A recent study has found that eating chili dishes may give some protection against ulcers developing, and may help their healing.

Another study found a risk factor for ulcers was the number of years of smoking, but the number of cigarettes smoked was not so important. And, surprisingly, regular coffee drinking and moderate alcohol consumption reduced the risk of getting an ulcer.

The development of an ulcer worries many people, from factory workers to shop assistants or professionals.

You normally know something is wrong since ulcers typically produce a burning or gnawing pain. But sometimes there is only an ache or a vague pain. Discomfort frequently occurs at night and normally starts one and a half to three hours after eating. Eating a snack or antacids normally relieves the pain within a few minutes.

Peptic ulcer disease is likely to affect about 10 percent of Americans. This may involve either a gastric or a duodenal ulcer.

The age at which an ulcer first develops has been steadily increasing and nowadays the maximum risk is between the ages of 45 and 55. In developing countries, ulcers develop at a much earlier age.

These days men have a greater risk of getting an ulcer, although last century women had a higher risk. In Australia, Britain and the United States ulcers are more common in unskilled and semi-skilled workers than in professionals.

Our stomach consists of a muscular bag that holds food and helps its digestion. It contains gastric acid (dilute hydrochloric acid) produced by a series of chemical reactions called a “proton pump”. The acid not only helps kill any harmful organisms in food but also enables the enzyme pepsin to digest proteins since pepsin works only in an acid environment.

Fortunately, the acid doesn’t normally harm the stomach although the acid will attack throat tissues and the intestines. The stomach is protected by a lining called the mucosa. A healthy mucosa is unique among body tissues in that it is unaffected by the acid’s corrosive effect. It is made of a web of long gastric-gland tubes. These have a small opening (the gastric pit) at the top which releases both mucus and gastric acid. The mucus, in turn, protects the underlying mucosa from acid attack.

Damage to the mucosa enables an ulcer to develop but, unless the acid reaches very high levels, the amount of acid a person produces doesn’t increase the risk of an ulcer.

Doctors have revolutionized the treatment of ulcers over the past 20 years. Australian researchers discovered that the bacterium Helicobacter pylori damage the mucosa lining the stomach and the duodenum (the tube which takes food out of the stomach to the intestines). The bacteria live in the protect ed environment below the layer of mucus. Once the mucosa is damaged gastric acid and pepsin contribute to the ulcer’s growth. Acid-suppressing drugs will heal most ulcers within two months.

The bacteria combine with gastric acid to cause about 95 percent of duodenal ulcers and two-thirds of gastric ulcers. A minority view is that the bacteria do not initiate the damage to the mucosa, but only infect the area once it is damaged.

Non-steroidal anti-inflammatory drugs can also damage the mucosa. These, together with the acid, cause the one-third of gastric ulcers hot produced by the bacteria. These drugs include aspirin and other drugs used in the treatment of arthritis, muscle strains, and other problems. Smoking, stress, and anti-inflammatory drugs can increase the severity of any ulcer.

Drugs such as ranitidine (Zantac) taken daily with the evening meal will heal 95 percent of duodenal ulcers within eight weeks. Gastric ulcers usually take two weeks longer to heal than duodenal ulcers. About 10 percent of ulcers prove difficult to heal. The drug omeprazole (Losec) is usually effective in these more stubborn cases.

It is essential to eliminate the bacteria, otherwise, the ulcer is likely to recur within a year in 70 percent of cases. If the bacteria are eliminated, less than 5 percent of patients will get another ulcer. The presence of the bacteria also increases the risk of stomach cancer 4 times.

However, eliminating the bacteria is not easy. The two main methods both involve taking three drugs several times a day for one or two weeks. The most effective, (and expensive) treatment is called “Proton pump inhibition”. “Bismuth triple therapy” is cheaper but gives about one-third of patients troublesome side-effects. Either method will eliminate the bacteria in about 90 percent of cases.

In those cases where the treatment fails, a repeat course of the drugs is usually successful. The bacterial level should be checked one month after treatment.

A recently developed method involves drinking some radioactively labeled urea. The Helicobacter, if present, can generate carbon dioxide from the urea and so the breath is tested to see if radioactivity is present in exhaled carbon dioxide.

A bleeding ulcer is more serious. An adrenaline injection to the area may stop the bleeding or heat applied to the ulcer through an endoscope may seal it. A rapidly bleeding ulcer may need surgery.

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