I have a history of stomach and duodenal ulcers. My gastroenterologist recommended that I not eat fruits or vegetables. He said that both my bowel and stomach are holding too much gas. Is this related to the ulcer problem? He also suggested that I drink Metamucil or Citracel three times a day and that I take a stool softener. I'm nervous that this is not safe and that my body will become addicted to these products. Are all these medications necessary? What are they supposed to accomplish?

P.B.

Ulcers in the stomach and upper small intestine, or duodenum, are referred to as peptic ulcer disease, because the stomach's peptic acid is involved in their formation. There is no known association between peptic ulcers and eating fruits and vegetables.

We know of two causes for peptic ulcers. The most common cause is Helicobacter pylori, a type of bacteria that resides in the stomach. Medical research has associated H. pylori with 75 to 95 percent of ulcer cases, but doctors are still unsure exactly how the germ causes the ulcers. Nevertheless, if someone with ulcers has H. pylori and it is eradicated by antibiotics, the chance of their ulcers recurring is less than 5 percent. The second cause of ulcers is regular use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve) and other pain relievers. These medications lead to ulcers by interfering with the formation of the protective barrier in the lining of the stomach and duodenum.

You say that your doctor thinks you are "holding too much gas." What are your symptoms? Some people have a sensation of bloating, or cramping, sometimes associated with constipation, which improves after bowel movements. This is commonly referred to as irritable bowel syndrome. The cause of irritable bowel syndrome is not clear, but it may be associated with an intestine that is very sensitive to stimulation by gas and food. You may notice that certain fruits or vegetables, especially beans, make your symptoms worse. This is due to the gas produced when these foods are broken down in the colon. You may want to avoid these foods.

Some doctors also recommend fiber, in the form of Metamucil or Citracel, to increase the bulk of stools and improve the passage of stool through the bowel. This is also helpful in people who are constipated. Other laxatives, such as lactulose (Chronulac) or docusate (Colace), that tend to soften the stool may also help. All of these medications are safe, are not absorbed by the intestine to any significant extent, and are not habit-forming. Their overall effect is to improve the flow of stool and reduce the bloating and cramping.

Other medications may not be as safe for the long term. Laxatives that work by causing the colon to contract harder, such as bisacodyl (Dulcolax), are useful in the short term. With chronic overuse, they can cause a weakening in the colonic muscle that will lead to a colon that cannot contract, and subsequently even worse constipation. Similarly, drugs used for intestinal cramps, such as dicyclomine (Bentyl) can be habit-forming if used for long periods. You should discuss specific medications with your doctor and decide on a regimen that is appropriate for you.