Ulcer is an open sore in the mucous membrane. As the ulcer develops, part of the tissue breaks down and dies, leaving raw, inflamed area that heals slowly. Peptic ulcers occur in the digestive system. There are two main types: duodenal ulcers form in the duodenum, the upper part of the small intestine. Gastric ulcers form in the stomach. During digestion, the stomach. During digestion, the stomach produces hydrochloric acid and an enzyme called pepsin. These powerful digestive juices can eat through the lining of the stomach and duodenum. Formally, mucous secretions protect the stomach and duodenum from the effect of digestive juices. Duodenal ulcers result from an overproduction of hydrochloric acid and pepsin. Gastric ulcers are supposed to result from a weakening of the stomach’s defence against the two digestive juices.

The development of peptic ulcers is influenced by factors such as stress and the use of tobacco both of which stimulate acid production. Overuse of aspirin also promotes the formation of ulcers by irritating the stomach lining. Most peptic ulcers cause pain in the upper part of the stomach. The pain usually occurs when the stomach is empty, either between meals or at night. Antacid medications relieve the pain temporarily by neutralising these stomach acids. Peptic ulcers can lead to complications like blockage of the stomach, or duodenum, internal bleeding and perforation of the stomach wall, most of these conditions require surgery.

Peptic Ulcer

A dear relative, uncle Shri Basantlal Sharma died of peptic ulcer at the age of 71. Apparently, he was in good health but underwent severe mental tension for several decades. His printing press business was not doing well, he had to find money to construct a house, get the daughters married and maintain a suitable lifestyle. He had a few attacks of peptic ulcer which were cured in 2-3 weeks time.

He developed a confidence that he knew more than the doctor about his disease and could cure it with his diet and homeopathic pills. He was a heavy smoker, drank many cups of hot tea every day, and boasted that he ate chillies and pickles. One day after a good marriage feast he drank glasses of an appetiser made of boiled raw mangoes. He developed discomfort just after the meal and he was in agony the time he reached home. He was a strong willed person and could bear pain. His condition continued to deteriorate. His pulse grew feeble, his blood pressure was hardly recordable and he became semi-conscious. He was taken to hospital and was diagnosed as having a perforated bleeding peptic ulcer.

Blood transfusion was started and he was advised immediate operation. But it was all too late, he died before reaching the operation theatre. If he had been more careful he could have been saved and made this world more colourful for us. Before 900 B.C. peptic ulcer was an uncommon disease. Today it is so common it may be related to tension and result-oriented life. Are stomach and mind inter-dependent? Quite a few people say that the condition of the mind depends on the type of food, but it is disputable.

The mind condition definitely affects the stomach, if you are morose your appetite disappears, if worried and tense the stomach secretes more acids and cause peptic ulcer. There may be a burning pain in the tummy if exams are approaching. If you are a dynamic man, full of responsibility and result oriented you are an easy target. Competitiveness produces pain in the stomach. "keKeep your mind cool" if you want to head for the 21st century fats without getting pangs in the stomach.

It was not easy to believe that the mind and the stomach being so far away from each other, still the mind can affect the stomach. It is true that stomach is affected by what man thinks. The braain, through the nervous system, controls the activity of these stomach. When angry or worried the stomach secrets more gastric juices containing hydrochloric acid and pepcin. When these juices are more than required to digestthe food it breaks the lining of stomach or duodenum and cause indigestion and abdominal pain. 25% of all men and 17% of women in today’s affluent society suffer from peptic ulcer. This disease makes you suffer but does not kill. Duodenal ulcer is more common in men, 3 times more often than in women. Gastric ulcer is in women twice more common than in men. Duodenal ulcer commonly attacks between the age of 25 to 55 years (the peak occurs at the age of 40). The gastric ulcer is common between 40 and 70 years (peaks around 50). There may be a vague dull pain in the upper part of abdomen with little burning sensation. It could sometimes be felt in the lower part of the abdomen or chest. Generally in duodenal ulcer the pain comes half an hour to 3 hours after a meal. You get relief taking food, vomiting or swallowing antacids.

It usually comes for 2-3 weeks and then is relieved for 2-3 months or even a year. As vomiting relieves pain, some patients learn to initiate vomiting knowingly. There may be flatulence, loss of weight and heart burn. Sometimes this pain could be confused with angina (heart pain). The stomach is flexible, it can stretch like a bladder. When you overeat, it stretches and this stretch stimulates the stomach to secrete more gastric juices. To avoid peptic ulcer you must not overeat. Why are peptic ulcers more common in the South an in the North? In South India, people are fond of chillies and the staple diet is rice. In the North, the intake of chillies is less and the staple diet is wheat. It is known that people in Africa and India who in general eat more roughage food get fewer ulcers than Europeans and Americans.

Chillies will irritate and stimulate the stomach and more gastric juices will be secreted. As a rice eater the consumption of fibre is less. There is more susceptibility to peptic ulcer. Wheat especially with its bran is protective against peptic ulcer.Hurry, worry and curry supported by oevereating and less fibre in the diet can make you a target for not a deadly disease but prolonged agonising peptic ulcer. Excessive alcohol, tea or coffee, tobacco, drugs like aspirin and cortisone cause gastritis and later peptic ulcer.

When the cause is removed, dietary or mental, the ulcers heal quickly. If this continues for a long time or is repeated continuously the ulcer will become chronic. Gastric and duodenal ulcers are different in many ways. In the gastric ulcer, gastric juices are secreted in less quantities. In duodenal ulcer there is more secretion. There is danger of getting cancer of stomach in later years with gastric ulcer, but there is no such chance with duodenal ulcer. In one study it was found that two patients developed ulcers during a period of severe emotional stress. Peptic ulcer may not be primarily due to such apparent causes like diet, genetics or occupational hazards. They may be merely non-specific stress effects of attempting to endure more than we can. Instead of complicated drug therapies or surgical operations, we can . Instead of complicated drug therapies or surgical operations, we can often help ourselves better by identifying the decisive cause, which may be a member of the family, the boss, or merely our emphasis on the importance of being right every time.

The stress of frustration and psychic insults are too much for a man to bear. Here are few hints to save yourself from stress and peptic ulcer:

1. Even if you systematically want to bestow love, do not waste time trying to befriend a mad dog.
   
   
   
2. Admit there is no perfection, but in each category of achievement something is tops. Be satisfied to strive for that.
   
   
   
3. Whatever situation you meet in life, consider first whether it is worth fighting for.
   
   
   
4. Try to keep your mind on the pleasant aspect of life and on action which can improve your situation.
   
   
   
5. Try to forget everything that is irrevocably ugly or painful.
   
   
   
6. Do not underestimate the delight of real simplicity in your life style. Pompous artificiality earns dislikes.

Peptic ulcer is a disease of the rich middle class or upper class as big money and tension go together. It is common in metropolitan cities. In a slow moving, sleepy inhabitation of a hilly district or a remote village the incidence is much less.

Many members of the same family suffer from acidity? Why? Is the genetic factor responsible? Do we inherit the disease from parents? It is likely that may be the food habits and emotional behaviour are the same in "ulcer families".

It is more common if you have the blood group "O". It is also associated with respiratory diseases. Ulcers can be big or small as small as a few millimeters or as big as 10 cm. Gastric ulcer generally develops on the lesser curvature of the stomach and the duodenal ulcer at the beginning of duodenum called duodenal cap. The ulcer at the beginning of duodenum called duodenal cap. The depth of the ulcer can also vary. It may be superficial or deep. There is always fibrosis alongwith the ulcer and it could be quite a bit more if the ulcer has been there for a long time.

If you have a strong immune system or a superior body healthwise, the chances of ulcer are less. The damage to the stomach will depend upon how many bouts of the disease you have had. Every bout leaves the stomach damaged. Later, with increased attacks there will be damage in terms of thickened,wall, reduced churning movements of stomach, anaemia and B-complex deficiency due to defective absorption by the stomach wall.

Diet – No specific diet has been proved beneficial in ulcer therapy. A patient can be his own best guide: avoid any food which causes discomfort. Avoid fried and spicy food because they lead to excessive secretion.of gastric juices. Lots of salads and vegetables with their peel on may irritate the tummy. Food should be non-irritating. Chew it well before eating. A milk diet is often recommended to ulcer patients, it stimulates acid secretion. It should be taken in moderation between meals or bed time. Keep the stomach light. Eat as often as you can. Steaming hot drinks are not recommended for those having peptic ulcers. A hot cup of tea has been described as a health hazard by medial researchers.

Two surgeons at the Manchester Royal Infirmary believe that they have established a link between preference for a very hot drink and peptic ulcer. Doctors Rosy Mccloy and Robert Pearson made their discovery by monitoring the temperatures of food and drinks consumed by ulcer sufferers and comparing them with normal patients. Doctor Mccloy said "our research has already shown a significant link between hot drinks and ulcer". The doctors found some patients liked their tea or coffee steaming at 70 centigrade. "Well if you stepped into a bath with water with that temperature you would jump out pretty quickly. Water with that temperature you would jump out pretty quickly. It would scald you", they added.

Smoking: There could be many reasons why you should not smoke. It is very encouraging to know that ulcers heal faster in persons who do not smoke. Smoking is more common in patients with ulcers. Stronger cigarettes cause more acidity. Death comes early for peptic ulcer patients who smoke rather than those who do not.

Alcohol & Caffeine: You may get nausea, vomiting, blood in vomit or stool, hours after taking alcohol, painkiller drugs or eating a lot of chillies. Alcohol and caffeine increase gastric secretion and damage the gastric mucus, and may be the causative factor if used excessively. Research in United States has shown that students who drank more coffee got ulcers later in life, though drinking milk seemed to counter them.

Painkillers: Aspirin, non-steroidal anti-inflammatory drugs, cortisones can produce gastric ulcer. The aspirin and anti-inflammatory drugs cause superficial mucosal erosion in the stomach. They cause chronic gastric disturbance, common in patients taking large doses of aspirin for a long time. They help in the deterioration of the duodenal wall also. A few studies, especially with cortisone, have concluded that peptic ulcer is more common where steroids are used as long-term therapy. If you are suffering from gastric or duodenal ulcer you are advised not to take these drugs.

Investigations

Barium meal X-ray: A radio opaque dye is drunk by the patient and then X-rays taken of the stomach. To find the ulcer many X-rays, from different angles will be required. X-rays may show 30-40% of duodenal ulcers.

Endoscopy: Here a long flexible tube is inserted through the mouth into the stomach to directly visualise the ulcer, and in case of doubt a small piece of mucosa can be punched out for pathological examination.

Stool and Blood: A stool test can be done for occult blood and also a blood test for anaemia and raised ESR.

Acid Secretion Studies: Gastric secretion of the stomach is aspirates and the quality of acid in gastric juice is detected. This test is not much useful as a normal person can show the same percentage.

Rest: Physical and mental rest is important. Take rest away from home, possibly on a health farm. It will take you out from the tense atmosphere of your business and family.

A physician teaches relaxation technique to his ulcer patients successfully. He asks them to learn to concentrate on their palms. Once you have mastered the technique you can relieve stomach pain by concentrating on your palms.

Good quality sleep will be of great help. Use relaxation technique before going to bed. Quite a few people derive relief from water treatment. It helps the body to relax and induces good quality sleep. If you have a severe pain, the diet should be bland. An ample supply of milk at regular intervals is of some help.

Fasting is useful for patients with peptic ulcer. When you fast, the first two or three days are bad, as the stomach expects food at meal times and excretes more gastric juices. In two or three days when you do not eat at all the stomach stops secreting gastric juices or it reduces them to a great extent. The pain in the stomach is reduced and of course, when you fast the healing of the ulcer is the fastest. After 7-10 days of fast the patient can be brought gradually on a bland diet.

Patients are given anti-spasmodic drugs to relieve stomach pain but there is no evidence that they increase the rate of healing. It takes a few days after hospitalisation for relief to start. If you are not improving after being put on bland diet, the physician will suspect that you are not taking enough rest and may be smoking on the quiet.

The relaxation technique and water treatment added to your routine will help shorten the period of healing. A good supply of citrus fruit juices will help, but make sure they are sweet ones. They supply vitamin C which helps the ulcer to heal faster. The ulcer takes time to heal and it may require six weeks or more.

Several drugs are used to relieve pain caused by peptic ulcer. It has been that the pain is relieved by drugs as well as placebos (tablets with no medicinal value). This will indicate that your mental faculty plays a great role in bringing about relief in peptic ulcers.

Drugs

Antacids – These drugs neutralize the acid in the stomach. They react with hydrochloric acid and turn them in salt and water and thereby reduce gastric acidity.

Sodium bicarbonate and Calcium carbonate: Their duration of action is short, they are not recommended for long term use. If taken in large doses, they produce an undesirable effect. A combination of a large amount of milk and antacids may cause kidney damage, alkalosis and sodium retention. Magnesium and aluminium hydroxide are drugs commonly used. They are taken in the form of a white liquid or chewable tablets. Magnesium hydroxide causes diarrhoea and aluminium hydroxide causes constipation. They both may result in loss of tste for food. They are effective only if taken 7 times a day and may be not convenient for many patients as they cause inhibition of acid secretion. It may cause mental confusion (especially in elderly) gynecomastia and impotence. If taken for a long time they may increase the risk of developing cancer of the stomach.

Carbonoxolone Sodium (Biogastrone) has anti-inflammatory quality and helps in healing ulcers. Sodium retention can cause swelling. It is dangerous to take this drug if you have a heart problem. It causes loss of potassium, due to which you may have fatigue. Occasionally causes muscle paralysis due to excessive loss of potassium salt. In the case of the patient who can rest and take a proper diet, biogastrone has hardly any role as it does not increase the speed of healing.

It is always better to dwell deep to find out what has caused the disease and find a permanent cure. It is better to avoid drugs because of the side effects. In fact, drugs do not improve the situation where as change in life style can bring a permanent cure.

Peptic Ulcer: Health Farming
When you suffer from a peptic ulcer stop chewing tobacco or smoking. Ulcers heal faster when you give up tobacco. Do not take alcohol, it irritates and causes more acid secretion. Stop tea and coffee. Nicotine and caffeine stimulate gastric secretion. If you have tea, take it weak and not steaming hot. Sugar and sweets stimulate acid secretion. Stop sugar completely. If you cannot, cut down as much as possible. Avoid spicy, fried food.

Milk, cream, butter and ghee are good. They help to fight acidity and keep you free of pain for many hours. When pain is severe take more frequent meals, every hour or two hours. When food is repeated frequently all gastric juices are utilised to digest the food, so there is no gastric juice available to irritate the wound and it will heal fast. Drink plenty of water alteast 1 ? litres per day but preferably not with the meal, half an hour before or one hour after the meal. Water will dilute the gastric juices and reduce irritation.

Avoid pain killers, aspirins and antiinflammatory drugs. Do not take cortisone or steroids. They may cause bleeding ulcers. When pain is too acute you may bleed from the ulcers. The blood vomited will be back and will contain blood clots not fresh blood as comes from the throat or lungs. If bleeding is too much you will need immediate hospitalisation and blood replacement or even surgery if blood does not stop. Stools may be black due to the blood in it.

If the pain is too much, all foods will be repelled by the stomach, at such time it is better not to eat anything. Have cold water or soda water. If water is still not retained by the stomach give water by enema. Water can be absorbed from the intestine and thus save the body from dehydration. In some cases a short fast of 7-10 days may be tired. The pain subsides after 3-4 days of fasting. Then you can go on milk diet starting from ? litre and gradually increasing it upto 4--5 litres a day. Take it every hour in divided doses starting from 7 in the morning till 7 in the evening. Take plain water enema if constipated. This can be continued for 30-40 days and then gradually start adding fruits and fruit juices, soups, boiled vegetables and raw vegetables juices. In many cases we can do without a milk diet.

Start with easily digestible and soft food and more fibre food. In the beginning the food given should be easily digestible. We can soak 50 gms. of resins in water for 12 hours and then crush them in the same water, filter and drink it. In the beginning instead of vegetable soup give only the water of boiled vegetable. Later as digestion improves crush the vegetables also and make a proper soup. When eating fruits which are hard, chew them well, suck all the juice and throw away the roughage.

After an attack of peptic ulcer the body has more acidic tendency, so we should have more alkaline foods like vegetables, fruits and salads. But make sure they are not sour and not very rough as this may irritate the wound. Health farm experts prescribe juices of raw vegetables like cucumber, cabbage or white pumpkin. Juices are useful, later the stomach can tolerate sour fruits. Coconut water and tender soft coconut are recommended. If nothing else is available eat a ripe banana or a coconut which can make a perfect meal.

Avoid salty foods and meat. Take Chapati made of whole wheat flour, do not seive the flour. Fibre in the flour is useful. Chew the chapati well before swallowing, preferably eat the chapati and vegetables separately so that you can chew them well. Eat small quantity of food. If you eat too much, the wall of the stomach gets stretched and this stretch stimulates acid secretion.

Rest helps the ulcer to heal faster. Take complete rest for a few days, till the pain is relieved. Better go to a health farm away from your home atmosphere, where you can have better control on food and be away from tension.

Good sleep is important. If you have pin in the stomach and you sleep, the pain subsides. For breakfast take ripe bananas and milk, chapati, boiled vegetables for lunch and dinner. A glass of orange or sweet lime juice in the afternoon. Make sure that they are sweet. Vitamin C contained in citrus fruits helps. Take a cup of milk whenever you are in pain. Eat sweet fruits like papaya, pears, apples, mangoes etc., in between.

Take a hip bath for 10-15 minutes in summer or 1-2 minutes in winter or take a cold water ablution on your tummy for 1-2 minutes and go for a walk or do exercise in the open. If you are weak, do light exercise or walking, if you are strong you can jog or do a vigorous exercise.

Take a cold pack on the tummy for forty-five minutes in the afternoon or in the night, an hour after meals. A sauna or steam bath once a week is good to tone up the body. Relaxation plays a great role. Learn to concentrate on your palms. You can master it in few weeks. Whenever you have pain in the tummy, concentrate on the palms for relief.