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What is Ulcer
Ulcer can occur when stomach lining is overcome by excess gastric acids. This link between gastric acid and ulcers is well recognized by physicians. Researchers from a variety of disciplines are studying the physiology and biochemistry of peptide hormones - the chemical that stimulate and inhibit the production of gastric acid, in order to find solutions [1]. In general, acid secretion is dependent on two known factors: the mass of the acid secreting parietal cells of the mucosa of the stomach, and the stimulus which provokes the cells to secrete [2]. The term "peptic ulcer" describes both - gastric ulcer and duodenal ulcer [3].

Causes to ulcer [1,2,4]

• The main cause of duodenal ulcer incidence and recurrence is the Helicobacter pylori bacterium. There is a simple test to verify its existence, you should check with your physician.
• Psychogenic factors may provoke ulcer. For example, extreme stress, such as a life-threatening situation, can even bring on an ulcer almost overnight.
• Non-steroidal, anti-inflammatory drugs, used to treat arthritis and other joint problems may increase susceptibility.
• Certain heavy metals such as bismuth, an active bacteria in the antacid Pepto-Bismol, may even be the cause behind chronic recurring ulcers because the infection can remain in the body and strike again even after the ulcer have healed.
• Heredity may be significant in Ulcer disease. It has also been found that people with type O blood are 30-50% more likely to develop a gastric or a duodenal ulcer.
• Smoking and alcohol may contribute to ulcer’s formation and aggravation.
• Some researchers postulated a connection between high ulcer rates and high humidity.

Ulcer Symptoms and Treatment [1,5,6]
The average age of people afflicted from peptic ulcers is 55, but they can be found in people of almost any age. Americans spend more than $2,000,000,000 annually on medication to ease their symptoms, which can range from a vague discomfort under the rib cage to acute cramping, nausea, and vomiting. An ulcer can go undetected for months and years, since food temporarily buffers the irritating effects of excess stomach acid so the symptoms often disappear after eating. Some ulcers cause no pain or major discomfort and are detected only after the patient develops blood In the stools or anemia from the loss of blood. An unhealed Ulcer can result in complications such as perforation and hemorrhaging. About half of all ulcers heal themselves.
Some known effective drugs such as the antihistamines called H2 antagonists are use for effective healing, by blocking most gastric acid secreted into the stomach and letting the ulcer time to heal. Other treatment includes sucralfate, which is meant to strengthen the mucosal defense system of the stomach lining. The objective of treating ulcers is to alleviate symptoms and heal the ulcer by reducing gastric acid. Antacids are the basic for ulcer treatment. Diet is less important than previously thought, but most authorities encourage frequent feedings as a way of lowering gastric acidity.

Detecting Ulcer [5]
The patient’s symptoms may be enough to let the doctor make a preliminary diagnosis for a duodenal ulcer, however, an x-ray Is the only sure way to diagnose any ulcer. The radiologist views the barium the patients have swallowed, to see how well It is coating the lining. If healing is too slow or some other condition is suspected, the doctor may have a specialist pass a flexible lighted tube called an endoscope down your throat and into your stomach or duodenum for a look at the problem.

Diet for Peptic Ulcer [1,2,7,8]
Ulcer diets are individual, meaning that different foods bother different people. Diet has nothing to do with the cause of ulcer disease. In any case, a restricted diet is only needed if the ulcer is bleeding; in which case a hospital treatment is required.
Foods that contain protein stimulate the production of gastric juices that can bother your ulcer. Therefore you are advised to eat only three times a day and avoid snacks in between. For example, milk between meals stimulates the production of gastric juice because of its protein and may make matters worse.

Foods to be Avoided on the Peptic Ulcer Diet [6,7,9]
Alcohol, caffeine-containing foods (chocolate), beverages (tea, coffee), some medications, decaffeinated coffee, fried foods, aspirin (acetylsalicylic acid), spices such as pepper, chili powder, garlic or any highly seasoned food such as soup and gravy bases, bouillons, salad dressings and luncheon meats. Fats and greasy foods is commonly mentioned as bad for ulcer by ulcer sufferers, however fats are not restricted but rather recommended by the Joint Committee on Diet of the American Dietetic association and the American Medical Association, because fat diminishes gastric motility and secretion.
Some physicians insist on the regular use of milk in an ulcer diet, and the psychological value of milk as a "soothing" food cannot be overlooked. However, for ones that dislikes or doesn't tolerate milk, there is no harm in omitting it.

Foods Recommended for the Peptic Ulcer Diet
While food to avoid was determined clearly, there are various suggestions and controversies regarding recommended food for the peptic ulcer diet. I therefore bring some interesting research findings, as follows.

• fish oil and related substances may be beneficial not only in rheumatoid arthritis and cardiovascular diseases, but also in acute gastric mucosal injury.[10]
• a study on mice found that when the normal diet of the mice was supplemented with sliced banana for one week prior to the histamine injections there was a significant reduction in the incidence of gastric ulcers [11].
• A study a study on rats showed the depletion of fat reserves to a critical level triggers a metabolic stress response that then produces gastric ulcers [12]
• A study on rabbits showed that ulcer with a silk or chromic gut suture in its base, will heal if the rabbit is fed a diet of milk, bread, and boiled mashed carrots, but will tend to become chronic if the rabbit is fed a diet of hay, oats, and raw carrots [13]
• Soluble fibre from fruit and vegetables seem to be protective against duodenal ulcer and refined sugars a risk factor the role of fibre in the treatment and prevention of recurrence of duodenal ulcer is uncertain, as is that of essential fatty acids [4]
• Aloe vera polysaccharides have traditionally been used in Asian cultures as medicinal plants to enhance immunity and reduce oxidative injury. Research findings suggest it is effective in enhancing innate immunity and suppressing oxidative injury in oral ulcer animals [14]

Final thoughts
Ulcer symptoms and severity vary. It is important to detect the presence of peptic ulcer as soon as possible in order to avoid complications. In contrast to a hernia, ulcer can often be cured if treated with care.

References

1. Yamada, T. and K.L. Finn, Care and Feeding of Peptic Ulcers. USA Today., 1992. 120(2560): p. 82. 
2. Susser, M., Causes of peptic ulcer: A selective epidemiologic review. Journal of Chronic Diseases, 1967. 20(6): p. 435-456.
3. Stuttaford, T., When the pain of a peptic ulcer is hard to stomach, in The Times. 1998: London (UK), United Kingdom, London (UK). p. 18-18.
4. Misciagna, G., A.M. Cisternino, and J. Freudenheim, Diet and duodenal ulcer. Digestive and Liver Disease, 2000. 32(6): p. 468-472.
5. Anonymous, Ulcers: Modern treatments for an ancient ailment. Changing Times (pre-1986), 1980. 34(009): p. 49.
6. Yen, P.K., Diet and digestive problems. Geriatric Nursing, 1982. 3(6): p. 411-412.
7. Beatty, D., Parents must plan diet of boy with allergy; [FIN Edition]. Toronto Star, May 27, 1987: p. H.2.
8. Restrict diet only if ulcer is bleeding, in Observer. 2000: Sarnia, Ont., Canada, Sarnia, Ont. p. B.4-B4.
9. Roth, H.P. and H.S. Caron, Patients' misconceptions about their peptic ulcer diets: Potential obstacles to cooperation. Journal of Chronic Diseases, 1967. 20(1): p. 5-11.
10. Szabo, S. and C. Rogers, DIET, ULCER DISEASE, AND FISH OIL. The Lancet, 1988. 331(8577): p. 119. 
11. Elliott, R.C. and G.J.F. Heward, The influence of a banana supplemented diet on gastric ulcers in mice. Pharmacological Research Communications, 1976. 8(2): p. 167-172.
12. Yi, I. and F.K. Stephan, Body fat reserves attenuate gastric ulcers induced by restricted feeding in rats. Physiology & Behavior, 1996. 59(4/5): p. 931-936.
13. Ivy, A.C. and G.B. Fauley, Factors concerned in determining the chronicity of ulcers in the stomach and upper intestine: 1. Susceptibility of jejunum to ulcer formation 2. Effect of diet on healing of acute gastric ulcer. The American Journal of Surgery, 1931. 11(3): p. 531-543.
14. Yu, Z., C. Jin, et al., Effect of Aloe vera polysaccharides on immunity and antioxidant activities in oral ulcer animal models. Carbohydrate Polymers, 2009. 75(2): p. 307-311.

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