A generalized irritation of the stomach is called gastritis; a localized injury that is irritated and inflamed is an ulcer. An ulcer contains dead or damaged tissue. The irritation can be due to infection or to chemical agents. Peptic ulcers include gastric ulcers in stomach and duodenal ulcers in the first part of small intestine (duodenum) immediately below the stomach. Peptic ulcers may return year after year, sometimes in the same place and in the same season.

Peptic gastritis and ulcers can cause a lot of distress, mostly pain after eating and in the middle of the night. Beyond that, they can cause life-threatening complications such as bleeding, perforation (an abnormal opening) with spreading infection throughout the abdomen, and obstruction so that food cannot pass through.

It was believed until recently, that these ulcers were due entirely to stomach acid and other digestive juices that had somehow penetrated the stomach's defenses. Certainly these chemicals have a lot to do with causing ulcers. But not long ago, a physician discovered a bacterium called Helicobacter pylori infecting these ulcers. After the initial skepticism that any germ could actually live in hydrochloric acid wore off, a revolution in treatment occurred that is still evolving. Now, in addition to controlling acid, patients may be given antibiotics to eliminate this infection.

Another major cause of peptic ulcers is pain medicines, specifically NSAIDs - non-steroidal anti-inflammatory drugs - such as ibuprofen and naproxen. These medicines promote ulcers in several ways. If patients have any tendency toward peptic disease, they should try to avoid them.

Mild symptoms that readily ease with antacids may require only a change of diet. Alcohol, tobacco, and caffeine are likely to worsen the disease. Very effective medicines are now available without a prescription. Drugs like Neoceptin-R, Proceptin, Pantobex etc. decrease acid production significantly. In addition, physicians are now being encouraged to detect and treat every ulcer patient for Helicobacter pylori so that the ulcer will be less likely to return. The patient should also consult the physician if symptoms persist, because an ulcer may be cancerous. Patients may be advised to have x-rays or a gastroscopy.

Ulcer surgery is a last resort, but an effective one. Medical treatment has become so effective in the last generation that it is harder and harder to find a surgeon with much ulcer experience.

Points to remember

• Ulcers are a common cause of indigestion
  
• They can lead to severe complications if not treated
  
• Many forms of treatment are effective, and some help to prevent recurrence