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Ulcers Unmasked: Understanding Types, Symptoms, and Treatments

By Adaobi Rhema Oguejiofor

Beyond just painful stomach aches, there is a diverse landscape of ulcers impacting various corners of the body. Whenever ulcer is mentioned, the mind quickly goes straight to the most common type of ulcer, which is the one that affects the stomach. However, the truth is that other types of ulcers affect the human body. These painful sores can occur in diverse locations, from the mouth to the toes, and although they are not quite common they are just as intense and pose serious health risks.

Ulcer is a painful open sore that can either show up on the skin, in the lining of an organ, or on the surface of any body tissue. It can occur on many parts of the body including the stomach, intestines, mouth, and eyes. It is slow to heal and sometimes recurrent. In some cases, ulcers disappear on their own, while in other cases they may require medical treatment to prevent serious complications.  Injuries, diseases, and infections can be a cause of this condition, for instance, leg and foot ulcers generally manifest from a wound that did not heal well due to another health issue, such as blood flow problem.

What the sore looks like depends on its location and why it appears. Its corresponding symptoms typically depend on its underlying causes. The main symptoms of ulcer in general are pain or discomfort around the area where the ulcer has developed, nausea, heartburn, or itching and treatment can include antibiotics, acid reducers, antiviral drugs, surgery, or lifestyle changing.

A research by the Nigerian Journal of Gastroenterology and Hepatology in 2022 stated that, in Nigeria, about 87. 7 percent of the people are living with ulcers caused by the helicobacter pylori infection with the northern part of the country having a higher prevalence compared to other regions of the country.

According to a Medical Doctor, Robert Burakoff, there are different types of ulcers, and all types of ulcers share the similarity of being sores that occur somewhere in the body causing pain. Also, a lot of them are caused by bacterial infection. However, they have certain differences, which include where they occur in the body and how they are treated. Some common types of ulcers are stomach ulcer, skin ulcer, mouth ulcer, and corneal ulcer.  

The most common type of ulcer is the stomach ulcer, which is also referred to as peptic ulcer. This ulcer is a sore on the lining of the stomach or the lower intestine that occurs when stomach acids, which help digest food, damage the walls of the stomach or lower intestine. By the generic build-up of the stomach, it is usually protected by a mucus layer that prevents stomach acids from damaging its walls but when this mucus layer breaks down, stomach acids can reach the stomach walls and lead to the damage that causes ulcer.

Stomach ulcer can be caused by two main factors including infection with a bacteria called helicobacter pylori and from the long-term use of nonsteroidal anti-inflammatory medicine (NSAIDs) like aspirin and ibuprofen. The prevalence of ulcer caused by NSAID use is higher in older people compared to younger adults. Both of these causes contribute to the breakdown of the protective coating that prevents stomach acids from reaching the walls of the stomach.

Other less common causes for stomach ulcers include infections caused by certain viruses, fungi, or bacteria apart from helicobacter pylori, medicines that increase the risk of developing ulcer, like corticosteroids, medicines used to treat low bone mass, and some antidepressants, particularly when taken alongside NSAIDs, surgery or medical procedures that affect the stomach or lower intestine, as well as chronic diseases like cirrhosis or chronic obstructive pulmonary disease.

A gastroenterologist at the university of Abuja teaching hospital, Dr. Crystal Umejiaku, in an interview, stated that stomach ulcer, which is also referred to as peptic ulcer is very common, especially in developing countries like Nigeria. She advised that it be treated immediately as various complications could arise from it. She started that there are two those of ulcers which are the gastric ulcer which happens in the stomach and the duodenal ulcer which occurs in the small intestine.

Another common type of ulcer that exist is skin ulcer. This type of ulcer is a round, open sore or wound that appears on the skin. It could be due to a minor skin injury that is not healing properly because of infection, inflammatory conditions, or blood circulation issues. When the ulcer is small or mild, it might not necessarily be considered dangerous on its own, but it could become severe if it is not treated properly.

There are few types of this ulcer and they include pressure ulcer, which is also called bedsores or decubitus ulcers. This type develops when there is continued pressure on a certain area of the body, which compresses the blood vessels under the skin and disrupt blood circulation. There is also the venous ulcer, which can occur especially on the legs, when blood circulation is not flowing as usual, causing pressure, excess fluid and open sores to form. These ulcers typically have an uneven border around a shallow sore with a red base, sometimes covered by yellowish tissue. Another type is the ischemic ulcer known as an arterial ulcer. It develops when there is reduced blood flow to the feet or legs. A patient may develop a sore that is dark red, yellow, gray, or black, with a raised edge around the wound. Under it is also the neuropathic skin ulcer, which is sometimes called diabetic ulcer, these kind of ulcer typically develop due to nerve damage in people with uncontrolled diabetes.

Mouth ulcers is another type of ulcer where sores are found in or around the mouth. There are many disorders that can cause mouth ulcer. Some of the main causes are canker sores, which can occur as a result of some viral infections, an injury from dental work, or biting the tongue or cheek. It can also be caused by Gingivostomatitis, which is an infection of the mouth and gums that causes swelling and sores as a result of poor mouth hygiene. It is mostly a common infection in children. There is also the oral herpes that involves a viral infection brought about by the herpes simplex virus type. This infection causes cold sores on the mouth, lips or gums.

The Corneal ulcer, which is also known as Keratitis, on the other hand, is another type of ulcer that has to do with an open sore in the outer layer of the cornea. It is usually caused by bacterial infection, especially in people who wear contact lenses and do not clean them properly.

The symptoms of ulcer differ depending on the type of ulcer a person has. Although all ulcers cause pain and discomfort in the area of the body where they appear, there are some specific symptoms people with ulcers can experience with peculiarity to the type.

For stomach ulcer some symptoms are a dull and burning pain that comes and goes in the upper part of the abdomen, feeling full soon after eating a meal, nausea, vomiting, bloating, and belching, and very black stool or stool with blood.

For skin ulcer, the symptoms could be that the sores typically look circular, open and raw, the ulcers might ooze clear fluid, blood, or pus when infected, the wound may be raised, inflamed, or have a discolored border, the ulcer is also itchy, painful, and sometimes feel like it is burning.

When it comes to mouth ulcer the symptoms include pain in the mouth, red bumps that develop into an ulcer in the mouth, sore with a white or yellow center, and mouth soreness that eliminates the desire to eat.

While Corneal ulcer symptoms include severe pain and eye soreness, redness of the eye, the feeling like one has something in the eye, tearing of the cornea, pus or discharge, blurred vision, light sensitivity and also swelling of the eyelids.

Just like the symptoms, treating these ulcers could also differ. Stomach ulcers are treated with medicines that help manage the effects of stomach acid damage and alleviate the helicobacter pylori infection. Proton pump inhibitors like Omeprazole (Prilosec), Ssomeprazole (Nexium), and Lansoprazole (Prevacid) could be used, as well as antibiotics.

For skin ulcer, treating it depends on the type of skin ulcer, how severe it is, and the patient’s overall health. Some treatment options include medications like prescribed antibiotics, dressings by keeping the wound covered to help keep it moist, clean, and infection-free to help support the healing process, as well as medical procedures. For very severe cases, a medical procedure like a skin graft, or amputation, in extremely severe ulcer cases, may be recommended. Also, Blood circulation treatments like wearing compression socks, exercising, and getting massages may help the blood circulation in the legs to improve.

In the case of mouth ulcers, the kind of treatments applied depends on the type of mouth ulcer experienced. For common types of mouth ulcers, the typical treatments include gently cleaning the mouth and teeth regularly, using medicines like antihistamines, antacids, and corticosteroids to rub on the sore, using non-alcohol-based over-the-counter (OTC) mouthwashes and medically prescribed mouthwashes like chlorhexidine mouthwash. If the mouth ulcer is caused by oral herpes, topical antiviral creams and oral antiviral tablets like Acyclovir, Famciclovir, and Valacyclovir can be prescribed for usage.

Some common treatments for corneal ulcer are antibiotic, antifungal, and antiviral eye drops, steroid or anti-inflammatory eye drops and in severe cases, an ophthalmologist might suggest a corneal transplant to replace a damaged cornea with a healthy one in order to restore vision.

Although ulcers in many cases are not life-threatening, they can significantly affect a patient’s quality of life. There are a number of ways this disease can be prevented from developing in the stomach, skin, mouth, or corneal. Stomach ulcer caused by NSAIDs like Ibuprofen and Aspirin can be prevented by lowering the dosage intake and reducing how often one uses these OTC medications. If taking NSAIDs for pain management is necessary, then taking them along with a proton pump inhibitor tablet can reduce the risk of developing a stomach ulcer. Additionally, quitting smoking can also lower the risks.

For other ulcers, regular check with doctors is advised. Medical experts also generally recommend implementing certain healthy lifestyle changes, such as keeping chronic diseases like diabetes, high blood pressure, or high cholesterol under control, as well as exercise to maintain healthy blood flow, and eat a healthy diet that supports healing.

The National Institutes of Health (NIH) noted that the best way to prevent mouth ulcers that are not related to cancer or herpes is to brush the teeth twice a day and scheduled dental checkups regularly. While corneal ulcers can be prevented by using protective eyewear when doing activities that can lead to an eye injury.

Ulcers are preventable and treatable despite being slow to heal and sometimes recurrent. It is not life threatening if discovered and taken care of early. To this end, it is important that people go for regular checkup with the doctor to avoid letting diseases like ulcer linger and become severe.