Types of ulcers: characteristics, causes and dangers they pose.

Summary of the most important types of ulcers, and the reasons why they can be very dangerous.

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.

The signs of the presence of an ulcer in the patient range from superficial bleeding wounds to intense abdominal pain of a corrosive nature. Of course, this type of lesion is associated with a series of symptoms that are at the very least uncomfortable.

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

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 pus secretion and sustained by a local vice or by an internal cause."

Translating this terminology into gentler language, we can say that it is a lesion in a tissue that causes loss of substance and is difficult to heal..

To understand the clinical significance of this type of tissue damage, it is necessary for us to resort, as has become the tradition, to epidemiological figures. To do so, let us look at ulceration, let us look at peptic ulcer, the most widespread type of ulcer in the population worldwide.:

• According to various studies, 10 % of the population in any given location will suffer a peptic ulcer at some point in their lives.
• In some sample groups, the proportion of those affected is as high as 12.4 %.
• The mortality rate is very low, causing the death of between two and three persons per 100,000 inhabitants per year.
• This ulcerative process is correlated with the presence of the bacterium Helicobacter pylori, present in 50% of the world's population.

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

1. Peptic ulcer: the queen of gastric lesions

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

In the past, an excessive presence of hydrochloric acid (a compound essential for the digestion of food) in the stomach was considered to be the main trigger for the ulcerative process, but more recent research places the microorganism as the main cause of ulceration. more recent research places the microorganism Helicobacter pylori Helicobacter pylori as the main suspect..

Most of the reported cases are associated with this bacterium, which, as mentioned above, is found in the digestive tract of 50% of the global population. Even so, this infection is usually silent, as 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 a metabolic end-product.. This toxic compound will naturally 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 the consumption of non-steroidal Anti-Inflammatory drugs are also correlated with the appearance of peptic ulcer.

The most common symptomatology of peptic ulcer disease includes feelings of general malaise, vomiting and nausea, corrosive abdominal pain and weight loss.. Specific treatment becomes essential, as corrosive bleeding or gastric perforation are almost guaranteed complications if medical help is not obtained by the patient.

• You may be interested in "Is it true that we have a second brain in the 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 other deeper layers of the epithelium..

An example of this type of lesion is 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) indicates that until 2010 there were an average of 5,000 cases per year, and although today about half of these cases are registered, it continues to be a problem to be considered.

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

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

3. Corneal ulcers

This is one of the types of ulcers affecting 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 ocular pain in the patient, photophobia and a considerable decrease in visual capacity.

This type of lesion is associated with several infectious agents, such as Staphylococcus aureusbacteria 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 candidiasis..

Generally, these lesions are classified as acute or chronic depending on the length of time they remain in the patient.

Symptomatology includes 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 tissue there can be invasion

As we have seen, the presence of pathogenic microorganisms is clearly associated with the appearance of ulcerative processes. The epidermis and mucous membranes in contact with the environment are a breeding ground for a variety of harmful bacteria.As they grow on our tissues, they tend to release toxic metabolic compounds that destroy our cells.

Thus, we could spend days and days compartmentalizing the types of ulcers according to the tissue they affect, as we have named a few, but we have left out genital ulcers, rectal ulcers or vascular ulcers, for example. Some of them do not necessarily have to be associated with the presence of bacteria, since, for example, a lack of irrigation in a specific tissue and deficient tissue nutrition can cause local cell death.

What we want to emphasize in this space is the need to consult a medical professional when a gastric ulcer or the presence of an ulcerous lesion in a visible epithelial region is suspected. However "unserious" they may seem at first, these wounds are an open door to the entry of various harmful pathogens, which can complicate the patient's clinical picture very quickly. very quickly.

Bibliographic references:

• Ayala, A. E. 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. Medicina clínica, 125(15), 590-597.
• Mycobacterium ulcerans, World Health Organization. Retrieved August 23 from 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. Retrieved August 23 from https://medlineplus.gov/spanish/pepticulcer.html#cat_95.
• Vascular ulcers: treatment, ulcers.net. Retrieved August 23 from https://www.ulceras.net/monografico/106/94/ulceras-vasculares-tratamiento.html.