A peptic ulcer is an abnormal area of mucosa that has been damaged by the pepsin and hydrochloric acid of gastric juice, with consequent inflammation of the underlying and surrounding tissue. Erosion may subsequently occur into the lamina propria and submucosa to cause bleeding.
Most peptic ulcers occur either in the duodenum or in the stomach, where the pH is sufficiently low for peptic action, although ulcers may also occur in the lower esophagus, as a result of refluxing of gastric contents, and rarely in certain areas of the small intestine. Colonic ulcers are not included in this category.
Pain is the outstanding feature, varying from ‘discomfort’ to ‘severe’. It is usually felt in the epigastric region, although in longstanding, severe cases in which the ulcer penetrates into other organs, the patient may complain of backache or lower abdominal pain.
The pain is often described as ‘burning’ or ‘gnawing’. Sometimes a patient points with one finger to a spot in the epigastric region (the ‘pointing sign’), and this tends to indicate an ulcer rather than simple gastritis.
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