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Ulcers of Intestine - Causes, Diagnosis, and Treatment

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When the acid of the stomach starts damaging the lining of the digestive tract, it causes ulcers. Read the article to learn more.

Written by

Dr. Neha Rani

Medically reviewed by

Dr. Sugreev Singh

Published At August 3, 2023
Reviewed AtAugust 3, 2023

What Are Intestinal Ulcers?

An ulcer is a discontinuity in the bodily membrane that obstructs the normal functioning of the affected organ. Intestinal ulcer refers to any discontinuity in the membrane of small and large intestines.

What Are the Causes of Intestinal Ulcers?

There are various causes of intestinal ulcers, as mentioned below:

  • Peptic Ulcer Disease - It includes gastric and duodenal ulcers.

  • Infectious Diseases - These are caused due to bacterial, viral, and protozoal infections. Typhoid ulcers, tuberculosis ulcers, pseudomembranous colitis, and amoebic ulcer are a few of them.

  • Inflammatory Bowel Disease - Crohn's disease and ulcerative colitis.

  • Malignancy - Cancer causes ulcers in the stomach.

What Is Peptic Ulcer Disease?

Peptic ulcer disease is caused due to breaking in the inner lining of the gastrointestinal tract. Peptic ulcer occurs in the stomach and duodenum. If the ulcer is in the duodenum, it is called a duodenal ulcer. Peptic ulcers can also involve the lower esophagus and jejunum.

What Are the Causes of Peptic Ulcer?

  • Helicobacter Pylori Bacteria - The mucus lining of the stomach and the duodenum is impacted by Helicobacter pylori, which is present in the gastric epithelial cell. It spreads from one person to another through food and drink and is the most typical cause of ulcers. It is also passed by the infected person's saliva, stool, or vomit. The bacteria stick to the gastric mucosa and cause inflammation resulting in the discontinuation of the epithelial lining of the mucosa.

  • NSAIDs (Nonsteroidal Anti-inflammatory Drugs) - Prostaglandins (lipid that acts as a hormone produced by the body at the site of infection or injury) found in the gastric mucosa inhibits gastric acid secretion and stimulates bicarbonate secretion. Drugs like Aspirin, Ibuprofen, and Naproxen are taken for fever, and pain blocks Prostaglandin secretion by inhibiting the COX-1 enzyme resulting in decreased bicarbonate and mucosal blood flow. Thus peptic ulcer occurs due to increase gastric acid secretion.

What Are the Symptoms of Peptic Ulcer?

The symptoms vary from person to person, the location of the ulcer, and the patient's age. The patient shows signs of indigestion. In the case of gastric ulcers, epigastric pain occurs 15-30 minutes after meal intake, whereas, in duodenal ulcers, pain occurs two to three hours after food intake. Thus duodenal ulcers are also known as nocturnal ulcers. The common symptoms are:

  • Dull or burning pain in the upper region between the breast bone and belly button.

  • Feeling full after eating a small portion of food.

  • Nausea and vomiting.

  • Weight loss.

  • Melena (black stool).

  • Hematemesis (vomiting blood).

What Is the Diagnosis of Peptic Ulcers?

  • Imaging Test:

    • Upper Endoscopy or Esophagogastroduodenoscopy (EGD) - It is an imaging technique to check the esophagus, stomach, and duodenum. The endoscope (thin, lighted tube) has a camera at one end, which is put inside the mouth and throat. As the endoscope goes inside the stomach, the images captured by the camera can be seen by the radiologist on the screen.

    • Barium Swallow Test - It is an imaging technique to check upper gastrointestinal tract problems. The patient swallows thick barium liquid, which coats the organs. The radiologist then takes a series of single X-rays to identify the problem. It is indicated only when endoscopy cannot be performed.

  • Laboratory Tests:

    • Blood Test - Complete blood profile is performed.

    • Stool Test - A stool sample is collected to check for Helicobacter pylori infection.

    • Urea Breath Test - Helicobacter pylori bacteria breaks urea into carbon dioxide. The patient swallows a urea pill that contains carbon molecules and breathes it into a bag. This is subsequently taken to a lab for examination. In the case of Helicobacter pylori infection, the amount of carbon dioxide will be more than average.

What Is the Treatment for Peptic Ulcers?

The treatment for peptic ulcer depends on the type of ulcer, and the treatment plan includes lifestyle modifications, medicines, and surgery in some cases.

  • Lifestyle Modifications - These include changes in dietary habits (avoiding food that worsens the condition), quitting smoking, limiting alcohol and caffeine intake, and not using NSAIDs.

  • Medicines

    • Antibiotics - Usually, a combination of antibiotics and other medicines are given to treat the ulcer and get rid of the infection by killing Helicobacter pylori bacteria.

    • Blockers (Histamine Receptor Blockers) - Drugs like Ranitidine and Cimetidine act by lessening the quantity of acid that the cells lining the stomach produce.

    • PPI (Proton-Pump Inhibitors) - Drugs like Rabeprazole, Pantoprazole, and Omeprazole help lower the stomach's acid level, thus protecting the stomach and duodenal lining.

    • Antacids - They act by neutralizing the acid produced by the stomach.

  • Surgery - Surgery is indicated only when the patient is non-responding to the medicines and at high risk of complications. Surgical options are partial gastrectomy or vagotomy.

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic and inflammatory condition affecting the colon. It is associated with colon wall erosion and bleeding. It starts from the rectum and might involve the colon. The leading cause for ulcerative colitis is still unknown, and researchers have suggested that autoimmunity and changes in the gut microbial flora can be one of the reasons.

What Are the Signs and Symptoms of Ulcerative Colitis?

  • Abdominal pain and cramps.

  • Bloody diarrhea with or without mucus.

  • Malnutrition and weight loss.

  • Rectal pain.

  • Fever.

What Is the Diagnosis of Ulcerative Colitis?

Tests for the diagnosis of ulcerative colitis include:

  • Blood Tests- To test for anemia (low hemoglobin) and inflammation.

  • Stool Test - To test for bacteria, parasites, inflammatory markers, and blood.

  • Colonoscopy - Through the rectum, a tube containing a camera is introduced. It is to check for abnormalities like erosion or tissue growth in the large intestine. It is advised at regular intervals to rule out cancer.

  • Biopsy - A tissue sample from the colon is removed for analysis.

  • Flexible Sigmoidoscopy - It is used to investigate the lower part of the colon. It is advised when the doctors want to check the causes of rectal bleeding, chronic diarrhea, intestinal problem, and abdominal pain.

What Is the Treatment for Ulcerative Colitis?

The disease's severity and scope will determine how it is treated. Maintenance therapy with drugs is advised for every patient.

  • Medication - Medicines are prescribed to decrease swelling and inflammation. Sulfasalazine and 5-aminosalicylates are the drugs of choice. In addition, glucocorticoids can be prescribed for patients who do not progress after two weeks of treatment. In severe cases, a medication known as biologic (these drugs block specific steps in the inflammatory process) is used. Infliximab and adalimumab are few of the biologic drug.

  • Hospitalization - Patients must be hospitalized in severe cases like loss of electrolytes and dehydration due to diarrhea.

  • Surgery - It is indicated in cases of colon perforation, blockage, excessive bleeding, strictures (narrowing and constriction in the organs), and cancer. Proctocolectomy (surgery to treat ulcerative colitis) involves removing the entire colon and rectum and creating a new pathway in the abdominal wall for waste management. In a few cases, only the diseased part of the colon and rectum is removed. The small intestine and rectum are then attached to form a pouch to pass stool through the rectum. Bowel movements in such patients will be more frequent and watery than expected.

What Is Crohn's Disease?

It is an inflammatory bowel disease in which the digestive tract (mainly small and large intestines) becomes swollen and causes irritation.

What Are the Symptoms of Crohn's Disease?

The symptoms are common, as seen in ulcerative colitis, with periods of severe symptoms followed by mild or no symptoms. Abdominal pain, diarrhea, fever, bloating, weight loss, anal fissures (tears in the tissue of the anus), anal fistulas (a passage that is formed between the bowel end and anus skin), and rectal bleeding are a few of them.

What Is the Treatment for Crohn's Disease?

As no specific treatment is available, the focus is on managing and treating the symptoms.

  • Antibiotics - To prevent severe infection, which can lead to pus and fistula formation.

  • Antidiarrhoeal Medication - To stop diarrhea, Loperamide is given.

  • Bowel Rest - Intravenous nutrition is provided after stopping food and water intake so that the intestine can heal.

  • Immuonsuppressors - To prevent inflammation immune system is suppressed using drugs like Cyclosporine and Azathioprine.

  • Surgery - No surgery can treat Crohn's disease, but surgeries are performed to treat the symptoms of perforations and bleeding.

Conclusion:

Intestinal ulcers, especially peptic ulcer, is a widespread condition. Ulcers, if left untreated, result in severe complications. Once the diagnosis is made, the patient needs to be treated immediately based on symptoms and severity. Along with the treatment, educating patients to understand the disease and lead a healthy lifestyle is essential. They must be aware to seek medical help to lead an active life.

Dr. Sugreev Singh
Dr. Sugreev Singh

Internal Medicine

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