New approaches to the pathogenesis of peptic ulcer based on the protective action of saliva with special reference to roughage, vegetable fibre and fermented milk products.

Epidemiologic studies have shown differences in the prevalence of peptic ulcer disease among various communities to be related to variation 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 gall bladder longer, loses its alkalinity and therefore its ability to damage the mucous cells. Roughage, cellulose and vegetable fibres and fermented milk products act in a similar manner. When food is well masticated, containing plenty of vegetable fibres and fermented milk products such as ghee and yoghurt, 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 hasty eating is avoided and good is chewed well. The pattern of diet, especially the relative dietary preponderance of short-chain fatty acids, such as those present in milk, yoghurt and other fermented milk products, have a protective action; the short-chain fatty acids retard gall bladder contraction and thus diminish the amount of bile entering the duodenal lumen.