A Review on Gastrointestinal Disease - Ulcer and its Treatment

Abstract

To enhance self-esteem and life skills, adolescent girls need to be empowered to resist social and family pressures. However, traditional dressings, due to their simple structure and single functionality, are inadequate for clinical needs. As a result, researchers have focused on advanced polymer dressings and hydrogels to address therapeutic challenges in ulcer treatment. Recent innovations, including self-healing hydrogels, stimuli-responsive hydrogels, nanocomposite hydrogels, bioactive hydrogels, and 3D-printed hydrogels, have shown greater therapeutic potential, leading to improved patient outcomes. This review highlights the importance of various hydrogels at different stages of wound healing in managing diabetic foot ulcers, emphasizing their role in advancing diabetic wound care through phase-specific and targeted approaches. Gastric ulcers extend into the muscularis propria layer of the gastric epithelium, commonly occurring in the stomach and proximal duodenum, though they may also appear in the lower esophagus, distal duodenum, or jejunum. Patients with gastric ulcers usually experience epigastric pain within 15–30 minutes after a meal, whereas duodenal ulcers are typically painful 2–3 hours post prandially.High blood glucose is a hallmark of diabetes, a chronic metabolic disease. Diabetic foot ulcers are significant complications of diabetes mellitus, associated with high morbidity, mortality, and healthcare costs. These ulcers are often infected, with the risk of progressing to cellulitis, bloodstream infections, gangrene, or even amputation. Enhancing the health of patients with diabetic foot ulcers requires knowledge of current treatment options and the limitations of these therapies. Chronic and complex ulcers in the lower limbs are frequent, persistent, and clinically significant complications, especially in patients with diabetes, peripheral vascular disease, or dermatological conditions. These lesions are marked by delayed healing, high recurrence rates, and significant risk of infection, amputation, and functional decline, placing a substantial burden on both patients and healthcare systems. Inresponse, recombinant human epidermal growth factor (rhEGF) has emerged as a novel and effective therapeutic strategy.

Introduction

1. Complex Ulcers: Definition and Characteristics

• Complex ulcers are chronic wounds that do not heal within 3 months and are often associated with systemic conditions such as diabetes, vascular diseases, or infections.

• They often involve necrosis, poor circulation, and reduced tissue viability, leading to pain, disability, and reduced quality of life.

2. Causes and Risk Factors

• Common causes include:

  • Diabetes mellitus

  • Obesity

  • Peripheral vascular disease

  • Cancer

  • Organ failure

  • Immune dysfunction

  • Infection

  • Poor mobility

• Types of complex ulcers: diabetic foot ulcers, venous/arterial ulcers, pressure ulcers, burns, necrotizing fasciitis, etc.

3. Global Impact and Epidemiology

• Affect ~1% of adults, 3.6% of people over 65, and >5% of those over 80.

• Lifetime risk: ~10%; ulcer-related mortality ~2.5%.

• In the U.S., 7 million suffer from hard-to-heal ulcers, with only half receiving proper care.

• Annual cost exceeds $20 trillion globally.

• Amputation risk: 30% in untreated cases; 50% mortality within 5 years post-amputation.

• During COVID-19, amputations rose by 50% in 2020.

4. Diabetic Foot Ulcers

• A major subtype of complex ulcers.

• 25% of diabetics develop foot ulcers; 15% of these require amputation.

• Diabetes is globally prevalent: 6.3% overall, with the highest in North America (13%).

• Driven by sedentary lifestyles and poor diet, especially in Asia.

5. Peptic Ulcers

• Two types: gastric and duodenal ulcers.

• Common in older adults (55–65 years).

• Caused mainly by H. pylori infection, NSAIDs, and excess stomach acid.

• Affect ~5 million people in the U.S.; 35% of gastric ulcers cause severe complications.

6. Causes of Ulcers (General)

• Infection (e.g., H. pylori)

• Excess acid production

• Long-term use of NSAIDs or corticosteroids

• Poor circulation (ischemia)

• Diabetes

• Smoking, alcohol

• Autoimmune disorders, trauma, cancer

• Nutritional deficiencies (e.g., protein, zinc, vitamin C)

7. Ulcer Treatments

???? General Principles

• Promote healing, prevent complications, and treat underlying causes (e.g., infection, poor circulation, diabetes).

???? By Ulcer Type:

• Peptic Ulcers: PPIs (e.g., omeprazole), antibiotics for H. pylori, avoid NSAIDs, manage stress.

• Venous Leg Ulcers: Compression therapy, wound care, sometimes surgery.

• Diabetic Foot Ulcers: Blood sugar control, offloading pressure, advanced dressings, antibiotics, possible surgery.

• Pressure Ulcers: Relieve pressure, good nutrition, wound management, infection treatment.

8. Advanced & Supportive Therapies

• Negative Pressure Wound Therapy (NPWT): Enhances healing via vacuum-assisted closure.

• Hyperbaric Oxygen Therapy (HBOT): Increases oxygenation in tissue.

• Innovative Biomaterials:

  • Hydrogels (e.g., self-healing, 3D-printed, bioactive)

  • Natural polymers (chitosan, cellulose, hyaluronic acid)

  • Synthetic polymers (PEG, PAA, polyacrylamide)

• Emerging treatments show promise in diabetic wound care and regenerative healing.

9. Natural Remedies for Peptic Ulcers

• Supportive only (not standalone treatment)

• Examples:

  • Probiotics – gut health, H. pylori management

  • Honey, licorice root (DGL) – healing & protective

  • Garlic, turmeric, ginger, aloe vera, cabbage juice, green tea – anti-inflammatory, antimicrobial

10. Research Gaps & Future Directions

• Need for:

  • Standardized clinical endpoints in trials.

  • Better biomaterial delivery systems (e.g., smart hydrogels, nanoparticles).

  • Biomarker-based personalization of treatments.

  • Large animal models to bridge lab to clinical practice.

  • Combined strategies (e.g., scaffolds + growth factors + cells) in rigorous trials.

  • Cost-effectiveness studies across healthcare settings.

Conclusion

The pathophysiology of chronic ulcers, developments in molecular biology and technology, and the desire to find early indicators of delayed healing have all contributed to the creation of a variety of cutting-edge modalities that may have a beneficial impact on the molecular processes underlying epithelialization. Among these is the application of EGF, which has been researched for more than 45 years. In comparison to other application techniques, its intra- and perilesional application gives the molecule more stability, improves its bioavailability in the wound, avoids denaturation, and produces more notable outcomes. It has shown great promise as an adjuvant therapy to shorten the healing period of chronic lesions in studies and a growing body of literature around the world. Intralesional administration has demonstrated high rates of epithelialization and granulation, which increases its bioavailability and effectiveness in the treatment of chronic ailments.

References

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Copyright

Copyright © 2025 Pise Atharv Santosh, Gaikwad Arindar Amarsen, Sawant Nishant Vilasrao. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.