Types of ulcer: characteristics, causes and dangers they pose

An ulcer is a sore or lesion in any tissue that causes the loss of substance. Although its location can be diverse and with very varied symptoms, the most typical of all is the peptic ulcer, which affects the wall of the stomach or duodenum.

Signs of the presence of an ulcer in the patient range from superficial bleeding wounds to severe abdominal pain of a corrosive nature. Of course, this type of injury has a series of symptoms that are less bothersome.

Due to the prevalence of this type of epithelial damage (as we will see below) and the possible worsening of the clinical picture without effective treatment, we find it necessary to inform all readers on ulcer types and how to identify them. In the medical field, every second until diagnosis counts.

• Related article: "Digestive system: anatomy, parts and functioning"

Types of ulcer: chronic debilitating lesions

According to the Royal Spanish Academy of the language (RAE), an ulcer is defined as “a solution of continuity with loss of substance in organic tissues, ordinarily accompanied by discharge of pus and sustained by a local vice or by a cause internal. "

Translating this terminology into a more friendly language, we can say that it is about a tissue injury that causes loss of substance and is difficult to heal.

To understand the clinical importance of this type of tissue damage, it is necessary that we resort, as is tradition, to epidemiological figures. For it, let's look at peptic ulcer, the most widespread type in the population globally:

• According to various studies, 10% of the population in any given place will suffer from a peptic ulcer at some point in their life.
• In some sample groups, the proportion of those affected rises to 12.4%.
• The mortality rate is very low, causing the death of between two and three people per 100,000 inhabitants per year.
• This ulcer process is correlated with the presence of the Helicobacter pylori bacteria, present in 50% of the world population.

As we see, we are before a relatively silent disease with a much higher prevalence than might initially be expected. Once we have contextualized the impact of this type of injury on society, it is time to dive fully into the types of ulcer.

1. Peptic ulcer: the queen of gastric lesions

Peptic ulcer is a lesion that affects the lining of the stomach or duodenum, the second case being much more frequent. It can affect both men and women from infancy to old age, since it is estimated that one in 10 people will suffer from it at some point in their life.

In the past it was considered that an excessive presence of hydrochloric acid (a compound essential for digestion of food) in the stomach was the main trigger of the ulcer process, but more recent research places the microorganism Helicobacter pylori as the main 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 global population. Even so, this infection is usually silent, since only 10 to 20% of those affected will suffer symptoms associated with it at some point in their lives.

H. pylori has a urease enzyme capable of producing ammonia as the final metabolic product. This toxic compound, naturally, will mistreat the gastric or duodenal mucosa, favoring the appearance of ulcers. Despite the importance of this pathogen in the process, it has been observed that other factors such as consumption of non-steroidal anti-inflammatory drugs are also correlated with the appearance of the ulcer peptic.

The most common symptoms of this disease include a feeling of general malaise, vomiting and nausea, corrosive abdominal pain and weight loss. Specific treatment becomes essential, since corrosive bleeding or gastric perforation are almost guaranteed complications if medical help is not obtained from the patient.

• You may be interested in: "Is it true that we have a second brain in our stomach?"

2. Skin ulcers

Less common than the previous ones, but certainly not unimportant, skin lesions are types of ulcers that cause the loss of the epidermis and even deeper layers of the epithelium.

An example to highlight in this type of lesion is the Buruli ulcer, caused by the bacterial microorganism Mycobacterium ulcerans. This microorganism produces a destructive toxin (mycolactone) that causes tissue damage and inhibits 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) tells us that until 2010 there were an average of 5,000 cases annually, and although today around half are registered, it continues to be a problem of course to consider.

These types of ulcers are usually painless and occur in 60% of cases on the lower extremities. (legs). They can also present in a form that is spread throughout the body. Lesions caused by M. ulcerans can even affect bone, and one of the greatest dangers they harbor is that facilitate the entry of other pathogenic bacteria into the patient's body by leaving a clear path in the ulcer epidermal.

Still, not all skin ulcers are associated with the exposed microorganism. There are pressure injuries (poor blood vessel irrigation in some dermal area) that occur, for example, in patients in hospitals who are unable to move for long periods of time.

3. Corneal ulcers

This is one of the types of ulcers that affects the ocular apparatus. It is defined as the loss of continuity in the epithelial surface of the cornea that is associated with necrosis or destruction of the underlying tissue. This, naturally, produces intense eye pain in the patient, photophobia and a considerable decrease in visual capacity.

This type of injury is associated with various 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. Mouth ulcers

Mouth ulcers are open wounds in the oral tissue that can be caused by different causes, such as autoimmune disorders, gingivitis, herpes simplex, mouth cancer, or oral yeast infection.

Generally, these lesions are classified as acute or chronic according to the length of stay in the patient.

Symptoms include pain in the oral apparatus, visible lesions, and a characteristic loss of appetite. In this case, special mouthwashes are the best allies to tackle the disease.

Where there is a tissue there may be an invasion

As we have seen, the presence of pathogenic microorganisms is clearly associated with the appearance of ulcer processes. The epidermis and mucous membranes in contact with the environment are a favorable place for various harmful bacteriaAs they grow on our tissues, they tend to discard toxic metabolic compounds that destroy our cells.

Thus, we could spend days and days compartmentalizing the types of ulcer according to the tissue they affect, since We have named a few, but we have 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 irrigation in a specific tissue and poor tissue nutrition can cause cell death local.

What we want to show in this space is the need to go to a medical professional when faced with suspicion of a gastric ulcer or the presence of an ulcer lesion in an epithelial region visible. As "not very serious" as they may seem at first, these wounds are an open door to the entry of various harmful pathogens, which can complicate the clinical picture of the patient very quickly.

Bibliographic references:

• Ayala, A. AND. G. (2008). Vascular ulcers: risk factors, clinical and prevention. Professional pharmacy, 22 (6), 33-38.
• Bascones-Martínez, A., Figuero-Ruiz, E., & Esparza-Gómez, G. C. (2005). Oral ulcers. Clinical Medicine, 125 (15), 590-597.
• Mycobacterium ulcerans, World Health Organization. Picked up on August 23 at https://www.who.int/topics/mycobacterium_ulcerans/es/
• Ruiz-Narváez, C. E., Martínez-Rodríguez, J. E., Cedeño-Burbano, A. A., Erazo-Tapia, J. M., Pabón-Fernández, C. D., Unigarro-Benavides, L. V.,... & 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. Picked up on August 23 at https://medlineplus.gov/spanish/pepticulcer.html#cat_95
• Vascular ulcers: treatment, ulceras.net. Picked up on August 23 at https://www.ulceras.net/monografico/106/94/ulceras-vasculares-tratamiento.html