What is an Ulcer?
Ulcers are sores that can appear both internally and externally on the body. In contrary to normal sores, ulcers can form holes and take longer to heal.
These sores are can be caused by infections, injuries as well as diseases.
An ulcer is very common, it is estimated that around 25 million of the population will develop an ulcer at some point in their life. Fortunately most types of ulcers are straightforward to treat and even cureable. (1)
There are certain risk factors for ulcers, some relate to lifestyle and others are medical conditions.
For example, smokers have an increased risk of developing an ulcer in the stomach. Whereas, if for instance you are on strict bedrest or lack mobility, ulcers on the skin can develop due to pressure. (2, 3)
Causes of ulcers can be divided into two main categories: external and internal.
Ulcers which appear on skin can be caused by:
It’s possible to get an ulcer from sitting or lying down too much, this is called a pressure ulcer or a bed sore. Pressure ulcers for most parts affects people who can’t walk, older people or people who are on strict bed rest. (4)
This is a common cause of venous ulcers. These are open sores occurring on the leg, usually just above the ankle.
This occurs when the veins and vessels in the legs are weakened therefore it can’t keep the blood flowing smoothly. This means the tissue isn’t getting the nutrients and oxygen it needs which causes cells to die. The end result is an ulcer. (5, 6)
People with diabetes have an increased chance of developing ulcers, especially on the feet, these are called diabetic ulcers. (7)
Diabetics are prone to nerve malfunctions, which can mean a loss of feeling or higher pain threshold. Therefore blisters, cracks and injuries can go unnoticed, leading to an ulcer.
When you add irregular blood sugar levels into the equation you get an inferior healing process, which leads to these ulcers taking several months to repair. (8, 9)
Clogged arteries are a common symptom of atherosclerosis. This also means your blood doesn’t flow as freely as what it should around the body which enhances poor circulation.
This is a common cause of a type of ulcer called ischemic ulcers.
This type of ulcer normally takes longer to heal because the weak blood flow also reduces the level of nutrients reaching leg tissue. (10)
Ulcers on the inside may be caused by:
Helicobacter Pylori (H. pylori)
pylori is a form of bacteria that breaks down the inner protective coating in the stomach and thereby causes inflammation.
This inflammation can lead to a peptic ulcer which is a raw area on the lining of the stomach, it can also transform into an open sore.
However, the bacteria can live in the stomach without creating an ulcer. (11)
In some cases a peptic ulcer can lead to a perforation. This is a medical emergency as it creates a hole through the stomach causing excessive bleeding. (12)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are forms of medication which if taken for prolonged periods begin to damage the protective mucus in the stomach. This can cause a stomach ulcer. (13)
Other medicines such as aspirin, ibuprofen and naproxen should also be taken in modest amounts to reduce the risk of ulcers.
People who smoke have an increased chance of developing peptic ulcers.
Studies suggest smoking increases the production of substances which harm the stomach lining, such as an enzyme called pepsin which helps break down proteins. (14)
Cigarette smoke has also shown to slow down the healing process of ulcers as well as increasng the chance of being affected by the H. pylori infection. (15)
This is a rare syndrome in which the body starts to overproduce a peptide hormone called gastrin. Gastrin produces acids for the stomach, therefore in this case too much acid is being generated, damaging the lining.
Overproduction happens because of a type of tumor called gastrinomas. These can also spread to the liver and close by lymph nodes.
Ulcers in the stomach and small intestine are symptoms of this condition. (16)
Ulcers which appear in the mouth are very common. For example, if you bite the inside of your mouth when eating, you could give yourself an ulcer of this kind. It can normally be treated with home remedies or over the counter medication.
However if the ulcers don’t go away within three weeks or becomes red and painful medical attention should be sought. (17)
This is an infection in the mouth which causes swelling and sores. It’s usually caused by a virus or bacteria.
It can develop after an infection by the herpes simplex virus, which is also a common cause of cold sores. (18)
This condition causes an itchy rash either on the skin or in the mouth. It is believed to be related to either an allergic or immune reaction. (19)
Some of the symptoms of this condition includes mouth sores and painful ulcers. (20)
Symptoms of ulcers will often depend on which type of ulcer you have. Some however may not even show any signs.
The following symptoms may occur:
Heartburn can be a symptom of stomach ulcers, it can be explained as a feeling of discomfort or chest pain and throat pain, typically after eating or experiencing stress. (21)
Abdominal pain is a normal symptom to have when an ulcer has developed in the stomach. The intensity of pain can vary from person to person, and some people might not even feel any at all. (22)
Fluctuations in Appetite
Some people experience a feeling of satiety, which translates into a complete lack of desire to eat and drink. (23)
However, ulcers within the stomach can also display the total opposite sensation. Even shortly after eating your tummy can feel empty and hunger pangs will never be far away.
Bloody or Dark Stools
Bloody stool is a sign which should be taken seriously, as it could be an indicator of a bleeding ulcer. (24)
The color can usually indicate where the blood is coming from. The darker the color the deeper the problem is. (25)
Ulcers which are on the skin’s surface are somewhat easier to identify because they are clearly visible. The symptoms can be described in the following manner:
Aching or pains in the leg are a common symptom seen in venous ulcers. (26)
When blood and fluid builds up in the legs it can cause the skin to appear shiny and dry, with little to no hair.
An ulcer on the leg can appear ‘punched out’ where the edges surrounding the sore are raised. (27)
Open sores in the mouth are a clear symptom of mouth ulcers. These aren’t contagious, and most of time clear out within a week or so. (28)
Some people will feel pain, others can have an uncomfortable feeling in the mouth when an ulcer is present. This can make eating and drinking very difficult. (29)
Diagnosis of ulcers depends on where it’s situated. Yet whatever type of ulcer it is, your doctor will always go through a standard procedure regarding: medical history, any medication currently being taking and a physical examination.
Further tests will differ in relation to the outcome of the initial proceedings:
Doctors or dentists can usually diagnose an ulcer on the skin or in the mouth simply by looking at it. (30)
Your doctor will start out by asking about your medical history, what symptoms you are having and will most likely ask about what medicines you take.
During a physical examination your doctor will check for signs on your body. For example, if it’s a suspected peptic ulcer your doctor will check for bloating, listen for specific sounds or check to establish which area you feel pain or tenderness. (31)
Further Diagnostic Tests
Computerized Tomography (CT) scan
This test is used to check for possible damage or perforations in the stomach wall due to ulcers. You will be given a drink with a special solution and an injection, after that, x-rays will be taken through a tunnel-like machine. (32)
Upper Endoscopy (EGD)
Diagnosis of stomach ulcers are usually done using an upper endoscopy (EGD). This is when a small camera is inserted through the throat to inspect the lining of the tube that connects the throat to the top of the small intestine. (33)
Doctors can also use blood samples to diagnose an ulcer. Sometimes even a biopsy is used, where a sample is taken for further examination. (34)
Sometimes a breath sample test can be done to check for the H. pylori bacteria, this is called a urea breath test. (35)
What is an ulcer? Ulcers are sores which develop both internally and externally on the body.
What causes an ulcer? Ulcers in the stomach and mouth are usually caused by damage to the inner linings. This could be as a result of acid, bacteria, medication or even stress Ulcers on the skin can be caused by injuries, irritation or infection.
How do doctors test for an ulcer? Doctors can diagnose the cause by using blood or breath tests, CT scans, or a biopsy.
When should you go to the doctors for an ulcer? When you have strong abdominal pains, feel faint or have bloody stools. If the ulcer is in the mouth, seek medical attention if it doesn’t go away after three weeks. For leg ulcers seek medical treatment when the sore develops an odor or fever like symptoms occur. (36, 37, 38)
Can you prevent an ulcer? Yes, by preventing and taking care of injuries. Keeping good mouth hygiene. Avoid medicines which cause ulcers, stop smoking and limit intake of alcohol.
What can relieve an ulcer? There are a few medicines to treat ulcers, talk to your health care provider to find the best for you. For mouth ulcers there are creams available such as antihistamines, antacids, and corticosteroids.
Can a peptic ulcer be cured? Yes with the right antibiotics treatment the H. pylori bacteria can be eliminated and the person will no longer suffer from this kind of ulcer. (39)
Can an ulcer be life threatening? In some cases stomach ulcers can cause excessive bleeding which can have detrimental effect if medical attention is not sought.
It’s clear there are many different forms of ulcers, of which they can develop both internally and externally.
Not all ulcers are caused by a disease, some are as a result of irritation or a build up of pressure.
Symptoms depend on where and what type of ulcer you have, yet if experiencing bad odor, excessive pain or blood in either stool or vomit medical attention should be sought.