An ulcer is described simply as a painful sore on skin surface or lining of internal organs. Peptic ulcers refers to any ulcer that affect the stomach, duodenum and sometimes the esophagus. Stomach ulcers are called gastric ulcers while ulcers in the duodenum (the first part of the small intestine) are called duodenal ulcers. Those that occur in the esophagus are referred to as esophageal ulcers.
Before the 20th century, peptic ulcer disease (PUD) had a tremendous effect on morbidity and mortality rates, but towards the last decades of the 20th century, epidemiological studies started showing a great decline in the incidence of peptic ulcer disease. The reason being that, new effective medications and acid suppressants were discovered, as well as the discovery of the actual causes of the disease, which made treatment easier and more effective.
Peptic ulcer disease is a widespread problem among different populations and there has been a lot of misconceptions about it in it’s etiology and treatment especially by the majority of the uninformed population in Third World countries.
Common Misconception About Peptic Ulcer Disease
In the past, and as some still do today, it was thought that our food (especially spicy foods) is the cause of ulcers. Others also regard “not eating” as the cause of developing ulcer. We know today that these are not true but erroneous misconceptions that people have. Although the food we eat do not cause or cure ulcers, a good diet will benefit your gastrointestinal tract and general health.
What Actually Causes Peptic Ulcer?
Mucosal injury or peptic ulcers occur when the balance between the aggressive factors in the gastrointestinal tract and the defensive mechanism of the gastrointestinal tract is disrupted. Aggressive factors such as gastric acid, pepsin, drugs, bacteria and bile salts can alter the defence mechanism by allowing back diffusion of hydrogen ions which subsequently causes epithelial cell injury in the stomach, duodenum or esophagus. Bacteria (Helicobacter pylori) is the most common cause of all peptic ulcer disease. This bacteria can colonise the stomach for a very long time and survive despite the highly acidic environment of the stomach and duodenum and cause inflammation of the lining of the mucosa which then results in an ulcer.
How the Body Naturally Protects Against Ulcer
Under normal conditions, a physiological balance exists between gastric acid secretion and gastroduodenal mucosal defence. The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of the epithelial lining and cholinergic stimulation. This mucus makes the superficial portion of the stomach and duodenal lining have a gel layer that is impermeable to gastric acid or pepsin which can erode the epithelium and cause ulcers.
In addition, there are special cells in the stomach and duodenum that secrete bicarbonate which is alkaline in nature to buffer or neutralise the gastric acid that lies near the surface of the stomach and duodenal mucosal; hence, protecting the epithelial lining from acidic erosion and ulcers.
Prostaglandin E (a chemical produced by the body) also plays an important role in the protection of the stomach and duodenum against ulcer occurence. It is this prostaglandin E that plays an important role in the production of bicarbonate by the cells of the stomach and duodenum, and it also it also increases the formation of the mucus layer of the stomach and duodenal lining.
Any factor that interferes with any of these natural defence mechanism of the body against the acidic corrosion of the gastrointestinal tract will eventually predispose the individual to develop any of the peptic ulcer disease. The general causative factors for peptic ulcer disease include:
- Bacteria (Helicobacter Pylori) colonisation of the stomach
- Use of non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, diclofenac and naproxen.
- Smoking and alcohol intake
- Hypersecretory disorders of gastric acid (Zollinger-Ellison Syndrome)