Ulcers at the cardiac end of the stomach are rare; they are much more frequent in the region of the outlet of the stomach, the lesser curvature. As mentioned earlier, the first thing to occur is an irritation of the stomach lining. This irritation alone may cause some pain, but generally the patient ignores it and hence it goes untreated. When ‘hunger pains’ set in, which are so called because they characteristically appear when the stomach is empty and disappear when some food is ingested, the lining is already affected and there is a strong possibility that an ulcer is beginning to develop. The stomach wall, now no longer protected, is being eroded by the action of the gastric juice and it is this which causes the pain. Normally, the walls of the stomach are saved from self-digestion by a protective enzyme. If the mucous membrane of the stomach is already damaged, causing pain, the patient need only eat a little food and the discomfort will be relieved at once, because the gastric acid must now act on the food and is simultaneously absorbed by it.
A neglected ulcer, one that has not been treated, continues to grow and in time becomes a crater-like formation. Even though the wall of the stomach becomes thicker, the ulcer may eventually perforate it and allow the chyme to leak into the abdominal cavity.
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