Common Characteristics of Ulcers
Ulcers--small, open breaks or craters in the lining of the upper gastrointestinal tract--usually develop in one of two sites. The most common form in the upper portion of the small intestine and are known as duodenal ulcers; less common are those in the stomach itself, which are gastric ulcers. Surprisingly, 15 to 20 percent of bleeding ulcers occur initially without pain.
Origins of Ulcers
In general, ulcers are caused by an imbalance in the stomach, either too much stomach acid or pepsin, the major digestive enzyme, or too little protective mucous and protein secretions. This imbalance allows the stomach acids and enzymes to, in effect, turn on the digestive tract itself, producing small ulcers. But there is not, as is commonly thought, a direct relationship between excessive acid secretion and ulcers. Many people with duodenal ulcers, for example, secrete large amounts of acid, but others do not. This has led many experts to suspect that poor tissue resistance and other factors, particularly cigarette smoking, that interfere with the flow of neutralizing secretions may contribute to ulcer development. Stress and emotional pressure are also frequently cited as causes of duodenal ulcers.
In the case of gastric ulcers, excessive acid secretion appears to be even less of a factor than in other forms of ulcer, since many patients have normal and even low levels of stomach acid. Again, external factors or substances have been implicated in the origin of gastric ulcers, the two major ones being alcohol and apsirin. Both are known to injure the stomach lining, and it is thought they increase the stomach's vulnerability to the acid that is present.
Symptoms of Ulcers
Pain--centered in the pit of the stomach, just below the rib cage--is the most characteristic ulcer symptom, and it usually follows a distinct pattern. It normally begins several hours after eating or during the night, developing when the stomach is empty. The pain can manifest itself as a chronic gnawing or aching; it may grow worse during or immediately after meals; or there may be no pain at all, just belching--any ongoing stomach discomfort should be called to a doctor's attention.
