Chronic indigestion and peptic ulcer

A medical debate as to what really causes gastric ulcers has been running for years. Leaving the almost universal symptom of dyspepsia aside for the minute, it seems highly likely that the gastric and duodenal ulcer have a multiple causation. An ulcer is a lack of continuity of tissue – a hole in other words. If you knock some skin off your leg and it does not heal, you have an ulcer. In a way you can liken a peptic ulcer (the modern term that includes both gastric and duodenal ulcers) to a hole anywhere. All sorts of things can cause a hole in the rug in front of your fire – for instance a spark may make a burn hole in it; somebody’s sharp stiletto heel may punch a hole in it; if you shut your dog in the room by accident he may scrape a hole in it, too. Holes in carpets are multifarious as far as their causation is concerned and so are peptic ulcers, and when such a hole is present developing symptoms of indigestion will occur.

It seems likely that all sorts of things produce small holes in the lining of the stomach. Something sharp such as a piece of pork crackling may graze your inside in the same way as you may graze or remove some skin from your knees by a minor accident. Of course these minor ‘ulcers’ soon heal, although the stomach is at special risk in some ways, as we shall see later. The air that surrounds most ulcers on our hands or shins does not interfere with healing. But your stomach always contains quantities of quite strong acid and powerful digestive enzymes that help you digest and utilize the food you eat. Exactly why the stomach and part of the duodenum do not automatically digest themselves all the time has always baffled doctors. But of course they do not. However, if acid levels are high a minor injury to the lining of these organs may well not heal very quickly. This acid theory has traditionally been put forward to explain why peptic ulceration occurs, but modern research suggests an entirely different basic causation, although gastric acid and intestinal enzymes are obviously implicated too.

In the 19th century a United States army surgeon called William Beaumont had a piece of luck with reference to one of his patients, a man called Alexis St Martin. This man suffered an abdominal wound which meant that there was an artificial opening of his stomach to the surface that would not heal (such an opening is called a fistula). Due to this disability it was possible to study the composition and volume of his gastric juices in varying circumstances from hour to hour. Dr Beaumont as a result gained early knowledge of the function of the stomach and the circumstances that altered this function. One of his findings was that if his patient was annoyed or angry his stomach did not empty itself as it should. In fact, it became overfull and acid-dyspepsia was experienced.

During the last few years research of a much more sophisticated nature has disclosed several other secrets of indigestion. Gradually a consensus of opinion has developed on how the gastrointestinal tract responds to emotions and to stress. Sudden emotional upsets or a toxic substance entering the stomach produce a quite sudden lack of tone in the stomach itself. The normal contractions that usually waft the contents of the organ gently along disappear. As a result the victim feels ‘sick with apprehension, and indeed vomiting may occur.


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