An ulcer may be defined as an erosion of the inside lining of the GI tract. In the stomach and duodenum, an erosion becomes an ulcer when the diameter of the ulcer is 5 mm or more. Technically, an ulcer is present when a hole in the lining of the stomach or small intestine has eroded into the deeper tissues of the stomach and small intestine.
Ulcers may be located in many different parts of the GI tract. Most commonly ulcers are located in the stomach or small intestine. However, ulcers may also be located in the mouth, small intestine and large colon (including the rectum). When the ulcers are located in the stomach or small intestine, they are called peptic ulcers. These are specific types of ulcers and do not necessarily have the same outcome or treatment as ulcers of the rectum or esophagus.
A rare condition, Zollinger Ellison Syndrome, causes diarrhea and ulcers. Patients with Zollinger Ellison Syndrome have increased gastrin levels. Gastrin is a hormone, which helps to regulate the secretion of acid. When gastrin is secreted by the pancreas in an unrestricted manner, diarrhea and chronic abdominal pain as well as reflux are encountered. This diagnosis can be evaluated by obtaining a fasting gastrin level. Patients should not be on proton pump inhibitors while having a fasting gastrin test performed.
Gastric ulcers are malignant in 5 percent of cases. Repeat upper endoscopy is required for patients who have gastric ulcers because of this fact. Treatment for gastric ulcers is similar to duodenal ulcers. In addition, due to the high association with Helicobacter pylori, most patients will be treated for Helicobacter pylori infection in order to facilitate healing and diminish recurrence of gastric ulcers.
Duodenal ulcers are almost always benign. The rate of malignancy is extremely low. Therefore, these ulcers do not require repeat endoscopy unless there is a complication present. Some patients do require repeat endoscopy for duodenal ulcers. However, this is rather uncommon. Again, patients with duodenal ulcers are usually treated for Helicobacter pylori.
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