An ulcer is an open sore that develops on the inner lining of an organ. Peptic ulcers, the most common type, form in the stomach or the first part of the small intestine, called the duodenum. While an ulcer itself does not directly cause cancer, a significant link exists through a common bacterial infection. Understanding the underlying causes of ulcers and seeking appropriate medical care is important.
Understanding Peptic Ulcers
Peptic ulcers are open sores that develop in the protective lining of the stomach or the duodenum. The stomach produces strong acids and digestive enzymes, and its lining is protected by a mucus layer. When this protective barrier is compromised, these digestive substances can erode the lining, leading to ulcers.
The two most frequent causes of peptic ulcers are infection with Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori weakens the stomach’s protective lining and causes chronic inflammation, making it vulnerable to acid damage. NSAIDs, such as ibuprofen or naproxen, also damage the stomach lining by interfering with its ability to produce protective prostaglandins.
The Connection Between H. Pylori and Gastric Cancer
It is not the ulcer itself that directly causes cancer, but rather the persistent inflammation triggered by a long-standing H. pylori infection. This chronic inflammation can lead to changes in the stomach lining over many years, increasing the risk of certain stomach cancers, specifically gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.
While H. pylori is a significant risk factor, most people infected with the bacterium do not develop stomach cancer. Only a small percentage (1% to 3%) of infected individuals will develop gastric adenocarcinoma, and less than 0.1% will develop MALT lymphoma. Ulcers caused by NSAID use are not associated with an increased risk of stomach cancer. The cancer risk is primarily tied to the chronic inflammatory effects of the H. pylori infection.
Recognizing Warning Signs
Peptic ulcers commonly cause a burning or gnawing pain in the upper abdomen, bloating, nausea, and heartburn. This pain may worsen between meals or at night, and sometimes improve after eating or taking antacids. Some individuals experience no noticeable symptoms, known as silent ulcers, until complications arise.
Certain “alarm symptoms” signal a more serious underlying condition, requiring immediate medical evaluation. These include unexplained weight loss, difficulty swallowing, persistent vomiting, and any signs of bleeding. Blood in stool might appear black and tarry, while vomit could resemble coffee grounds. Sudden, severe abdominal pain also requires urgent medical attention.
Managing Ulcers and Reducing Risk
Treatment for ulcers, particularly those caused by H. pylori, is effective for healing and reducing long-term cancer risk. Testing for H. pylori is standard practice; if positive, eradication therapy is prescribed. This therapy involves antibiotics to eliminate the bacteria and acid-reducing medications, such as proton pump inhibitors, for about 7 to 14 days. Successful eradication of H. pylori significantly lowers the risk of developing gastric cancer, especially MALT lymphoma, where treating the infection often leads to lymphoma regression.
For ulcers caused by NSAIDs, management involves stopping the medication if possible. Acid-reducing medications, such as proton pump inhibitors, are prescribed to facilitate healing. Protective medications like misoprostol may also be used. Lifestyle adjustments, such as avoiding excessive alcohol and smoking, support ulcer healing and promote overall digestive health.