Most of them are about the diameter of a dime and the thickness of a penny, the product of a mysterious phenomenon in which the stomach or the first part of the small intestine literally digests itself.
They are at once the focus of some of the most successful advances in treatment of any field of modern medicine and stubbornly resistant to prediction or prevention. Ironically, when they are at their worst, they often give no pain warnings, manifesting themselves, instead, as potentially fatal hemorrhages in the early hours of the morning.
No Precise Identification
It's not even certain if they are the product of a disease or the result of a condition created in the body by an assortment of factors--both environmental and inherited--that have yet to be precisely identified. There is one thing that is fairly certain about them, though. They aren't stress-related and you cannot worry yourself into one. The most common drug that is used to treat them remains one of the most significant and successful breakthroughs of the era, yet it is incapable of producing a cure.
One of the most mundane, frequently uncomfortable and--occasionally--potentially dangerous, of common disorders, they lack the drama that surrounds such high-tech marvels as sewing the heart of a baboon into the chest of a baby or transplanting kidneys, lungs and livers. They are the subject of so many misconceptions that they have developed what might be called a folklore of their own.
They affect 4 million Americans by most counts--80,000 of whom may be chronically disabled. They are ulcers.
Tucked away in an unpretentious two-story building at the Veterans Administration Westside Hospital, a nationally known clinic is trying to solve some of the riddles that continue to surround ulcers. Yet at the same time the program, the Center for Ulcer Research and Education, is working hard to overcome a blow to the momentum of its research program suffered in 1981 when the renowned founder of the center, which is known by the acronym CURE, died of cancer.
Dr. Morton I. Grossman, who started CURE in 1974, had turned it into an internationally known center. Grossman, in the years before his death, had become something of a guru in the field of ulcer medicine and research. When Grossman died at age 62, local experts in ulcer medicine agreed the program he founded lost some of its direction--a period from which its current director, Dr. George Sachs, is determined it will recover. Sachs took over the CURE program two years ago.
As a result, according to Dr. Gary Van Deventer, director of CURE's clinic, the center is now actively seeking as many as two to four times the number of patients--about 450--as are currently enrolled in its research projects. CURE patients can refer themselves, but they must have been positively diagnosed as having ulcers before they turn to CURE. They are assigned to treatment programs in which a variety of possible advances are being tested in concert with existing therapies. The treatment CURE offers its patients--including both veterans and non-veterans--is free.
The patients become participants in an attempt to solve some of the mysteries of ulcers, a medical problem so common as to be considered mundane, but which remains mysterious enough that it isn't even certain how long ulcers have afflicted humans. It seems likely, however, said Van Deventer and Dr. John Walsh, CURE's associate director, that ulcers--at least the variety that infests the upper portion of the small intestine (called the duodenum)--may be a development of the 20th Century.
Ulcer death rates and hospitalizations have been on the decline since the early 1960s, according to a CURE survey published in 1983. Deaths have been cut by half and hospitalizations by nearly a quarter in the last 20 years. Deaths still occur, however--though they are fewer than three out of every 100,000 people in the United States. Still, researchers have found the economic costs--not to mention the toll of physical discomfort--remain high for ulcers. Direct costs for hospital and doctor care are estimated at $3.2 billion a year in this country.
An ulcer occurs when acid and gastric juice that normally aid in the routine digestion of food encounter a small spot in the lining (or the mucosa, as it is technically known) of the stomach or the intestine that has for some reason--doctors don't understand the cause--lost its ability to resist the acid's effects. As a result, the acid and gastric juices literally eat into the stomach or intestinal wall, creating the ulcer.
The lesions are normally about a centimeter--or somewhat less than the diameter of a dime--across, and about as deep as the thickness of a penny. However, in extreme cases, ulcers can become as large as a silver dollar.