There is no clear ev­i­dence to sug­gest that the stress of mod­ern life, or a steady di­et of fast food, caus­es ul­cers in the stom­ach and small in­tes­tine, but they are nonethe­less com­mon. Pep­tic ul­cers are holes or breaks in the pro­tec­tive lin­ing of the duo­de­num (the up­per part of the small in­tes­tine) or the stom­ach-ar­eas that come in­to con­tact with stom­ach acids and en­zymes. Duo­de­nal ul­cers are more com­mon than stom­ach ul­cers. Com­par­a­tive­ly rare are esophageal ul­cers, which form in the esoph­a­gus or swal­low­ing tube, and are of­ten a re­sult of al­co­hol abuse.

Un­til the mid-1980s, the con­ven­tion­al wis­dom was that ul­cers form as a re­sult of stress, a ge­net­ic pre­dis­po­si­tion to ex­ces­sive stom­ach acid se­cre­tion, and poor con­sump­tion habits (in­clud­ing overindulging in rich and fat­ty foods, al­co­hol, caf­feine, and to­bac­co). It was be­lieved that such in­flu­ences con­tribute to a buildup of stom­ach acids that erode the pro­tec­tive lin­ing of the stom­ach, duo­de­num, or esoph­a­gus.

While ex­ces­sive stom­ach acid se­cre­tion cer­tain­ly plays a role in the de­vel­op­ment of ul­cers, a rel­a­tive­ly re­cent the­o­ry holds that bac­te­r­i­al in­fec­tion is the pri­ma­ry cause of pep­tic ul­cers. In­deed, re­search con­duct­ed since the mid-1980s has per­sua­sive­ly demon­strat­ed that the bac­teri­um He­li­cobac­ter py­lori (H. py­lori) is present in more than 90 per cent of duo­de­nal ul­cers, and about 80 per cent of stom­ach ul­cers.

Oth­er fac­tors al­so seem to con­tribute to ul­cer for­ma­tion. Overzeal­ous use of over-the-counter painkillers (such as as­pirin, ibupro­fen, and naprox­en), heavy al­co­hol use, and smok­ing, ex­ac­er­bate and may pro­mote the de­vel­op­ment of ul­cers. Re­search in­di­cates that heavy smok­ers are more prone to de­vel­op­ing duo­de­nal ul­cers than are non-smok­ers, that peo­ple who drink al­co­hol are more sus­cep­ti­ble to esophageal ul­cers, and that those who take as­pirin fre­quent­ly for a long pe­ri­od of time, are more like­ly to de­vel­op stom­ach ul­cers than those who don't.

Oth­er stud­ies show that stom­ach ul­cers are more like­ly to de­vel­op in el­der­ly peo­ple. This may be be­cause arthri­tis is preva­lent in the el­der­ly, and al­le­vi­at­ing arthri­tis pain can mean tak­ing dai­ly dos­es of as­pirin or ibupro­fen. An­oth­er con­tribut­ing fac­tor may be that with ad­vanc­ing age the py­lorus (the valve be­tween the stom­ach and duo­de­num) re­lax­es and al­lows ex­cess bile (a com­pound pro­duced in the liv­er to aid in di­ges­tion) to seep up in­to the stom­ach and erode the stom­ach lin­ing.

Al­so, for no known rea­son, peo­ple with type A blood are more like­ly to de­vel­op can­cer­ous stom­ach ul­cers. Duo­de­nal ul­cers tend to ap­pear in peo­ple with type O blood, pos­si­bly be­cause they do not pro­duce the sub­stance on the sur­face of blood cells that may pro­tect the lin­ing of the duo­de­num.

For­tu­nate­ly, pep­tic ul­cers are rel­a­tive­ly easy to treat; in many cas­es they are cured with an­tibi­otics, antacid, and oth­er drugs that re­duce the amount of acid pro­duced by the stom­ach. There are al­so a va­ri­ety of self-help and al­ter­na­tive treat­ments that can aid in re­liev­ing pain and in heal­ing ul­cers. Still, the dan­gers as­so­ci­at­ed with pep­tic ul­cers-such as ane­mia, pro­fuse bleed­ing, and stom­ach can­cer-are se­ri­ous, so ul­cers should al­ways be mon­i­tored by your doc­tor.

Symp­toms of ul­cers

The most com­mon symp­toms of pep­tic ul­cers are known col­lec­tive­ly as dys­pep­sia. Pep­tic ul­cers can oc­cur with­out dys­pep­sia or any gas­troin­testi­nal symp­toms, es­pe­cial­ly when caused by NSAids. Dys­pep­sia may be per­sis­tent or re­cur­rent and can en­com­pass a va­ri­ety of prob­lems in the up­per ab­domen, in­clud­ing the fol­low­ing:

• pain or dis­com­fort

• bloat­ing

• a feel­ing of full­ness. (Peo­ple with se­vere dys­pep­sia are un­able to drink as much wa­ter or oth­er bev­er­ages as peo­ple with mild or no dys­pep­sia.

• hunger and an emp­ty feel­ing in the stom­ach, of­ten one to three hours af­ter a meal.

• mild nau­sea. (Vom­it­ing, in fact, may re­lieve symp­toms.)

• re­gur­gi­ta­tion. (The sen­sa­tion of acid back­ing up in­to the throat.)

• belch­ing.

The pain of ul­cers can be ei­ther lo­calised in one place or dif­fuse. The pain has been de­scribed as burn­ing, gnaw­ing, or aching in the up­per ab­domen, or as a stab­bing pain pen­e­trat­ing through the width of the gut. The symp­toms may vary de­pend­ing on the lo­ca­tion of the ul­cer:

• Duo­de­nal ul­cers of­ten cause a gnaw­ing pain in the up­per stom­ach area sev­er­al hours af­ter a meal, and the pain is of­ten re­lieved by eat­ing a meal.

• Gas­tric ul­cers may cause a dull, aching pain, of­ten right af­ter a meal; eat­ing does not re­lieve the pain and may even wors­en it. Pain may al­so oc­cur at night. Ul­cer pain may be par­tic­u­lar­ly con­fus­ing or dis­con­cert­ing, since it may ra­di­ate to the back or to the chest be­hind the breast­bone. In such cas­es it can be con­fused with oth­er con­di­tions-even a heart at­tack.