A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. An ulcer occurs when the lining of these organs, normally protected by a thick mucus layer, is corroded by the acidic digestive juices which are secreted by the stomach cells. Peptic ulcer disease is common, affecting millions of Americans yearly.

For many years excess acid was believed to be the major cause of ulcer disease. Accordingly, treatment emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called Helicobacter pylori (H. pylori).

H. pylori is very common, infecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. While the mechanism of how H. pylori causes ulcers is not well understood, its elimination by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence.

Although H. pylori is often the cause of inflammation and ulceration, research had uncovered that when stomach pH is higher, other microorganisms besides H. pylori overgrow causing inflammation, gastritis and ulceration also. These include Lactobacillus, Enterobacter, Staphylococcus and Probionibacterium. [Gastroenterology, Jan 2002]

A slight reduction in stomach acid may result in the overgrowth of H. pylori, while lack of stomach acid can result in the overgrowth of other organisms. Good acid production is necessary for killing microorganisms; poor acid production or acid neutralization with antacids contributes to overgrowth. If H. pylori is already causing problems, acid neutralization may reduce overgrowth and symptoms but chronic use can contribute to the overgrowth of other organisms, flourishing at the higher pH, causing similar symptoms to return.

Symptoms of ulcer disease are variable. Many ulcer patients experience minimal indigestion or no discomfort at all. Some report upper abdominal burning or hunger pain one to three hours after meals and in the middle of the night. These pain symptoms are often promptly relieved by food or antacids. The pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Some patients have persistent pain even after an ulcer is completely healed by medication. Others experience no pain at all, even though ulcers return. Ulcers often come and go spontaneously without the individual ever knowing, unless a serious complication such as bleeding or perforation occurs.

The diagnosis of an ulcer is made by either a barium upper GI x-ray or an upper endoscopy (EGD - esophagogastroduodenoscopy). The barium upper GI x-ray is easy to perform and involves no risk or discomfort. Barium is a chalky substance administered orally. Barium is visible in x-rays, and outlines the stomach on x-ray film. However, barium x-rays are less accurate and may not detect ulcers up to 20% of the time.

An upper endoscopy is more accurate, but involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the stomach, esophagus, and duodenum. Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection. Biopsies can also be examined under a microscope to exclude cancer. While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous and for this reason biopsies are often performed.

Many doctors are successfully treating ulcers without the use of antacids and often these natural methods work whether or not the issue of H. pylori infection is directly addressed.