The word Peptic originates from the Greek -Peptikos meaning related to digestion. An ulcer is a shallow "excavation" of tissue which is a result of the shedding of a surface layer due to inflammation of that tissue. So Peptic Ulcer is the general term for this type of lesion when it occurs in the part of the Gastrointestinal Tract involved in digestion – in particular the oesphagus, stomach and duodenum.

We know that ulcers of this kind are due to inflammation of the lining of the digestive tract. We know that the stomach produces acid to break down food but the lining seems to be used to exposure to acid. The role of the "digestive juices" was first described by an American Army Physician William Beaumont who studied a war veteran who had sustained a serious abdominal wound which left a hole in his abdomen through which the stomach lining could be observed. Beaumont noted the stomach lining flushed red when the man got upset. May be this is where the notion of stress causing ulcers comes from?

We know that excess acid production can produce ulcers as with a condition called Zollinger Ellison Syndrome. This is where there is a tumour produces abnormal amounts of "gastrin" (first identified in 1902) ,the messenger chemical (hormone) that kick starts the acid producing cells in response to food being present in the digestive system. This over production of Gastrin means excessive amounts of acid is produced and ulcers result. It is a rare condition.

The cause of the inflammation has been a controversial issue for many centuries. However the discovery in 1982 of a bacterium now called Helicobacter Pylori by an Australian doctor, Barry Marshall, has shown that many ulcers are actually caused by infection by this germ. Infact it is believed that 80 % of ulcers in the stomach and 90% of those in the duodenum are due to Helicobacter infection. (it is interesting to note that Dr Marshall’s discovery was not widely accepted in the medical community at first. He like many famous researchers of yester year ended up using himself as a guinea pig – he took a large dose of infected liquid himself to prove his point- there is a link to an article on him at the end of this piece)

We also know that ulcers may also be caused by long term use of some medications in susceptible people. In particular the non-steroidal anti-inflammatory family of medication and aspirin.

But we can now finally put to bed the old wives tales that stress and/or spicy food cause ulcers!

American figures estimate that 1 in 10 Americans will develop a peptic ulcer at some time in their life.

In Australia, as in Amercia,Helicobacter is thought to have infected around 30% of the population. It is more common in older people and in certain ethnic groups especially the Chinese, Japanese, Vietnamese.

Of course it is important to note that not all people infected will have an ulcer.

There is an increased risk of stomach cancer associated with Helicobacter infection.

The means of transmission of the germ is not precisely known. Some people believe its is acquired from food for water. Others suggest it could be passed in through Kissing –( woohoo a new STD ??? )

It is thought that an infection with Helicobacter causes the lining of the stomach to lose its protective coating that normally protects it from the burning effects of the acid. The germ is spiral in shape and is thought to burrow, like a cork screw, into a safe place in the lining where it thrives. However , it is an irritant to the lining and this together with the acid burns may result in inflammation and an ulcer.

Pain is the main symptom of peptic ulcer. Some may be describe it as chronic Indigestion – a gnawing pain just below the ribs in the upper middle part of the abdomen. However it must be remembered that this alone cannot male the diagnosis and all pains of this nature should be properly investigated by a doctor.

It may develop over days or weeks. It may get worse after a meal. There may be reflux of acid taste into the mouth or burping. It may also come on in the middle of the night and be relieved by eating.

Yes. It is possible that an ulcer can completely erode the stomach wall although this is not common any more with heightened awareness and good early treatment. Some ulcers may erode blood vessels and cause bleeding. This can be life threatening.

Some stomach ulcers can become malignant.

If you have had an ulcer it is always important to be followed up by a doctor to ensure healing and monitor for recurrence, especially in the case of stomach (gastric) ulcers.

These days Peptic Ulcer is usually diagnosed by endoscopy. A doctor passes a fibre optic tube down the patient’s throat into their stomach under light anaesthetic and has a good look around the upper gastrointestinal tract. A biopsy may be taken which is sent to the lab for identification of Helicobacter . Some doctors may refer patients for a special series of xrays before endoscopy – these require the patient to drink a dye ( barium) which coats the lining of the gastro intestinal tract before the xrays are taken.

However, patients can be tested for Helicobacter without going through this test. It is as simple as blowing up a balloon. The patient simply blows into a test tube before and after drinking a marker substance. The tubes are then sealed and sent to the lab for testing. 

Over the centuries there have been all sorts of remedies for indigestion and maladies of the digestive tract. It was discovered early on that milk seemed to improve symptoms. Then ant- acids, like bicarbonate of soda, were thought to do the trick.

Then surgery came into vogue. In the early part of this century it was discovered that a nerve ( the vagus nerve) was intimately involved in acid production. So the intrepid surgeons thought cutting this nerve would heal ulcers. This method was still in vogue in some centres when I was a student. There were also all sorts of fancy bypass techniques where part of the stomach would be removed and a loop of intestine be used to by pass the affected area. There were of course risks and side effects associated with these procedures.

However, in the last few decades there have been enormous leaps forward in the treatment of peptic ulcers with the coming of medications, like the so called "H2 antagonists" (like cimetadine and ranitidine ) which could interfere with and reduce acid production. These medications revolutionised ulcer treatment and meant much less invasive procedures were performed.

But nothing has been so enormous as the impact of the discovery of Helicobacter and the fact that Ulcers are now treated with Antibiotics !! Who ever would have thought? The regime is quite specific and involves a cocktail of three medications which need to be taken exactly as directed. It is believed that eradication of Helicobacter will allow the ulcers to heal and hopefully reduce recurrence. The patient will probably also take one of the acid-reducing H2 antagonists. Generally the patient will be recommended to have a follow up endoscopy with biopsy for helicobacter in 6 – 12 months . A repeat breath test is useful to prove eradication of the germ as well

This is controversial and each person needs to discuss this with his or her doctor. Some people believe that people without symptoms don’t need to be treated. People who have symptoms of ulcer but none can be found at endoscopy where tests reveal a Helicobacter infection are usually recommended to take treatment. The Jury is still largely out on the issue of what we call asymptomatic carriers.

I believe that if you have symptoms of peptic ulcer you should talk to your doctor about investigations including a Helicobacter Pylori Breath test – it can usually be done by your local pathology lab on referral from your GP. Please feel free to download this article and take it along to your GP

I have added some links you may find interesting :

http://msnbc.com/news/76191.asp A newspaper article about the discovery of Helicobacter

http://www.niddk.nih.gov/health/digest/pubs/diagtest/uppend.htm this page explains all about endoscopy

http://www.niddk.nih.gov/health/digest/pubs/diagtest/upgi.htm this page explains the special xrays sometimes ordered for investigation of peptic ulcer

http://www.niddk.nih.gov/health/digest/pubs/hpylori/hpylori.htm this page has more information about Helicobacter