An ulcer is a sore or injury in any tissue that causes the loss of substance. Although its localization can be diverse and with very varied symptoms, the most typical of all is peptic ulcer, which affects the wall of the stomach or the duodenum.
Signs of an ulcer in the patient range from superficial bleeding to severe corrosive abdominal pain. Of course, this type of injury is accompanied by a number of symptoms because they are less annoying.
Due to the prevalence of this type of epithelial lesion (as we will see below) and the possible worsening of the clinical picture without effective treatment, we see the need to inform all readers about the types of ulcers and how to identify them. In the medical field, every second until the diagnosis counts.
Ulcer type: chronic debilitating lesions
According to the Royal Spanish Academy of Language (RAE), an ulcer is defined as “a solution of continuity with loss of substance in the organic tissues, usually accompanied by a secretion of pus and maintained by a local defect or an internal cause” .
By translating this terminology into a nicer language, we can say that it is an injury to tissue that causes loss of substance and is difficult to heal.
To understand the clinical significance of this type of tissue damage, we must turn, as tradition dictates, to epidemiological figures. For that, Let’s take a look at peptic ulcer, the most common type in the world population:
- According to various studies, 10% of the population in a given place will suffer from peptic ulcer at some point in their life.
- In some sample groups, the proportion of people affected is 12.4%.
- The death rate is very low, as it results in the death of two to three people per 100,000 inhabitants per year.
- This ulcerative process is correlated with the presence of the bacterium Helicobacter pylori, present in 50% of the world’s population.
As we can see, we are in front a relatively calm disease with a much higher prevalence than one might expect at first glance. Once we have contextualized the impact of this type of injury on society, it is time to delve fully into the types of ulcers.
1. Peptic ulcer: the queen of gastric lesions
Peptic ulcer is an injury that affects the lining of the stomach or duodenum, The second case being much more frequent. It can affect men and women from childhood to old age, as it is estimated that one in 10 people will suffer from it at some point in their life.
In the past, an excessive presence of hydrochloric acid (a compound essential for the digestion of food) in the stomach was considered to be the main trigger of the ulcer process, but more recent research places the microorganism Helicobacter pylori as the prime suspect.
Most of the reported cases are associated with this bacterium which, as we have already said, is found in the digestive tract of 50% of the world’s population. However, this infection is usually silent, as only 10-20% of those affected will experience the symptoms associated with it at some point in their lives.
H. pylori has a urease enzyme capable of giving rise to ammonia as a final metabolic product. This toxic compound will naturally abuse the gastric or duodenal mucosa, promoting the appearance of ulcers. Despite the importance of this pathogen in the process, it has been observed that other factors such as the consumption of nonsteroidal anti-inflammatory drugs are also correlated with the appearance of peptic ulcer.
The most common symptomatology of this disease includes the sensation of general discomfort, vomiting and nausea, corrosive abdominal pain and weight loss. Specific treatment becomes essential, because corrosive hemorrhages or gastric perforation are almost guaranteed complications if medical assistance is not obtained from the patient.
2. Skin ulcers
Less common than the above, but certainly not unimportant, skin lesions are types of ulcers that they cause the loss of the epidermis and even other deeper layers of the epithelium.
A notable example of this type of injury is Buruli ulcer, caused by the bacterial microorganism Mycobacterium ulcerans. This microorganism produces a destructive toxin (mycolactone) which damages tissue and suppresses the immune response.
This disease, foreign to the Western population, is one of the most neglected emerging pathologies in Africa and South America. The World Health Organization (WHO) points out that in 2010 there were on average 5,000 cases per year, and although today about half are registered, a problem is still ruled out.
This type of ulcer is usually painless and occurs in 60% of cases in the lower extremities. (Legs). They can also occur in a dispersed form throughout the body. Injuries caused by M. ulcerans can even affect bone, and one of the greatest dangers they present is that they facilitate the entry of other pathogenic bacteria into the patient’s body by allowing free passage through epidermal ulcer.
However, not all skin ulcers are associated with the exposed microorganism. There are pressure injuries (poor irrigation of blood vessels in certain areas of the skin) that occur, for example, in hospitalized patients unable to move for long periods.
3. Corneal ulcers
It is one of the types of ulcers that affects the eye system. It is defined as the loss of continuity of the epithelial surface of the cornea associated with necrosis or destruction of the underlying tissue. This naturally leads to severe eye pain in the patient, photophobia and a considerable decrease in visual capacity.
This type of injury it is associated with several infectious agents, such as Staphylococcus aureus, Bacteria of the genus Pseudomonas and fungi such as Candida. As we can see, there is a clear pattern between the appearance of ulcers and the invasion of pathogenic microorganisms.
4. Oral ulcers
Mouth ulcers are open sores in the oral tissues that can be caused by different causes, such as autoimmune diseases, gingivitis, herpes simplex, oral cancer, or oral thrush.
Generally, these lesions are classified as acute or chronic depending on the length of stay with the patient.
Symptoms include pain in the oral system, visible lesions, and a characteristic loss of appetite. In this case, special mouthwashes are the best allies in the fight against the disease.
Where there is tissue there may be an invasion
As we have observed, the presence of pathogenic microorganisms is clearly associated with the appearance of ulcerative processes. The epidermis and mucous membranes in contact with the environment are a favorable place for various harmful bacteriaBecause they thrive on our tissues, they often release toxic metabolic compounds that destroy our cells.
So we could spend days and days compartmentalizing the types of ulcers according to the tissues they affect, as we have named a few, but we left genital, rectal or vascular ulcers, for example. Some of them do not have to be associated with the presence of bacteria, for example a lack of irrigation in a specific tissue and poor tissue nutrition can cause local cell death.
What we want to show in this space is the need to visit a healthcare professional if you suspect a gastric ulcer or the presence of an ulcerated lesion in a visible epithelial region. As “not very serious” as they may seem at first glance, these sores are a open door to the entry of various harmful pathogens, which can complicate the patient’s clinical picture very quickly.
- Ayala, AEG (2008). Vascular ulcers: risk factors, clinic and prevention. Professional pharmacy, 22 (6), 33-38.
- Bascones-Martínez, A., Figuero-Ruiz, E., and Esparza-Gómez, GC (2005). Oral ulcers. Clinical Medicine, 125 (15), 590-597.
- Mycobacterium ulcerans, World Health Organization. Collected August 23 at https://www.who.int/topics/mycobacterium_ulcerans/es/
- Ruiz-Narváez, CE, Martínez-Rodríguez, JE, Cedeño-Burbano, AA, Erazo-Tàpia, JM, Pabón-Fernández, CD, Unigarro-Benavides, LV, … and Burbano-Imbachí, A. (2018). Helicobacter pylori, peptic ulcer and gastric cancer. Journal of the Faculty of Medicine, 66 (1), 103-106.
- Peptic ulcer, Medlineplus.gov. Retrieved August 23, from https://medlineplus.gov/spanish/pepticulcer.html#cat_95
- Vascular ulcers: treatment, úlceras.net. Collected August 23 at https://www.ulceras.net/monografico/106/94/ulceras-vasculares-tratamiento.html