Peptic ulcers and stomach cancer: Clinical

Peptic ulcers are deep erosions in the lining of the stomach or duodenum that lead to inflammation in the gastric or duodenal wall.

Sometimes, peptic ulcers develop acutely like after a toxic ingestion or ischemia, but more often the erosions are chronic, developing slowly over time.

Chronic ulcers are mostly benign, but they can sometimes develop into a malignant ulcer, termed stomach cancer, which is why an upper endoscopy with biopsy is essential to the diagnosis.

Chronic ulcers sometimes don’t cause any symptoms. When they do, the most common symptom is dyspepsia.

Dyspepsia includes epigastric pain related to eating food, early satiety, postprandial belching, and nausea.

With gastric ulcers, epigastric pain worsens when eating a meal because of the hydrochloric acid that’s produced in response to food.

With duodenal ulcers, epigastric pain is relieved while eating a meal, but it typically recurs 2 to 5 hours later or it can appear at night. That’s because with duodenal ulcers, Helicobacter pylori is involved in most cases and it increases the hydrochloric acid production by indirectly increasing gastrin production and when there’s no food to act as a buffer, the pain worsens.

Sometimes peptic ulcers can erode deep into the gastric and duodenal wall resulting in complications.

If an ulcer erodes into a blood vessel, then it can cause hematemesis or melena.

If there’s an ulcer in the pyloric antrum or in the duodenum, then it can cause gastric outlet obstruction. That can worsen the symptoms and even cause the individual to lose weight.

Peptic ulcers can also perforate into the peritoneal cavity causing peritonitis, and that causes severe abdominal pain and fevers.

With stomach cancer, things get a little more complicated. Risk factors include chronic mucosal inflammation, like in Helicobacter pylori infection, atrophic gastritis, and surgery on the stomach; as well as environmental triggers like tobacco, and occupational exposures to coal, steel, or iron.