(00:00:00) There are 10 to 20 million people in the United States who have or who are going to have peptic ulcer ulcer is mainly a disabling disease. It interferes with the joy of living it interferes with the joy of diet and interferes with productivity. It puts people in the hospital. It does put their life at (00:00:19) risk. Is there a stereotype is the person who is generally frenetic who's always rushing about the business person is that the person who is most likely to suffer from ulcers? (00:00:33) Well, I think of all sorts of is occurring in a setting which has 14 or 15 characteristics, which we can identify and depending upon which of these characteristics and how many of them you fit into you are more or less prone to the development of all sir, and these characteristics include such things as personality but there are many other factors which contribute to your vulnerability for example a family history of all sir makes you more vulnerable. If you are blood group typo. You are more vulnerable. If you live in the city, you are more vulnerable than if you live in the country your susceptibility Rises if you take 224 aspirin and of course of 24 hours your personality contributes to the development of ulcer and there's some evidence that people who tend to suppress their To anger in as I call it make themselves more fertile soil for the development of all sir, and there are a number of other characteristics as well. Including your smoking habits, your alcohol habits your age your sex men are more vulnerable to the development of peptic ulcer for example, been are women women seem to have an inborn protective mechanism against the development of all sir, so that when we see a woman with also we know we're dealing with a special category of vulnerability and having one or more of these characteristics makes you more vulnerable but does not in any way guarantee that you'll develop an ulcer. It simply means that you're more receptive to the possibility. What is an ulcer an ulcer can be thought of as a form of self digestion. It's a an erosion or a crater in the lining of most commonly the stomach or its Outlet the duodenum, it looks like a little Bomb crater it's a loss of tissue as a result of the digestive action of our own gastric juices. We literally digest our own stomach the fact that we all don't digest our own stomach is the basis for who gets all sir. And why why do some of us have all sirs and yet with the same amount of acid many of us do not have ulcers obviously, there's more involved than simply acid. And (00:02:54) again it goes back to those fourteen or fifteen categories are criteria (00:03:00) that you know, as a general rule what you can say is that either person manufactures too much of his or her stomach juices or the normal protective mechanisms and the upper gastrointestinal tract. Are we the faulty or they're not present at all. And so that even small amounts of acid may cause also in some people whereas in others large amounts of acid do not (00:03:23) I'm wondering what your opinion is of the many antacids. The over-the-counter compounds are they are they generally useful or are they generally a waste of money? (00:03:36) Well, there are really two answers to that question the basis for all modern therapy for ulcer is directed at Acid since we can't get a handle on a lot of the other causes of also we direct our attention toward the management of acid and one of the classes of drugs that manage acid are the antacids including those that are sold over the counter my objection to people going out and self treating with antacid is that one? They haven't established the diagnosis of all sir in themselves and maybe treating something quite different and more serious in many respects than an officer and two if they're not under a physician's care the risk to life and complications increases I think people should not be treating an ulcer with antacids and if people have an ulcer there are much more effective medications available than can be bought over the (00:04:32) counter in your book. You describe a young cab driver who is pushing himself through 16 or 18 hour days and is developing an ulcer. And yet has decided that at least until it lays him low. He's not going to do anything about it that it's just one of the the hazards of the trade that he's in. He's trying to build up a taxi Fleet. I would imagine that there may be people in the audience who are in that situation right now in one case or another where they're working very hard to achieve a goal and they may have some symptoms and they're not exactly sure what they are and it doesn't keep them home at least not for a long period of time. What do you suggest for people like that? (00:05:16) Well, that's of course a difficult question which can be given very flip answers. You know, I think it serves no useful purpose to tell people to slow down to throw away their wrist watches to quit worrying to cut their anxiety levels low and so on that's not useful advice. Although it's sensible advice. Most intelligent people will instinctively know that high anxiety high response to stress is harmful not only to the stomach and it's lining but to the heart and to the brain and other organs systems. What I would like people to do is to look over the also susceptibility test and see where they fit in terms of their vulnerability to also and then modify their lifestyle and I don't mean necessarily their personality but their overall lifestyle to the degree that they can after all there isn't very much you can do about the fact that your father had an ulcer. And there isn't much you can do about the fact that your blood group typo but there are things you can do something about you can change your eating habits. You can change your alcohol smoking and certainly your aspirin habits. You possibly can modify your response to stress. I think that one can encourage oneself to express hostility when one feels hostility, I think it's possible to anger out in a constructive way without either endangering you're endangering your job or threatening other people and I think the intelligent reader will have no trouble finding ways in which they can alter their susceptibility to all sir. I wouldn't want to mislead anyone into thinking that there are easy answers to this problem. It's a very complex disorder. We do a much better job treating an ulcer then we do preventing it and what I would like to see is more prevention of ulcers (00:07:10) as far as prevention goes in your book you talk about coffee and tea and alcohol and aspirin And I'd like you to talk a little bit more about those items and whether or not they are indeed the cause of ulcers. I think there may be a conception the among some people at least that coffee at least is a is a prime cause of (00:07:29) ulcers. Well, we can start with coffee coffee is of tremendous importance to the American people. We consume enormous amounts of coffee. We are the heaviest coffee drinkers in the world caffeine in coffee is a known stimulant of acid secretion. However, that does not mean that caffeine causes ulcers based on the best data we have available and it's very scanty with regard to drinking coffee and all sir. There isn't much evidence that coffee taken in moderation is harmful either to the also prone person or to the person who has an ulcer and the also risen he healed State I think people can enjoy their coffee if they so desire in moderation during an acute attack. Yes. There are reasons to believe that coffee should be avoided but in the period in between attacks, there's really no evidence that coffee the shortens the period of time between attacks makes a tax worse or increases the frequency of them with regard to alcohol, very similar things could be said alcohol is an irritant of the stomach. But again, it's very hard to indict alcohol taken in moderation as a specific cause of also and the same can be held for smoking as well more than the normal number of people who have also smoke there's a high correlation between smoking and having ulcers but it may well be that the kind of people who develop an ulcer are also the kind of person who smoke and who drink alcohol, they're all orally oriented habits and therefore it's very difficult to say That a b or c causes D. All we can say is that people with ulcers do drink more than normal amounts of coffee do smoke more than normal amounts of cigarettes and do have a higher than normal intake of tobacco that is not proof of a cause-and-effect relationship. However, now with regard to aspirin we're dealing with something entirely different Americans are enormous aspirin consumers the British take about 20 percent more than we do and the Australians take twice as much as the British do. And the number of years ago in South Australia an epidemic of ulcers broke out in young women a population group normally not susceptible to the development of all sir, without going into the details of it. It was eventually traced to their habit of taking tea and Aspen as a social event in the morning tea and Vincents. Let's have some tea and Vincents and they would imbibe tea and pop a couple of aspirin purely a social habit not specifically for a headache or joint pains or anything else. Well an enormous number of young women developed ulcers and so many in fact that it reversed the normal ratio of men to women in that particular area of the country it changed the whole epidemiology of ulcers. We now know that people who take as few as 224 aspirin a day lose blood in their bow, (00:10:50) Organs (00:10:51) that aspirin is a specific irritant to the gastrointestinal (00:10:54) tract. Now you're talking about aspirin taken every day over a over a period of time. (00:10:59) Although as few as two aspirin taking once can cause microscopic loss of blood in the stools. I have this week operated as an emergency on two women elderly women taking aspirin and a blood thinner for minor strokes who developed gastric ulcer from which they bled and which required emergency surgery aspirins a very safe drug. Now that's a little contradictory. But when you consider the number of people in the United States that consume the huge quantities of aspirin that they do it's really remarkable. We don't see you no more trouble from (00:11:39) and for people who are prone to ulcers again going back to the list the checklist. They might keep in mind (00:11:45) that there are other alternatives to aspirin and these people should keep in mind. That being also prone and taking aspirin significantly increases the risk of developing. Also there are other pain relievers for which aspirin or which can be substituted for aspirin certainly no person with a known all sir should take aspirin in any form whatsoever. One of the problems is that a lot of people are taking drugs that contain aspirin the name of which does not give a clue that it contains aspirin are over 300 compounds containing aspirin many of which give no clue that there's aspirin in them and I have had many patients deny that they were taking aspirin but on further questioning revealed that they are taking a drug like a scripting for example, which is aspirin or has aspirin and buffering which has aspirin in it and Alka-Seltzer which has aspirin in it. It's a matter of fact a dismay number of people take Compounds for the pain of an ulcer which is roughly akin to trying to put out a fire by dousing it with gasoline. One thing that (00:12:57) I was surprised to learn in your book was that ulcers don't go away (00:13:03) now. I think you should think of ulcer is a lifetime disorder. It waxes and wanes. It's a cyclical disorder. They may be periods of remission absence of symptoms that last as long as ten or even 30 years, but basically all sir is a lifetime disorder with few exceptions medications can control all sir, but they don't cure it surgery cures all sir, but not everyone with an also require surgery as a matter of fact only 10 or 15 percent of people with ulcers ever require surgery. There's something different about the person who require surgery they have developed a complication of one kind or another or they simply can't live with their also any more medications won't control it. But we think of ulcer is a lifetime disorder.