Ulcer, Aphthous: From 1 Different Sources
A small, painful ulcer that occurs, alone or in a group, on the inside of the cheek or lip or underneath the tongue. Aphthous ulcers are most common between the ages of 10 and 40 and affect more women than men. The most severely affected people have continuously recurring ulcers; others have just 1 or 2 ulcers each year.
Each ulcer is usually small and oval, with a grey centre and a surrounding red, inflamed halo. The ulcer, which usually lasts for 1–2 weeks, may be a hypersensitive reaction to haemolytic streptococcus bacteria. Other factors commonly associated with the occurrence of these ulcers are minor injuries(such as at an injection site or from a toothbrush), acute stress, or allergies (such as allergic rhinitis). In women, aphthous ulcers are most common during the premenstrual period. They may also be more likely if other family members suffer from recurrent ulceration.
Analgesic mouth gels or mouthwashes may ease the pain of an aphthous ulcer.
Some ointments form a waterproof covering that protects the ulcer while it is healing.
Ulcers heal by themselves, but a doctor may prescribe a paste containing a corticosteroid drug or a mouthwash containing an antibiotic drug to speed up the healing process.
This disorder is related to gastric ulcer (see STOMACH, DISEASES OF), both being a form of chronic peptic ulcer. Although becoming less frequent in western communities, peptic ulcers still affect around 10 per cent of the UK population at some time. Duodenal ulcers are 10–15 times more common than gastric ulcers, and occur in people aged from 20 years onwards. The male to female ratio for duodenal ulcer varies between 4:1 and 2:1 in di?erent communities. Social class and blood groups are also in?uential, with duodenal ulcer being more common among the upper social classes, and those of blood group O.
Causes It is likely that there is some abrasion, or break, in the lining membrane (or mucosa) of the stomach and/or duodenum, and that it is gradually eroded and deepened by the acidic gastric juice. The bacterium helicobacter pylori is present in the antrum of the stomach of people with peptic ulcers; 15 per cent of people infected with the bacterium develop an ulcer, and the ulcers heal if H. pylori is eradicated. Thus, this organism has an important role in creating ulcers. Mental stress may possibly be a provocative factor. Smoking seems to accentuate, if not cause, duodenal ulcer, and the drinking of alcohol is probably harmful. The apparent association with a given blood group, and the fact that relatives of a patient with a peptic ulcer are unduly likely to develop such an ulcer, suggest that there is some constitutional factor.
Symptoms and signs Peptic ulcers may present in di?erent ways, but chronic, episodic pain lasting several months or years is most common. Occasionally, however, there may be an acute episode of bleeding or perforation, or obstruction of the gastric outlet, with little previous history. Most commonly there is pain of varying intensity in the middle or upper right part of the abdomen. It tends to occur 2–3 hours after a meal, most commonly at night, and is relieved by some food such as a glass of milk; untreated it may last up to an hour. Vomiting is unusual, but there is often tenderness and sti?ness (‘guarding’) of the abdominal muscles. Con?rmation of the diagnosis is made by radiological examination (‘barium meal’), the ulcer appearing as a niche on the ?lm, or by looking at the ulcer directly with an endoscope (see FIBREOPTIC ENDOSCOPY). Chief complications are perforation of the ulcer, leading to the vomiting of blood, or HAEMATEMESIS; or less severe bleeding from the ulcer, the blood passing down the gut, resulting in dark, tarry stools (see MELAENA).
Treatment of a perforation involves initial management of any complications, such as shock, haemorrhage, perforation, or gastric outlet obstruction, usually involving surgery and blood replacement. Medical treatment of a chronic ulcer should include regular meals, and the avoidance of fatty foods, strong tea or co?ee and alcohol. Patients should also stop smoking and try to reduce the stress in their lives. ANTACIDS may provide symptomatic relief. However, the mainstay of treatment involves four- to six-week courses with drugs such as CIMETIDINE and RANITIDINE. These are H2 RECEPTOR ANTAGONISTS which heal peptic ulcers by reducing gastric-acid output. Of those relapsing after stopping this treatment, 60–95 per cent have infection with H. pylori. A combination of BISMUTH chelate, amoxycillin (see PENICILLIN; ANTIBIOTICS) and METRONIDAZOLE – ‘triple regime’ – should eliminate the infection: most physicians advise the triple regime as ?rst-choice treatment because it is more likely to eradicate Helicobacter and this, in turn, enhances healing of the ulcer or prevents recurrence. Surgery may be necessary if medical measures fail, but its use is much rarer than before e?ective medical treatments were developed.... duodenal ulcer
A usually chronic condition, started by irritation, with congestion in time, leading to edema, blistering, and the formation of an ulcer. Hylobacter infections seem to prolong and aggravate the condition, but the presence alone of the bacteria, without functional impairment, will not begin the disease. Possessing a certain “workaholic” panache...even boasted of in some business circles as if to validate one’s work ethic, it nonetheless is fatal if untreated.... gastric ulcer
A stomach or duodenal ulcer, caused by excess or untimely secretions of gastric acid and pepsin, poor closure of the pyloric sphincter and digestive acid leakage into the duodenum, or poorly mucin-protected membranes resulting from infection or allergen irritation... peptic ulcer
A cutaneous ulcer seen particularly in malnourished individuals. The cause of these ulcers is often ascribed to a synergistic infection by the spirochaete Treponema vincentii and the anaerobic Gram negative rod, Fusobacterium nucleatum.... tropical ulcer
Single or multiple (and often recurrent) transiently painful ulcers in the oral mucous membrane that are usually self-limiting. The cause is unknown and treatment is symptomatic.... aphthous ulcer
A branching ULCER on the surface of the cornea of the eye, caused by HERPES SIMPLEX infection.... dendritic ulcer
A chronic form of BASAL CELL CARCINOMA, the most common form of skin cancer.... rodent ulcer
A visible break in the body’s surfaces; e.g. skin, gut, urinary tract, which is not caused by acute trauma.... ulcer
See: EYES, INFECTION. ... corneal ulcer
See bedsores.... decubitus ulcer
See under ULCER.... venous ulcer
See: STOMATITIS. ... aphthous ulcers
A type of stress ulcer that occurs specifically in people who have suffered extensive skin burns.... curling’s ulcer
An open sore caused by a break in the mucous membrane lining the mouth. The ulcers are white, grey, or yellow spots with an inflamed border. The most common types are aphthous ulcers (see ulcer, aphthous) and ulcers caused by the herpes simplex virus. A mouth ulcer may be an early stage of mouth cancer and may need to be investigated with a biopsy if it fails to heal within a month.... mouth ulcer
A type of peptic ulcer.... stomach ulcer
a localized area of damage and breakdown of the skin due to inadequate arterial blood supply (*ischaemia). Usually it is seen on the feet of patients with severe atheromatous narrowings of the arteries supplying the legs.... arterial ulcer
a chronic, debilitating illness caused by Mycrobacterium ulcerans. It begins with a painless swelling, most often on the arm or leg, that develops into a necrotizing ulcer. The condition occurs most commonly in sub-Saharan Africa and Australia, with some 2 000 cases being reported annually. At present there is no vaccine; antibiotics are usually effective if prescribed at an early stage.... buruli ulcer
linear *erosion found on the lining of the stomach at or near the level of the diaphragm in patients with large hiatus *hernias. The cause is unclear but interruption in the blood supply (*ischaemia) is one of the likely explanations. Treatment involves *antisecretory drugs and treatment of anaemia, which is often present.... cameron’s ulcer
a form of *leishmaniasis of the skin caused by the parasite Leishmania tropica mexicana. The disease, occurring in Panama, Honduras, and the Amazon, primarily affects men who visit the forests to collect chicle (gum) and takes the form of an ulcerating lesion on the ear lobe. The sore usually heals spontaneously within six months.... chiclero’s ulcer
see interstitial cystitis. [G. L. Hunner (1868–1957), US urologist]... hunner’s ulcer
see peptic ulcer; Zollinger-Ellison syndrome.... jejunal ulcer
a carcinoma that develops at the edge of a chronic *ulcer of the skin, usually a venous ulcer in the ankle region. [J. N. Marjolin (1780–1850), French surgeon]... marjolin’s ulcer
a severe ulceration at the periphery of the cornea, characterized by an overhanging advancing edge and vascularization of the ulcer bed. It is usually very painful, progressive, and difficult to control. [A. Mooren (1829–99), German ophthalmologist]... mooren’s ulcer
see peptic ulcer; oesophagitis.... oesophageal ulcer
an uncommon anorectal condition that produces symptoms of anal pain, rectal bleeding, straining during defecation, and obstructed defecation (dyssynergic defecation). *Proctoscopy reveals one or more benign rectal lesions, which are thought to be due to abnormal straining during defecation leading to prolapse of the distal anterior rectal wall and internal anal *intussusception.... solitary rectal ulcer syndrome
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