Ulcer

An ulcer is a shallow or deep sore beginning in the lining of the stomach or the duodenum and extending down towards the muscular layer. It comes about for very different reasons: excessive production of acid, the mucus that protects against acid falling short, the effect of the bacterium called Helicobacter pylori, excessive stress, or following the use of drugs for rheumatism.

The complaints may be heartburn, burning, pain in the upper abdomen and vomiting; sometimes it causes bleeding from the stomach and perforation, and may call for medical or surgical treatment in hospital. There are a great many patients with a silent ulcer who come to hospital with bleeding although they have had no complaint at all.

Radiological investigation of the stomach — barium studies — sometimes falls short of making the diagnosis and endoscopic examination is asked for. The most certain diagnosis is made by endoscopic examination.

In one patient in ten with an ulcer, complications such as bleeding or perforation can develop. Most patients get through the bleeding from an ulcer on their feet and without knowing it; they notice only that the colour of the stool has turned black and that they feel slightly weak. Sometimes there is bleeding serious enough to put the patient into shock, and this situation always calls for watching and treatment in hospital. Very uncommonly there is bleeding serious enough that it can only be stopped surgically. If bleeding from an ulcer is met with during gastroscopy, this bleeding in the stomach can generally be stopped by sclerotherapy.

Sometimes an ulcer goes on and deepens so far that it passes through the muscular layer, perforating the wall of the stomach and causing the contents of the stomach to spill into the abdomen. Perforation of the stomach from an ulcer always calls for surgical treatment.