antacid, to set it right. The impression that every gastro-intestinal upset, from indigestion to severe pain in the abdomen, calls for an antacid, is erroneous. Although it is true that antacids counteract the excess of acid to prevent sour eructations, frequent



use is unjustified. They hamper the digestion in the stomach.

Hydrochloric acid is the natural constituent of the secretions from the stomach, mean to make the digestive enzymes active. Why then should anybody work against this useful phenomenon provided by nature? Well, we may have to react when the natural phenomenon becomes unnatural, that is, when it is in excess and associated with a disease called peptic ulcer. Peptic ulcer is the term designated to localized destruction of the inner wall or mucosa of the stomach (gastric ulcer) or the upper part of the small intestine (duodenal ulcer). In other words, it is a wound (sore) inside the stomach or duodenum. A peptic ulcer is usually associated hyperacidity; however, there are some people who have 6 to 8 times more acid than normal, yet do not suffer from the disease. On the other hand, there are others who have low acidity and may have peptic ulcers. A condition related to acidity is gastro esophageal reflux disorder also called reflux esophagitis or heartburn. Its causes and treatment is similar to peptic ulcer.

Symptoms: Peptic ulcers are of two types: Duodenal and Gastric. A duodenal ulcer is associated with a sharp, penetrating, and burning type of pain in the upper part of the abdomen which occurs mostly on empty stomach and is relieved by food. Therefore, patients with duodenal ulcer tend to eat more and gain weight.

In gastric ulcers the pain increases immediately or soon after a meal, and bloating vomiting may occur after meals. The pain experienced after meals is due to acid secretions flowing over the gastric ulcer, stimulating the pain receptor. Patients with gastric ulcer and thin and lean. The final diagnosis is made by examination of the stomach and its contents, and by X-ray after a barium meal and by endoscopy in which a flexible fibre optic tube is passed through mouth into stomach and its end is illuminated to see changes in the inner lining. If the need be, the endoscopist can cut a tiny piece of tissue for minute or biopsy

examination.

Causes: All of us produce acid in stomach but only a few with weak defenses develop ulcers. The causes of peptic ulcers are complex, involving constitutional, emotional, neurogenic, and biochemical factors. Constitutionally, a person having a lean and thin physique, being highly emotional, and belonging to blood group 'O' is more prone to suffer from a peptic ulcer. It appears that in these persons the activity of nerve to stomach (vagus) is more, causing hyperacidity, increased mobility or movement, spasm, and localized necrosis (degeneration) of the mucosa. Besides, hot and spicy food, excessive smoking and excessive

use of alcohol, tea, the coffee, and certain drugs like corticosteroids, aspirin, indomethacin, caffeine, and theophylline may also be responsible or peptic ulcers.

The treatment of peptic ulcer consists of general measures and use of specific drugs. If complications like bleeding or perforation at the site of the ulcer occur, surgical intervention may become necessary.