ulcer

An ulcer is a local defect resulting from the loss of surface tissue, leaving a crater-like lesion that extends through the epithelial layer and into deeper tissues. Ulcers can involve mucosal surfaces anywhere in the body or the skin, and they are distinguished from simple erosions by their depth and tissue loss.

In the gastrointestinal tract, peptic ulcers occur in the stomach or duodenum. Most are associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs, with other factors such as smoking, stress, and gastritis contributing in some cases. Gastric ulcers and duodenal ulcers present with abdominal pain or indigestion and may cause bleeding or perforation if complicated.

Skin ulcers include pressure ulcers from prolonged pressure over bony prominences, venous ulcers from chronic venous insufficiency, and arterial ulcers from inadequate blood supply. Diabetic patients may develop neuropathic foot ulcers. Ulcers in the mouth, genital tract, or other mucosal surfaces also occur and can reflect local irritation, infection, or systemic disease.

Diagnosis involves a clinical assessment complemented by targeted investigations. Gastrointestinal ulcers may require endoscopy with biopsy to exclude cancer, assess healing, and test for H. pylori. Skin ulcers are evaluated by wound examination, vascular studies if indicated, and monitoring for infection or edema.

Treatment targets the underlying cause and the local wound. Gastrointestinal ulcers are managed with eradication of H. pylori when present, reduction or avoidance of NSAIDs, acid-suppressive therapy, and treatment of complications. Skin ulcers require appropriate wound care, management of edema or venous insufficiency, pressure relief for ulcers due to immobility, infection control, and addressing comorbid conditions.

Prognosis varies with cause and location; many ulcers heal with appropriate therapy, though recurrence can occur, particularly in peptic and vascular-related ulcers. Prevention focuses on risk factor modification, infection management, and regular wound care for at-risk individuals.