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.
Similar content being viewed by others
References
Malhotra SL, Majumdar CT, Bardoloi PC: Peptic Ulcer in Assam. Gut 5:355–358, 1964
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, 1967
Billington BP: Observations from New South Wales on the changing incidence of gastric ulcer in Australia. Gut 6:121–133, 1965
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 24–25
Cleave TL: Peptic Ulcer. Bristol, J. Wright, 1962
Malhotra SL: Peptic ulcer in India and its etiology. Gut 5:412–416, 1964
Malhotra SL: Protective action of saliva in peptic ulceration. Scand J Gastroent 2:95–104, 1967
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, 1967
Malhotra SL, Saigal ON, Mody GD: Role of saliva in the aetiology of peptic ulcer. Brit Med J 1:1220–1222, 1965
Sand HF: The carbonic acid content of saliva and its role in the formation of dental calculus. (Thesis) University of Oslo, 1949
Will JH, Forbes JC: Dietary effects upon the acid neutralising power of the saliva. J Dent Res 18:409, 1939
Dewar MR, Parfitt GJ: Mucin content, physical properties of saliva and caries activity. J Dent Res 33:751–756, 1954
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, 1967
Malhotra SL: Peptic ulcer. J Ass Physicians India 13:907–914, 1965
Dogra JR: Studies on peptic ulcer in South India. Introduction and clinical study of 258 cases. Indian J Med Res 28:145–161, 1940
Somervell TH, Orr IM: Some contributions to the causation, pathology, and treatment of duodenal ulcer and its complications. Brit J Surg 24:227–245, 1936
Hadley GG: A note on peptic ulcer. Ind coun med Res Group Discussion on Peptic Ulcer, 1959
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, 1950
Ball PAJ, James AH: The histological background to gastric ulcer. Lancet 1:1365–1367, 1961
Badenoch J, Brooks BN: Recent Advances in Gastroenterology. London, Churchill, 1965, p 107
James AH: The Physiology of Gastric Digestion, London, Arnold, 1957, pp 108, 128
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 235
Florey HW, Harding HE: Further observations on the secretion of Brunner's glands. J Path Bact 39:255–276, 1934
Wilhelm CM, Finegan RW, Hill FC: The physiological control of gastric acidity. Amer J Dig Dis 4:547–550, 1937
Varley H: Practical Clinical Biochemistry. Third edition. London, Heinemann, 1962
Hoffman WS: The Biochemistry of Clinical Medicine. Chicago, Year Book Medical Publishers, 1964
Boyden EA: Sphincter of Oddi. Hypertrophy of the Sphincter Choledochus. Surgery 9:443–446; 10:567–571, 1941
du Plessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974–978, 1965
Lawson HH: Effect of duodenal contents on the gastric mucosa under experimental conditions. Lancet 1:469–472, 1964
Spira JJ: Gastro-duodenal Ulcer. London, Butterworths, 1956
Malhotra SL: Effect of diet on faecal urobilinogen excretion and its possible relationship to the pathogenesis of peptic ulceration. Gut 9:183–186, 1968
Malhotra SL: Effect of patterns of eating and antacids on faecal urobilinogen excretion. Gut 9:38–41, 1968
Hong SS, Magee DF, Crewdson F: The physiologic regulation of gall bladder evacuation Gastroenterology 30:625–630, 1956
Illingworth CFW: Peptic Ulcer. Edinburgh, Livingstone, 1953
Sarles: Quoted from The Biliary System. A symposium of the NATO Advanced Study Institute. Edited by W. Taylor. Oxford, Blackwell, 1965
Malhotra SL: Serum lipids, dietary factors and ischaemic heart disease. Amer J Clin Nutr 20:462–474, 1967
Indian Council of Medical Research: Diet Atlas of India. Sp Rep, Series No. 48, New Delhi, 1964
Popjak G, French TH, Folley SJ: Utilization of acetate for milk-fat synthesis in the lactating goat. Biochem J 48:411–416, 1951
Crider JO, Thomas JE: A study of gastric emptying with the pylorus open. Amer J Dig Dis 4:295–300, 1937
Wilkie DPD: Coincident duodenal and gastric ulcer. Brit Med J 2:469–470, 1926
Marks IN, Shay H: Observations on the pathogenesis of gastric ulcer. Lancet 1:1107–1111, 1959
Aagaard P, Andreassen M, Kurz L: Duodenal and gastric ulcer in the same patient. Lancet 1:1111–1112, 1959
Editorial: Gastric ulcer and the ulcer equation. Lancet 1:1131, 1959
Jennings GH: Causal influences in haematemesis and melaena. Gut 6:1, 1965
Malhotra SL: Diets for peptic ulcer. Brit Med J 1:295, 1966
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Malhotra, S.L. New approaches to the pathogenesis of peptic ulcer based on the protective action of saliva. Digest Dis Sci 15, 489–496 (1970). https://doi.org/10.1007/BF02283880
Issue Date:
DOI: https://doi.org/10.1007/BF02283880