Prevention of Gastric Ulcers

Abstract

Upper gastrointestinal tract integrity is dependent upon the delicate balance between naturally occurring protective factors as mucus or prostaglandins and damaging factors as hydrochloric acid present normally in the digestive juices. An imbalance causes peptic ulcer formation and destruction of gastrointestinal tract mucosal lining. Ulcer may develop in the esophagus, stomach, duodenum or other areas of elementary canal. In women, gastric ulcers are more common than duodenal ulcers, while in men the opposite is true. The ulcer irritates surrounding nerves and causes a considerable amount of pain. Obstruction of the gastrointestinal tract may occur as a result of spasm or edema in the affected area. The ulcer may also cause the erosion of major blood vessels leading to hemorrhage, hematemesis and/or melena. Deep erosion of the wall of the stomach or the intestine may cause perforation and peritonitis, which is a life-threatening condition needing emergency intervention. Duodenal ulcers are almost always benign but stomach ulcers may turn malignant. Although mortality rates of peptic ulcer are low, the high prevalence of the disease, the accompanying pain and its complications are very costly. The ongoing rapidly expanding research in this field provides evidence suggesting that, with therapeutic and dietetic advances, gastric ulcer may become preventable within the next decade. This could be achieved by strengthening the defense mechanisms of the gastric mucosa and, in parallel, limiting the aggression of predisposing factors causing gastric ulceration. The defenses of the gastric mucosa are incredibly efficient under normal mechanical, thermal or chemical conditions. These defenses can endure insults from food, gastric enzymes and acid secretion. Even trauma caused by a biopsy wound is dealt with and can heal relatively fast, within hours. However, under certain condition, some risk factors may contribute to mucosal injury and initiation of gastric ulcer, as psychological stress, increased hydrochloric acid secretion, Zollinger Ellison syndrome and family history of gastric ulcer. Conditions associated with increased risk of gastric ulcer include also chronic disorders as liver cirrhosis, chronic obstructive pulmonary disease, renal failure, organ transplantation and rheumatoid arthritis. In addition, severe physical stress as in case of burns, major surgery or head trauma may also contribute as risk factors. Avoidable risk factors that may predispose to gastric ulcer include smoking, high consumption of alcohol and intake of some medications as non-steroidal anti-inflammatory drugs. Some factors are thought to aggravate already established gastric ulcer, but are no longer considered risk factors predisposing to it, as ingestion of too hot or cold foods or drinks, eating spicy food and intake of caffeine. The key cause of gastric ulcer is now known