Ulcers, Gastric and Duodenal

(also peptic ulcers), a chronic disease characterized by the formation of ulcerations in the stomach or duodenal wall. Gastric and duodenal ulcers were classified as an independent nosologic entity in 1829 by the French physician J. Cruveilhier. They may occur at any age but develop most often in men between the ages of 25 and 50.

There is no generally accepted theory explaining all the factors involved in the origin of a peptic ulcer. Many investigators regard the condition as two different diseases. According to the most popular theory, the ulcers result from the digestive action of gastric juice on the mucous membrane. They may be caused by increased activity of the juice or by decreased resistance of portions of the mucous membrane to the normal action of the juice. The production and acidity of gastric juice increase in most cases; the tone of the vagus nerve, which regulates gastric secretion, also increases. Factors contributing to the development of a peptic ulcer include hereditary predisposition, poor eating habits, excessive consumption of spicy foods, alcohol abuse, smoking, and mental stress. Gastritis sometimes precedes a peptic ulcer.

Gastric and duodenal ulcers are usually located in the initial segment of the duodenum or along the lesser curvature of the stomach, near the pylorus. They are round or oval in shape and vary in diameter from several millimeters to 5–6 cm. Usually there is only one ulcer, but two may occur at the same time, for example, one in the stomach and the other in the duodenum.

The main symptom is intermittent pain in the epigastric region after eating. In some cases the pain arises 30 to 60 minutes after eating, and in others two to four hours after eating. Sometimes pain occurs on an empty stomach. The pain is accompanied by heartburn, which is relieved by taking sodium bicarbonate. Nausea, vomiting, and constipation may occur. Peptic ulcers occasionally remain asymptomatic for a long time. A cyclical course is characteristic: exacerbations (generally in spring and fall) alternate with remissions.

Complications arise if a peptic ulcer penetrates the surrounding organs, that is, the pancreas, liver, gallbladder, or bile ducts. If the ulcer destroys the entire wall of the stomach or intestine, perforation of the abdominal cavity occurs, causing peritonitis and sharp abdominal pain. Another serious complication is bleeding after destruction of the wall of a blood vessel. It is manifested by sudden weakness, fainting, bloody vomit resembling coffee grounds, tarry liquid stools, and acute anemia. Chronic ulcers that have been present for many years have a proliferation of dense scar tissue along the margins. In the case of a typical ulcer, scarring may result in cicatricial stenosis and interference with the emptying of food from the stomach. A gastric ulcer sometimes undergoes malignant degeneration.

An important aid in diagnosing a peptic ulcer is roentgenography with barium used as the contrast medium. It reveals both the ulcerous defect in the contours or topography of an organ, as well as indirect signs of the ulcer. Another method of examination is endoscopy, which makes possible visual observation of the condition of the mucous membrane, determination of the location and nature of the ulcer, and performance of a biopsy.

Treatment varies with the stage of the disease. It involves a change in eating and living habits and the administration of drugs to reduce gastric secretion, neutralize gastric juice (for example, alkaline mixtures when the acidity is high), and stimulate healing. Sometimes coating agents, antispasmotics, or sedatives are prescribed. Physical therapy or special treatment at a health resort may also be necessary. Persons suffering from a peptic ulcer require regular clinical observation. Chronic ulcers that do not respond to therapy and those resulting in complications require surgery. Resection of two-thirds of the stomach results in a stabilized decrease in secretion. Local excision of the ulcer or conservative resection of the stomach, supplemented by severing of branches of the vagus nerves (vagotomy), lowers the secretory function.

Peptic ulcers may be prevented by proper diet, abstention from drinking alcohol and smoking, and prompt treatment for gastritis.