Definition

This term describes both stomach and duodenal ulcers, whose symptoms are very similar.

Incidence/Age/Sex

Gastric or stomach ulcers used to be more common in the early 1900s and are becoming less frequent. Duodenal ulcers, that is ulcers of the first part of the intestine leading out of the stomach are much more common.

Duodenal ulcers are two to three times commoner than gastric ulcers and around 10 - 15% of the population will suffer with them. They are four or five times more likely to occur in men than women. Both gastric and duodenal ulcers are more common in older people. Duodenal ulcers are also more common in the North of England and Scotland.

Causes/Prevention

Ulcers occur when the caustic gastric juices which contain acid and enzymes to help break down the food (pepsin) break through the defences to attack the lining of the stomach. The stomach contains a mucus, bicarbonate and other substances which help to protect the stomach lining.

It is now known that a bacterium called Helicobacter pylori has an important role in promoting both gastric and duodenal ulcers although we are not sure why. It is possible that infection with this bacterium causes an increase in the amount of acid in the stomach or it causes an alteration in the protective mucus layer. Acid secretion is increased by Helicobacter pylori when it stimulates a hormone called gastrin which itself promotes acid secretion.

Helicobacter pylori is found in around 90 - 95% of duodenal ulcer patients and around 70% of gastric ulcer patients.

Patients with peptic ulcers often have a family history of the disease and most people with Blood Group O have more ulcers than those with other blood groups. Gastric and duodenal ulcers are also found more commonly in people taking non-steroidal anti-inflammatory drugs, such as Aspirin, Ibuprofen, Diclofenac and other drugs used for pain relief and the treatment of inflammation in arthritis.

Steroid tablets may contribute to the development of ulcers, but diet, stress and alcohol are important.

Signs and Symptoms

Indigestion is the classic symptom and pain in the epigastrium (the top part of the abdomen just below the ribs in the centre of the abdomen) is frequent. Pain is often worse at night when the patient is hungry and may be accompanied by nausea. Self treatment with antacid tablets and liquid is common and causes temporary relief from pain. Most people with a duodenal and/or gastric ulcer which heals will have a relapse within one or two years.

Complications

Gastric and duodenal ulcers can perforate or bleed. Perforation occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away and the stomach or duodenal contents can leak into the surrounding abdomen. This causes severe persistent pain.

Bleeding from duodenal and gastric ulcers may occur if an underlying artery is eroded and when this happens a patient may vomit blood (haematemesis) which may look like fresh red blood or may look rather black like coffee-grounds. Alternatively, the blood may pass through the gut and become changed so that the motions or stools become tarry black and sticky with a characteristic smell. Both perforation and bleeding from ulcers can be life threatening.

Diagnostic Tests

When a duodenal or gastric ulcer is suspected the common test performed is that of gastroscopy which allows direct visualization of the stomach and duodenal lining.

Gastroscopy - This test is performed with a thin flexible tube containing a fibre optic light source with a video camera at the top end. A tube is passed through the mouth and down the oesophagus or gullet into the stomach


Written by Medpages Editorial Team
Last Editorial Review: 18/1/2010