Gastric Ulcer

D. Z. Epstein, M.D., Melbourne

In this modern age of speed, and "lack of time" to eat and masticate the food properly, the gastric and duodenal are among the most common disorders, affecting equally males and females, young and old, and even small children of few years of age.

The condition can be defined by the presence of a typical ulcer in the gastric mucous membranes and sometimes in deeper muscular coats of the stomach. The condition is characterised by the presence of severe pains after food, occasional haemorrhage.

What is the cause of this extremely common disorder? Unfortunately, in spite of its frequency and the amount of research done of the subject, there is no known and obvious reason to this complaint. One thing is always present - an abnormal quantity of strong digestive fluid called hydrochloric acid, normally always present in the stomach for digestion of food. But what causes this presence of increased quantity in the gastric juice?

Here different factors have been advocated by different doctors. There are some who maintain that improper diet has a great effect on the formation of the ulcer. Too much of food which is difficult to digest, or too spicy food, which excites the secretion of this juice. Others advocate that diet deficient in certain factors would produce ulcer. The absence of well-balanced diet with full ration of vitamins would do it. Others again blame alcohol for it, or tobacco, or continuous 'showers' with bacteria from infection teeth, tonsils or gall bladder. The theory however which has gained most support lately if that the complaint affects mostly so-called 'highly strung' people or people very emotional, with personality conflicts which possibly causes increased peristaltic movement and Increased secretion of gastric juices. If this factor alone is not the sole cause, it certainly is a contributor in conjunction with many other excesses or deficiencies of diet.

What are the symptoms and how can we recognise a case of gastric ulcer? This is not so very difficult. Almost no other condition will give us pains after we have eaten, when food enters the stomach, and cessation of pain when stomach is at rest. No other condition will give us present of blood in fairly frequent vomiting and presence of blood in defecation. However, if we have any doubt regarding the condition the determination of the quantity of gastric juices present in the stomach and x-ray will always be a sure sign which cannot be possibly mistaken with any other disorder.

If however somebody is still doubtful, with new procedure called gastroscopy we can look and, see directly inside the stomach. What is the treatment of the complaint? This is unfortunately not very satisfactory. Not knowing the cause the treatment will have to be undertaken to a certain extent by trial and error. However the basic principles which we always observe are physical and mental rest and peace. If there is no mental peace the movement of the stomach will be still violent and secretion of the gastric juices profuse. Then it would follow whole array of remedies to neutralise the excessive acidity of the stomach. Then of vital importance is the diet, which should be mind, so as not to irritate the ulcer and at the same time nutritious so as to supply all the proteins, fats and carbohydrates needed. Milk usually corresponds to this requirement. This diet should BE also supplemented by different vitamins and minerals.

Sometimes however the food causes too much pain to the patient, which no sedatives will relieve, then the patient has to be fed by a tube directly to the intestine, avoiding the 'sick' portion.

With all this treatment and especially with mental and physical peace, and correct diet, we can heel most of the leers with time, admitting however that a relapse can occur kith any return to excesses or 'worries'. The small proportion of cases which will not respond to prolonged treatment and will continue having severe pains or blood haemorrhages must eventually undergo a surgery where the whole ulcerated part will be dissected. Then only the patient will have peace. But even this treatment, if we want to avoid relapses, in other part of the stomach, should be followed by dietetic measures and above everything else by peaceful and happy mind.

In those cases if we could succeed in instilling in a patient a new way of living, a new philosophy, to replace his 'mad rushes' and emotional upsets with life's failures, we would make a tremendous step towards relieving this important and troublesome disorder.