Ulcer

By an ulcer of the stomach or duodenum we generally mean a circumscribed substance defect of the mucous membrane, which also affects deeper layers beyond the actual mucous membrane.

Gastric or duodenal ulcers are circumscribed mucous membrane defects that reach the deeper layers of the stomach and intestinal wall and whose diameter can range from a few millimetres to more than three centimetres. They usually result from an inflammation of the gastric mucosa, the so-called chronic gastritis, which lasts for weeks, months or even years and is always accompanied by a loss of tissue substance.

The main cause of gastroduodenal ulcer disease is considered to be a disturbed balance between aggressive factors and protective mechanisms of the mucous membrane. Aggressive factors include hydrochloric acid, digestive enzymes of the stomach and bile acids. The production of mucus in the stomach, good blood circulation in the gastric mucosa and sufficient regeneration of the upper cell layers of the gastric and duodenal mucosa are regarded as protective factors.

Important influencing factors which can impair the finely tuned interplay of these mechanisms are stress and smoking, but also certain pharmaceuticals as well as colonisation of the stomach lining with the bacterium Helicobacter pylori ' (especially painkillers which are frequently used in joint diseases - for example acetylsalicylic acid, diclofenac and cortisone preparations - can lead to ulcers. Therefore, when prescribing these drugs, usually a protective drug is prescribed at the same time).

Approximately half of the ulcers heal within four to eight weeks even without specific therapies. However, recurrences often occur (with drug therapy, over 90% of the ulcers heal in the same period. Very often, however, recurrences occur after completion of therapy, in up to 70% of patients within the first year).

Complications of gastroduodenal ulcers often occur acutely and without any precursors. A sometimes life-threatening complication is the bleeding from the ulcer with subsequent tar stool (It is noticeable by blood vomiting or black coloration of the stool, so-called tar stool and occurs in up to 20% of all ulcer patients. Also highest life-threatening danger exists if the ulcer breaks through into the free abdominal cavity. Such a perforation, in about 5% of all ulcer patients, suddenly leads to severe permanent pain and irritation of the peritoneum. Here, the patient usually indicates a dull permanent pain with radiation in the back. All three complications require surgical treatment, which must be performed immediately, especially in the case of severe bleeding or perforation).

Furthermore, the ulcer can break into neighboring organs, resulting in penetration, especially of the pancreas.

Long-term ulcer disease can lead to late complications. These are, for example, inflammatory scarred constrictions in the area of the ulcerations, which can lead to emptying disorders of the stomach. The patients suffer from a feeling of fullness, vomiting and weight loss. In addition, a chronic ulcer ventriculi can degenerate carcinoma in about 3% of cases, whereas ulcers of the duodenum practically never degenerate.

The bacterium Helicobacter pylori is found in 95% of patients with duodenal ulcer and 70% of patients with ventriculi ulcer. But also healthy adults over 50 years are about 50% carriers of Heliobacter pylori.

https://de.wikipedia.org/wiki/Ulcus _{(Wikipedia CC-by-sa-3.0)}