There you are, having pepperoni pizza, when that feeling comes over you: pressure, burning and fullness in your upper abdomen and a bitter taste in the back of your throat. To add insult to injury, your kid brother reminds you about your ulcer and advises you to start eating better. You wonder how you could again get along with the diet recommended to you when the ulcer was first detected years ago.
Similar scenes are repeated over and over in great restaurants and dining rooms every day. And along with it, the myth about food causing ulcers is perpetuated.
The Answer Is No
It is now well established that food has little or nothing to do with ulcer development. Food's true effect on ulcers is dwarfed by other, more important factors. But the word has not gotten out, and many people erroneously cling to the (now disproven) notion that if you have had an ulcer, you must be careful about what you eat for fear of making the ulcer worse or causing a new one.
Peptic ulcer disease refers to ulcers involving the lower part of the stomach and upper intestine (the duodenum) into which the stomach empties. Theories about cause have evolved over time, but for many years it was thought that the type of food you ate mattered: foods that stimulate acid secretion, are acidic themselves, or spicy foods that burn the mouth were all assumed to be important in causing or aggravating ulcers. However, in recent years, it has become clear that the vast majority of peptic ulcers have one of two causes:
- A bacterial infection (that is, Helicobacter pylori infection)
- Nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or aspirin)
A small percentage of ulcers are caused by other problems (such as excessive acid production or tumors).
Why the Myth Persists
However, the myth about the role of foods in ulcer disease is difficult to debunk for several reasons:
- Understanding about the cause of ulcers is relatively recent.
- Publicity about this "breakthrough" has been relatively minor outside of medical circles.
- It seems intuitive that spicy foods must be bad for the stomach.
- There is widespread confusion between the symptoms of heartburn or other causes of stomach pain and those of ulcer disease.
- There are dietary causes of non-ulcer stomach trouble, such as alcohol-induced gastritis (stomach inflammation).
Reflux vs. Ulcers
They symptoms described as heartburn is usually due to gastroesophageal reflux disease (GERD), a condition that is much more common than ulcer disease. With GERD, acid from the stomach washes back (refluxes) into the lower part of the stomach and causes burning, pressure, belching and a bitter taste. It is often worse after eating, especially if you lie down. Spicy foods certainly may provoke symptoms of GERD and, if frequent, damage to the lower esophagus may lead to narrowing, difficulty swallowing, or other complications. Ulcer disease, on the other hand, usually causes upper abdominal pain that is relieved by eating and worse between meals, bleeding (causing black, tarry stools) or no symptoms at all. Effective treatments are available for both problems.
So, if you have GERD, by all means, avoid those foods that you have noticed worsen your symptoms and if symptoms are frequent, talk to your doctor about treatment options. If you have ulcer disease, avoid NSAIDs, find out (with your doctor's help) if you have H.Pylori infection, and if you do, take the antibiotics that effectively eradicate the bacteria. And if your kid brother keeps pestering you about your diet, give him that lecture about his smoking.
Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.