What Are Ulcers?

The term ‘ulcer’ means, in the most general sense, a lesion anywhere but more often in the digestive tract. It’s often used, though, as a shorthand term for the phrase ‘peptic ulcer’. The latter isn’t a condition of the colon – the major portion of the large intestine – at all. It affects the stomach usually, but may also occur in the duodenum (the first section of the small intestine), or even the esophagus (the section leading from the throat or pharynx to the stomach).

General ulcers or lesions that occur in the colon are typically part of other IBDs or inflammatory bowel diseases, such as Crohn’s or ulcerative colitis. By contrast, peptic ulcers are sores in the stomach or duodenum lining where the holes cause contact between its contents and inner tissues.

That contact can be both painful and lead to secondary complications. Here’s how…

The digestive system is not, strictly speaking, a closed system with a hole at each end. The epithelial tissue lining it evolved mechanically and biochemically into what is known as a permeable membrane. That is, materials can pass through it selectively, with water and nutrients or vitamins produced in the digestive tract moving into the body.

However, when stomach acid (a type of hydrochloric acid), bile, and actual semi-digested food pass through the stomach or intestines, pain and disease can result. Toxins, for example, then pass directly into the bloodstream rather than being moved down and eliminated. Looking at the other direction, when blood passes out of the surrounding tissues and into the digestive system, the result is pain and abdominal cramping, bleeding, and bloody stools, with resulting anemia.

Both circumstances have serious health consequences and ulcers are the lesions that make such inappropriate movements of material possible. They are the ‘holes’ through which the substances pass.

The causes of ulcerative colitis, Crohn’s and other diseases involving colon lesions are not known. However, in the case of peptic ulcers in the stomach there is very strong evidence about the cause: infection. Once thought to be the result of stress and diet (in the form, for example, of spicy foods), research now strongly favors the view that bacteria are the culprit.

In fact, one organism in particular is thought to be the main culprit in most peptic ulcers: Helicobacter pylori or H. pylori. It lives and multiplies within the mucous layer that lines the stomach and small intestine, a substance that provides it with a ‘good’ growth medium.

There are other possible causes, however, such as overuse of pain relievers. NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin (Bayer, and others), ibuprofen (Advil, Motrin), and naproxen (Aleve) can produce lesions in the stomach lining or small intestine.

Buffering helps but coated aspirin, for example, only delays dissolving the drug so that it occurs not in the stomach but in the small intestine. That can benefit some, in particular by changing the site at which the drug begins to act, but some individuals are more sensitive in the intestine than the stomach.

Short-term, occasional lesions are a normal occurrence, even when unpleasant, and the body typically heals itself within a day or two. Long-term problems, such as ulcerative colitis, Crohn’s, or chronic peptic ulcers require professional diagnosis and treatment. See your physician for guidance.

What is Crohn’s Disease?

Crohn’s disease is one among many digestive disorders in which the lining becomes inflamed. That inflammation produces ulcers (lesions or open sores in the lining) that produce abdominal pain and diarrhea. It is often progressive and leads to even more serious health consequences.

The cause(s) of the disease are not known, but an abnormal immune system response to a bacterium (known as MAP or Mycobacterium avium subspecies paratuberculosis) is suspected. Despite the lack of a clear cut culprit several risk factors are known. Diet and stress can affect the course and impact of the disease but have been ruled out as causes.

Genetics is near the top of the list, not surprisingly given the immune system response aspect of the disease. Roughly 20% of those with Crohn’s have a parent or close relative similarly afflicted. Those with an affected sibling are 30 times more likely to develop Crohn’s than the general population. Unlike many diseases, Crohn’s tends to occur in younger people, usually between the ages of 20-30.

The intestinal inflammation of the disease produces diarrhea by causing cells to secrete large amounts of salt and water. The colon is unable to absorb all this fluid (part of its natural role in the digestive system). The result is diarrhea.

One effect is swelling of the intestinal tissue and scaring as the ulcers heal. That results in less efficient movement of the chyme (the semi-fluid mass of digested food) through the colon. The effects are felt as cramping and abdominal pain. In more advanced or severe cases nausea and vomiting are common. Bloody stool is common, as well, as moving chyme causes inflamed tissue to rupture, allowing blood to flow into the colon. The ulcers can become enlarged, moving deep into intestinal tissue, worsening the problem.

The net result, apart from the pain, is often reduced appetite and unhealthy weight loss. The symptoms lead to a desire not to eat, but the weight loss is exacerbated by less efficient digestion of food. In extreme circumstances such low intake and absorption of calories and nutrients leads to many secondary consequences.

Diagnosis is fairly straightforward. Blood tests check for anemia and during a colonoscopy a physician can see the distinctive signs directly. A biopsy (tissue samples that can be removed during the procedure) are used to confirm the presence of Crohn’s.

A less invasive procedure known as a flexible sigmoidoscopy uses a lighted tube to examine only the lower two feet of the colon and rectum while a colonoscopy involves inserting a tube all the way into the intestine. It takes only a few minutes to complete.

A physician may recommend a barium enema as well. A safe, mildly radioactive barium fluid is introduced into the colon where it provides a contrast dye for an X-ray. The fluid coats the lining of the intestine to create a silhouette of the colon and rectum. In a variation, X-rays can also be taken if the patient ingests the barium fluid.

A more modern diagnostic procedure, known as capsule endoscopy, involves swallowing a tiny camera in the form of a pill, which makes its way down the digestive tract. It takes photos along the way, which the physician examines.

Unfortunately, there is no cure known for Crohn’s disease as yet, but drug therapy to reduce inflammation is a common treatment. Surgery has helped many afflicted by removing ulcerated tissue (sometimes sections of the bowel), reducing symptoms. Unlike ulcerative colitis, Crohn’s infected tissue may occur in spots with healthy tissue in between, not throughout an entire length. That allows for a more targeted repair of affected tissue.

Common Intestinal Parasites

Over 700 bacterial species inhabit the human colon, many of which are essential to good digestion and overall health. There are some intestinal parasites, though, that are at best benign and at worst potentially lethal.

The majority of those divide into two groups: one-celled organisms (called protozoans) and parasitic worms. They generally enter the gut as a result of consuming inadequately cooked or poorly washed food, or contaminated water. Once there, they find the mucous lining on the intestine a conducive growth environment and they reproduce.

The result is frequently an infection that, left untreated, can lead to harmful health consequences. That can run the gamut from unpleasant abdominal cramps with constipation or diarrhea to nausea, colitis, or even blindness.

E. vermicularis, for example, (a common roundworm) can induce sleep disturbances and infects about 200 million people worldwide. The adult male worms are about 2-5 mm in size (about the length of a pencil lead) and the females 8-13 mm. Females can lay up to 15,000 eggs. Fortunately, most die within 3 days and infection is often cured spontaneously by the immune system within 4-6 weeks.

Giardia, or G. lamblia, can cause nausea, vomiting, and diarrhea. This pear-shaped protozoan is extremely common, infesting more than 2.5 million individuals in the U.S. alone annually, according to the CDC. It can be spread by contact with feces or, because it’s water borne, by drinking contaminated water. It’s even resistant to the chlorine in normal tap water. Incubation generally takes 1-2 weeks, after which symptoms begin to appear.

Hookworms like A. duodenale can cause anemia. Along with its cousin, N. americanus, this parasite is less common today in developed countries than in the past, thanks to improved plumbing and better sanitation. Still, it is prevalent enough to be the second most common helminthic (parasitic worm) infection in the U.S.

One of the reasons is that, unlike many others, they can infect the host through the pores or hair follicles; they don’t require a break in the skin or ingestion. Within about six weeks, the parasite has attached itself to the intestine where it feeds. Symptoms may not appear for long periods, but the hookworm acts like an anticoagulant, leading ultimately to blood loss and hence anemia. In advanced stages it can produce mental retardation in children.

E. histolytica may cause intestinal ulcers, fever, or peritonitis. It’s unfortunately very widespread, producing up to 50 million cases per year worldwide, of which 100,000 or so are fatal. After malaria, it’s the most second leading cause of death from protozoan infection. It acts to disrupt the mucous lining in the intestine, resulting in colitis, ulcers, and possible bloody diarrhea.

Fortunately, all of these can be guarded against with proper health procedures and most are readily treated, once diagnosed. Once infected, many antibiotics are effective. Naturally, prevention is always the best option. Food should be thoroughly washed and/or well-cooked. Keeping the immune system healthy and practicing good colon health can minimize the odds of disease in the first place.