The American Journal of Digestive Diseases

, Volume 15, Issue 5, pp 489–496 | Cite as

New approaches to the pathogenesis of peptic ulcer based on the protective action of saliva

  • S. L. Malhotra
Point Of View

Abstract

Epidemiologic studies have shown differences in the prevalence of peptic ulcer disease among various communities to be related to variations in diet and eating patterns. Results of studies of the effect of diet and pattern of eating on saliva, on gastric juice, and on the amount of bile are reviewed. It is suggested that bile, and not hydrochloric acid, plays the causative role in pathogenesis of peptic ulceration. The role of saliva in the prevention of peptic ulcer is emphasized. The salivary mucus swallowed with food is protective because it decreases the flow rate of bile which, when held in the gallbladder longer, loses its alkalinity and therefore its ability to damage the mucous cells. When food is well masticated, resulting in an increase in the amount of salivary mucus, peptic ulceration may be prevented and cured and relapses may be prevented. This does not require a big change in the pattern of diet but only a change in the manner of eating so that meal-scamping is avoided and food is chewed well. The pattern of diet, especially the relative dietary preponderance of short-chain fatty acids, such as those present in milk, yogurt and other fermented milk products, has a protective action; the short-chain fatty acids retard gallbladder contraction and thus diminish the amount of bile entering the duodenal lumen.

Keywords

Public Health Epidemiologic Study Hydrochloric Acid Alkalinity Peptic Ulcer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Malhotra SL, Majumdar CT, Bardoloi PC: Peptic Ulcer in Assam. Gut 5:355–358, 1964Google Scholar
  2. 2.
    Malhotra SL: Epidemiological study of peptic ulcer in the South of India. Observations from Madras on the changing incidence of peptic ulcer with special reference to causation. Gut 8:180–188, 1967Google Scholar
  3. 3.
    Billington BP: Observations from New South Wales on the changing incidence of gastric ulcer in Australia. Gut 6:121–133, 1965Google Scholar
  4. 4.
    Segi M, Fujisaku S, Kurihara M: Mortality for gastric and duodenal ulcer in countries and its geographical correlation to mortality for gastric and intestinal cancer. Schweiz Z Allg Path 22:777, 1959 (Quoted by Watkinson G: Modern Trends in Gastro-enterology (Vol 3). Edited by WI Card. Butterworths, London, 1961, pp 24–25Google Scholar
  5. 5.
    Cleave TL: Peptic Ulcer. Bristol, J. Wright, 1962Google Scholar
  6. 6.
    Malhotra SL: Peptic ulcer in India and its etiology. Gut 5:412–416, 1964Google Scholar
  7. 7.
    Malhotra SL: Protective action of saliva in peptic ulceration. Scand J Gastroent 2:95–104, 1967Google Scholar
  8. 8.
    Malhotra SL: Faecal urobilinogen content in populations with different peptic ulcer incidence in India and its possible role in the aetiology of ulceration. Scand J Gastroenterology 2:337–343, 1967Google Scholar
  9. 9.
    Malhotra SL, Saigal ON, Mody GD: Role of saliva in the aetiology of peptic ulcer. Brit Med J 1:1220–1222, 1965Google Scholar
  10. 10.
    Sand HF: The carbonic acid content of saliva and its role in the formation of dental calculus. (Thesis) University of Oslo, 1949Google Scholar
  11. 11.
    Will JH, Forbes JC: Dietary effects upon the acid neutralising power of the saliva. J Dent Res 18:409, 1939Google Scholar
  12. 12.
    Dewar MR, Parfitt GJ: Mucin content, physical properties of saliva and caries activity. J Dent Res 33:751–756, 1954Google Scholar
  13. 13.
    Malhotra SL: A study of the effect of saliva on the concentration of mucin in gastric juice and its possible relationship to the aetiology of peptic ulcer. Gut 8:548–555, 1967Google Scholar
  14. 14.
    Malhotra SL: Peptic ulcer. J Ass Physicians India 13:907–914, 1965Google Scholar
  15. 15.
    Dogra JR: Studies on peptic ulcer in South India. Introduction and clinical study of 258 cases. Indian J Med Res 28:145–161, 1940Google Scholar
  16. 16.
    Somervell TH, Orr IM: Some contributions to the causation, pathology, and treatment of duodenal ulcer and its complications. Brit J Surg 24:227–245, 1936Google Scholar
  17. 17.
    Hadley GG: A note on peptic ulcer. Ind coun med Res Group Discussion on Peptic Ulcer, 1959Google Scholar
  18. 18.
    Brooks JR, Erksine JM, Gephart T, et al: The chloride output rate of the human stomach in healthy subjects and ulcer patients. Surg Gynec Obstet 90:155–170, 1950Google Scholar
  19. 19.
    Ball PAJ, James AH: The histological background to gastric ulcer. Lancet 1:1365–1367, 1961Google Scholar
  20. 20.
    Badenoch J, Brooks BN: Recent Advances in Gastroenterology. London, Churchill, 1965, p 107Google Scholar
  21. 21.
    James AH: The Physiology of Gastric Digestion, London, Arnold, 1957, pp 108, 128Google Scholar
  22. 22.
    Magee DF: The physiology of gall bladder emptying in the biliary system, A symposium of the NATO Advanced Study Institute. Edited by W Taylor. Oxford, Blackwell, 1965, p 235Google Scholar
  23. 23.
    Florey HW, Harding HE: Further observations on the secretion of Brunner's glands. J Path Bact 39:255–276, 1934Google Scholar
  24. 24.
    Wilhelm CM, Finegan RW, Hill FC: The physiological control of gastric acidity. Amer J Dig Dis 4:547–550, 1937Google Scholar
  25. 25.
    Varley H: Practical Clinical Biochemistry. Third edition. London, Heinemann, 1962Google Scholar
  26. 26.
    Hoffman WS: The Biochemistry of Clinical Medicine. Chicago, Year Book Medical Publishers, 1964Google Scholar
  27. 27.
    Boyden EA: Sphincter of Oddi. Hypertrophy of the Sphincter Choledochus. Surgery 9:443–446; 10:567–571, 1941Google Scholar
  28. 28.
    du Plessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974–978, 1965Google Scholar
  29. 29.
    Lawson HH: Effect of duodenal contents on the gastric mucosa under experimental conditions. Lancet 1:469–472, 1964Google Scholar
  30. 30.
    Spira JJ: Gastro-duodenal Ulcer. London, Butterworths, 1956Google Scholar
  31. 31.
    Malhotra SL: Effect of diet on faecal urobilinogen excretion and its possible relationship to the pathogenesis of peptic ulceration. Gut 9:183–186, 1968Google Scholar
  32. 32.
    Malhotra SL: Effect of patterns of eating and antacids on faecal urobilinogen excretion. Gut 9:38–41, 1968Google Scholar
  33. 33.
    Hong SS, Magee DF, Crewdson F: The physiologic regulation of gall bladder evacuation Gastroenterology 30:625–630, 1956Google Scholar
  34. 34.
    Illingworth CFW: Peptic Ulcer. Edinburgh, Livingstone, 1953Google Scholar
  35. 35.
    Sarles: Quoted from The Biliary System. A symposium of the NATO Advanced Study Institute. Edited by W. Taylor. Oxford, Blackwell, 1965Google Scholar
  36. 36.
    Malhotra SL: Serum lipids, dietary factors and ischaemic heart disease. Amer J Clin Nutr 20:462–474, 1967Google Scholar
  37. 37.
    Indian Council of Medical Research: Diet Atlas of India. Sp Rep, Series No. 48, New Delhi, 1964Google Scholar
  38. 38.
    Popjak G, French TH, Folley SJ: Utilization of acetate for milk-fat synthesis in the lactating goat. Biochem J 48:411–416, 1951Google Scholar
  39. 39.
    Crider JO, Thomas JE: A study of gastric emptying with the pylorus open. Amer J Dig Dis 4:295–300, 1937Google Scholar
  40. 40.
    Wilkie DPD: Coincident duodenal and gastric ulcer. Brit Med J 2:469–470, 1926Google Scholar
  41. 41.
    Marks IN, Shay H: Observations on the pathogenesis of gastric ulcer. Lancet 1:1107–1111, 1959Google Scholar
  42. 42.
    Aagaard P, Andreassen M, Kurz L: Duodenal and gastric ulcer in the same patient. Lancet 1:1111–1112, 1959Google Scholar
  43. 43.
    Editorial: Gastric ulcer and the ulcer equation. Lancet 1:1131, 1959Google Scholar
  44. 44.
    Jennings GH: Causal influences in haematemesis and melaena. Gut 6:1, 1965Google Scholar
  45. 45.
    Malhotra SL: Diets for peptic ulcer. Brit Med J 1:295, 1966Google Scholar

Copyright information

© Hoeber Medical Division • Harper & Row, Publishers, Incorporated 1970

Authors and Affiliations

  • S. L. Malhotra
    • 1
  1. 1.From the Medical DepartmentSouth Eastern RailwayCalcuttaIndia

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