics

1. About 20 million Americans develop at least one stomach ulcer during their lifetime. 2. Stomach ulcers affect about 4 million Americans every year. 3. More than 40,000 Americans have surgery because of persistent symptoms or problems from ulcers every year. 4. About 6,000 Americans die of stomach ulcer-related complications every year.

Diets for Stomach Ulcers This diet is a guideline that may help to decrease gastric irritation and excessive gastric acid secretion. This diet may also help prevent uncomfortable side effects such as heartburn. ***This is only a guideline. Before changing your diet, please consult your doctor. y y y y y y y y Eat three small meals and three snacks evenly spaced throughout the day. It is important to avoid periods of hunger or overeating. Eat slowly and chew foods well. Be relaxed at mealtime. Sit up while eating and for 1 hour afterward. Avoid eating within 3 hours before bedtime. Bedtime snacks can cause gastric acid secretion during the night. Cut down on caffeine-containing foods and beverages, citrus and tomato products, and chocolate if these foods cause discomfort. Include a good source of protein (milk, meat, egg, cheese, etc.) at each meal and snack. Antacids should be taken in the prescribed dose, One-hour and 3 hours after meals and prior to bedtime. This regimen is most likely to keep the acidity of the stomach at the most stable and lowest level. Milk and cream feedings should not be used as antacid therapy. Although milk protein has an initial neutralizing effect on gastric acid, it is also a very potent stimulator. Hourly feedings of milk have been shown to produce a lower pH than three regular meals. Caffeine-containing beverages (coffee, tea, and cola drinks) and decaffeinated coffee cause increased gastric acid production but may be taken in moderation at or near mealtime, if tolerated.

Risks of Developing a Stomach Ulcer y y y y y y y y y Family history of ulcers Smoking Excess alcohol consumption Use of nonsteroidal anti-inflammatory medications (aspirin) or corticosteroids. Zollinger-Ellison syndrome Improper diet, irregular or skipped meals Type O blood (for duodenal ulcers) Stress does not cause an ulcer, but may be a contributing factor Chronic disorders such as liver disease, emphysema, rheumatoid arthritis may increase vulnerability to ulcers

Zollinger-Ellison Syndrome What is Zollinger-Ellison Syndrome? Zollinger-Ellison Syndrome is a rare condition that causes severe stomach ulcers. It is characterized by tumors (gastrinomas) in the body. The tumors most commonly form in the pancreas and duodenum. The tumors cause ulcers because they secrete a substance called gastrin, which stimulates excessive acid secretion by the stomach. Ulcers associated with Zollinger-Ellison Syndrome are often difficult to control. They are more persistent and less responsive to treatments than usual ulcers are. Zollinger-Ellison Syndrome may occur at any age, but it is more likely to appear between the ages of 30 and 60 years old. Symptoms of Zollinger-Ellison Syndrome The most common symptoms of Zollinger-Ellison Syndrome are: y y y y y diarrhea abdominal pain bleeding fatigue and weakness yellow fat in stool

How serious is Zollinger-Ellison Syndrome? Zollinger-Ellison Syndrome is a serious condition. The tumors may spread to the lymph nodes and liver. The earlier it is detected, the better the chances of recovery. Treatment options for Zollinger-Ellison Syndrome Zollinger-Ellison Syndrome can be treated. If the tumors are big enough, the doctor may choose to perform surgery to remove the tumors. If the tumors are small or too numerous to be removed, the doctor will probably prescribe acid-reducing medication. The patient will probably have to take the medication for a long period of time. In very severe cases of Zollinger-Ellison Syndrome, the entire stomach may have to be surgically removed. How is Zollinger-Ellison Syndrome Diagnosed? Your doctor will perform blood tests, an upper endoscope examination and barium x-ray to determine if he thinks you have Zollinger-Ellison Syndrome.

What is upper endoscopy?

Upper endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible tube through which the lining of the esophagus, stomach, and duodenum can be viewed using a TV monitor.

How do I prepare for endoscopy?

To accomplish a safe and complete examination, the stomach should be empty. The patient will most likely be asked to have nothing to eat or drink for six hours or more prior to the procedure. Prior to scheduling the procedure, the patient should inform his or her physician of any medications they are currently taking, any allergies, and all of their health problems. This information will remind the doctor whether the patient may need antibiotics prior to the procedure, what potential medications should not be used during the exam because of the patient's allergies, and will provide the individual scheduling the procedure an opportunity to instruct the patient whether any of the medications they are taking should be held or adjusted prior to the endoscopy. Knowledge whether the patient has any major health problems, such as heart or lung diseases, will alert the examiner of possible need for special attention during the procedure.

Why have you been scheduled for an endoscopy?

Upper endoscopy usually is performed to evaluate possible problems with the esophagus, stomach or duodenum, and evaluate symptoms such as upper abdominal pain, nausea or vomiting, difficulty in swallowing, intestinal bleeding anemia, etc.. Upper endoscopy is more accurate than X-ray for detecting inflammation or smaller abnormalities such as ulcers or tumors within the reach of the instrument. Its other major advantage over X-ray is the ability to perform biopsies (obtain small pieces of tissue) or cytology (obtain some cells with a fine brush) for microscopic examination to determine the nature of the abnormality and whether the abnormality is benign or malignant (cancerous).

What is gastritis?
Gastritis is a condition in which the stomach liningknown as the mucosais inflamed. The stomach lining contains special cells that produce acid and enzymes, which help break down food for digestion, and mucus, which protects the stomach lining from acid. When the stomach lining is inflamed, it produces less acid, enzymes, and mucus. Gastritis may be acute or chronic. Sudden, severe inflammation of the stomach lining is called acute gastritis. Inflammation that lasts for a long time is called chronic gastritis. If chronic gastritis is not treated, it may last for years or even a lifetime. Erosive gastritis is a type of gastritis that often does not cause significant inflammation but can wear away the stomach lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive gastritis may be acute or chronic.

The relationship between gastritis and symptoms is not clear. The term gastritis refers specifically to abnormal inflammation in the stomach lining. People who have gastritis may experience pain or discomfort in the upper abdomen, but many people with gastritis do not have any symptoms. The term gastritis is sometimes mistakenly used to describe any symptoms of pain or discomfort in the upper abdomen. Many diseases and disorders can cause these symptoms. Most people who have upper abdominal symptoms do not have gastritis.

What causes gastritis?

Helicobacter pylori (H. pylori) infection causes most cases of chronic nonerosive gastritis. H. pylori are bacteria that infect the stomach lining. H. pylori are primarily transmitted from person to person. In areas with poor sanitation, H. pylori may be transmitted through contaminated food or water. In industrialized countries like the United States, 20 to 50 percent of the population may be infected with H. pylori.1 Rates of H. pylori infection are higher in areas with poor sanitation and higher population density. Infection rates may be higher than 80 percent in some developing countries.1 The most common cause of erosive gastritisacute and chronicis prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Other agents that can cause erosive gastritis include alcohol, cocaine, and radiation. Traumatic injuries, critical illness, severe burns, and major surgery can also cause acute erosive gastritis. This type of gastritis is called stress gastritis. Less common causes of erosive and nonerosive gastritis include
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autoimmune disorders in which the immune system attacks healthy cells in the stomach lining some digestive diseases and disorders, such as Crohn's disease and pernicious anemia viruses, parasites, fungi, and bacteria other than H. pylori