Peptic Ulcer

DESCRIPTION

Peptic ulcers (an ulcer is an erosion in the mucous membranes that produces a crater-like lesion) can occur anywhere in the digestive tract, but are most common in the lower half of the stomach (gastric ulcer) or in the upper part of the duodenum, the first 30 cm (12”) of the small intestine directly below the stomach (duodenal ulcer). Duodenal ulcers are four to five times more common than gastric ulcers, and are four times more common in men than in women. While duodenal ulcers are almost always benign, gastric ulcers may become malignant. Ulcers can affect all ages, and about 1 in 10 Americans develops a peptic ulcer at some period in his or her lifetime.

Despite their different locations, both types of ulcer are the result of excessive damage to the mucosal cells
that line the stomach and duodenum. To protect the stomach and small intestine from the corrosive gastric
juices secreted to digest food (hydrochloric acid and pepsin), these cells produce a layer of mucin, a thick slippery mucus, along with other factors that neutralize any acid that manages to come into contact with the stomach or intestinal lining. Mucosal cells lining the stomach and intestines are constantly renewed, with normal turnover occurring every 72 hours, so any damaged cells are quickly replaced. These protective mechanisms are normally quite effective; only when the mucosal cells are overwhelmed can an ulcer form.

Contrary to popular opinion, excessive secretion of gastric acid is rarely the problem. In fact, patients with gastric ulcers tend to secrete normal or even reduced levels of gastric acid. About half of patients with duodenal ulcers do have a higher than normal gastric acid output, because as a group, duodenal ulcer patients have twice as many acid-producing cells ( parietal cells) in their stomachs as people without ulcers. Even with this increase in parietal cells, however, the protection offered by the mucosal cells lining the stomach and small intestine is normally more than adequate to prevent ulcer formation. Problems only arise when normal mucosal cell function is disrupted by factors such as Helicobacter pylori infection, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), alcohol, nutrient deficiencies, stress, and other factors (discussed below).

 
FREQUENT SIGNS AND SYMPTOMS

• Burning, gnawing, cramp-like or aching pain or “heartburn” that occurs shortly before a meal, 45–60 min after eating, or hours later, during the night.
• Pain may be severe enough to cause wakening from a sound sleep.
• Pain typically lasts 30 min to 3 hours.
• Pain is often interpreted as heartburn, indigestion or hunger.
• Pain is usually in the upper abdomen, but may also be below the breastbone or in the back.
• Pain is usually greatly relieved by eating, drinking milk, or taking antacids.
• Pain can be relieved by vomiting (some people).
• Nausea, loss of appetite, with resulting weight loss.
• Weight gain due to eating more to ease discomfort.
• Pain is comes and goes. Weeks of intermittent pain may alternate with short pain-free periods.
• Pain may follow a predictable pattern, increasing in frequency during periods of stress.
• Ulcer crater or deformity in the stomach or upper small intestine is visible on X-ray or fiberoptic (endoscopic) examination.
• Positive test for blood in the stool.
• Anaemia.

Warning: individuals experiencing any peptic ulcer symptoms must be monitored by a physician, even if following the natural approaches outlined below. Peptic ulcer complications such as haemorrhage, perforation, and obstruction are medical emergencies that require immediate hospitalization.

 
CAUSES

• Helicobacter pylori infection: in some people H. pylori infection increases gastric acidity, leading to ulcer formation:
• Infection with the bacterium H. pylori is found in 90–100% of duodenal ulcer patients, and 70% of gastric ulcer patients.
• Approximately 50% of people over age 50 test positive for H. pylori, which does not always cause ulcers, but is now thought to be a factor in other stomach disorders (e.g., gastritis, esophagitis, acid indigestion, stomach cancer).
• Tests to determine the presence of H. pylori include:
• Measuring the level of antibodies to H. pylori in the blood or saliva
• A breath test that measures the level of a gas produced by H. pylori as a metabolic by-product
• Culturing material collected during an endoscopy (an examination of the stomach or duodenum using a fiberoptic tube with a lens attached to it).
• Predisposing factors for H. pylori infection are:
• Low gastric acid levels: (1) In addition to its use in digesting food, gastric acid destroys invading pathogens; low gastric acid secretion therefore provides a hospitable environment for colonization by H. pylori. (2) The ability to secrete stomach acid decreases with age; studies have found low stomach acidity in more than half of those over age 60. (3) Low acidity may also result from the use of antacids and H2 blockers (e.g., Pepcid, Tagamet, Zantac).
• Low levels of vitamin C, E, and other antioxidants in the gastrointestinal lining: H. pylori damages the stomach and intestinal lining by producing oxidants (a type of free radical), which may explain why not everyone with H. pylori develops ulcers; those whose diets are high in antioxidants are afforded protection.
• Non-steroidal anti-inflammatory drugs (NSAIDs):
  NSAIDs relieve pain and inflammation by blocking the enzyme cyclo-oxygenase (COX):
• COX comes in two forms, one of which (COX-2) triggers the synthesis of inflammatory compounds, while the other (COX-1) balances this action by causing the production of factors that protect the gastrointestinal mucosal cells and limit gastric acid output.
• NSAIDs block both COX-1 and COX-2, thus significantly increasing the risk of ulcer formation.
• Studies have shown that the risk for gastrointestinal bleeding because of peptic ulcers is increased not only in individuals using higher doses of NSAIDs to treat arthritis and headaches, but also in those using the lower doses (300mg, 150mg, 75 mg) commonly recommended to prevent heart attacks and strokes:
• Risk is dose dependent – a dosage of 75 mg q.d. is associated with 30% less bleeding than 150mg q.d., and 40% less bleeding than 400 mg q.d.
• Combining NSAID use with smoking is especially harmful; NSAID use causes an ulcer, and smoking stimulates gastric acid output, worsening ulcer symptoms and severity.
• Smoking: smoking causes increased frequency of ulcer formation, decreased response to peptic ulcer therapy, and increased mortality as a result of peptic ulcers:
• Smoking increases occurrence and severity of peptic ulcers by:
• Increasing the backflow (reflux) of bile salts into the stomach. Bile salts are extremely irritating to the stomach and initial portions of the duodenum
• Decreasing the secretion of bicarbonate (an important neutralizer of gastric acid) by the pancreas
• Accelerating the passage of food from the stomach into the duodenum.
• The chronic anxiety and psychological stress associated with smoking appear to worsen ulcer activity.
• Stress and emotions: a large study of 4,000 persons found that while the number of stressful events did not correlate with ulcer risk, those individuals who perceived their lives as stressful were at increased risk of developing peptic ulcer. These data suggest that the person’s response, not the amount of stress, is the significant causative factor. As a group, ulcer patients tend to repress emotions.
• Food allergy: clinical and experimental evidence shows food allergy is a primary factor in many cases of peptic ulcer:
• In one study, 98% of patients with X-ray evidence of peptic ulcer also had food allergies. In another study of 43 allergic children with X-ray-diagnosed peptic ulcer, 25 had food allergies.
• Milk, in particular, may be a causative factor since it is not only a highly allergenic food but also significantly increases the production of gastric juices.

 

RISK INCREASES WITH

• Helicobacter pylori infection.
• NSAID use (e.g., aspirin, ibuprofen, acetaminophen)
• Frequent use of antacids or drugs such as Pepcid, Tagamet, Zantac: a low acid environment increases susceptibility to H. pylori infection and contributes to nutrient deficiencies and food allergies since food cannot be properly digested without sufficient hydrochloric acid. Taken regularly, antacids can also lead tobowel irregularities, kidney stones and other side effects.
• Male sex: peptic ulcers are roughly twice as common in men as in women; duodenal ulcers are four times more common in men than in women.
• Smoking.
• Food allergy.
• Type O blood group (for duodenal ulcers): persons with this blood type typically secrete more stomach acid than those with the other blood types.
• Excessive stress, especially when coupled with a tendency to repress emotions.
• Disease-promoting diet: a diet based on animal products and processed foods, with little consumption of fresh vegetables, legumes, fruits, nuts and seeds, and whole grains is low in protective factors – fiber, flavonoids, and antioxidants.

PREVENTIVE MEASURES

• Avoid frequent use of NSAIDs: work with a physician to discover and heal the underlying causes of pain and inflammation. Effective natural anti-inflammatory agents exist that provide the temporary relief needed during healing without damaging the lining of the gastrointestinal tract.
• Don’t smoke
• Avoid frequent use of antacids: antacids are relatively safe when used occasionally according to label instructions, but avoid antacids that contain aluminium. For gas (flatulence) and bloating, activated charcoal is an effective natural remedy that, unlike antacids, will not disrupt proper digestion.
• Avoid excessive stress as best you can by avoiding excessive work hours, poor nutrition, and inadequate
  rest.
• Identify and eliminate any allergenic foods from your diet.
• Follow a health-promoting diet: consume a nutrient dense diet rich in whole, unprocessed, preferably  organic foods, especially plant foods (fruits, vegetables, beans, seeds and nuts), and cold-water fish, and low in animal products.
• Don’t repress feelings: be assertive, expressing thoughts and feelings in a kind way, as one would wish
  to be treated, to help improve relationships at work and at home.
• Build long-term health: take time to build long-term health by discovering enjoyable outlets of self-expression, getting regular exercise, and performing stress-reduction techniques and calming, deep-breathing exercises.

 

Expected outcomes

Complete healing of peptic ulcers within 2–4 weeks.

 

 TREATMENT

Diet

• Identify and eliminate allergenic foods, especially milk, from your diet.
• Identify and eliminate foods that irritate your stomach lining or cause additional secretion of stomach acid. Common food irritants include coffee, alcohol, citrus juices, sugar, and hot and spicy foods.
• Eat a diet rich in high-fiber plant foods: a fiber-rich diet is associated with a reduced rate of ulcers. Therapeutic use of a high-fiber diet in patients with duodenal ulcers decreases the recurrence rate by 50%. Consuming fiber-rich fruits and vegetables is preferable to the use of fiber supplements (pectin, guar gum,
  psyllium) since plant foods also contain a wide variety of protective flavonoids and antioxidants.
• Increase consumption of steamed green vegetables, leafy greens and alfalfa sprouts: all are good sources of vitamin K, which promotes healing of the mucosal lining and prevents bleeding.
• Consume fresh cabbage juice and other vegetable juices daily: raw cabbage juice is well documented as producing remarkable recovery from peptic ulcers. In one study, 1 L of fresh cabbage juice q.d., taken in divided doses, resulted in total ulcer healing in an average of 10 days. The cabbage should be juiced, and the juice taken immediately after preparation. Cabbage juice’s high glutamine content is likely a primary reason for its effectiveness. (Glutamine is also recommended as a nutritional supplement, see below.)
• Eat five mini-meals a day: by consuming frequent small meals, triggering excessive digestive acid production is avoided and will ensure that any acid present has something to digest other than the stomach lining.
• Try a cup of chamomile tea with meals: chamomile is an antispasmodic, eases abdominal gas, has a mild anti-inflammatory effect on the lining of the digestive tract, and also has antimicrobial properties.

Nutritional supplements

• Vitamin A: all mucosal tissues rely on vitamin A. When vitamin A status is inadequate, keratin is secreted in these tissues, transforming them from their normally pliable, moist condition into stiff dry tissue that is unable to carry out its normal functions, and leading to breaches in integrity that significantly increase susceptibility to infection, food allergy, and peptic ulcer formation:
• In rats, vitamin A has been shown to inhibit the development of stress ulcers.
• Vitamin E: a powerful antioxidant, vitamin E protects fat-soluble components of the body, such as mucosal cell membranes, from damage by free radicals
• Vitamin E, like vitamin A, has been shown to inhibit development of stress ulcers in rats.
• In addition, vitamin E protects vitamin A and increases its storage.
• Vitamin C: an essential antioxidant found in all water-soluble body compartments, vitamin C strengthens and maintains normal mucosal integrity, improves ulcer healing, and enhances immune function. In addition, vitamin C regenerates vitamin E after it has used up its antioxidant potential.
• Flavonoids: a group of plant pigments largely responsible for the colours of fruits and flowers, flavonoids exert significant antiulcer activity by:
• Counteracting both the production and secretion of histamine, an inflammatory chemical that stimulates the release of gastric acid:
• Studies on guinea pigs and rats have demonstrated that the flavonoid, catechin, provides significant antiulcer protection
• In human studies, catechin reduced histamine levels in gastric tissue in both normal patients and those with gastric and duodenal ulcers.
• Several flavonoids have also been shown to inhibit H. pylori, plus, unlike antibiotics, the flavonoids also augmented natural defense factors that prevent ulcer formation.
• Glutamine: an amino acid, glutamine is a critical nutrient for the growth and function of intestinal cells, playing an important role in the manufacture of compounds that line and protect the stomach and small intestine:
• The high glutamine content of cabbage juice is thought to be largely responsible for its effectiveness in treating peptic ulcers.
• Bismuth subcitrate: a naturally occurring mineral, bismuth acts as an antacid and exerts activity against H. pylori:
• Although Pepto-Bismol, which is bismuth subsalicylate, is the best known bismuth preparation, another form of bismuth, bismuth subcitrate, has produced better results against H. pylori.
• Zinc: zinc increases mucin production and has been shown to have a protective effect against peptic ulcers in animals and a curative effect in humans:
• In addition to its effect on mucin production, zinc protects against free radical damage, acts synergistically with vitamin A, and is involved in wound healing, immune system activity, inflammation control, and tissue regeneration.

Botanical medicines

• Deglycyrrhizinated licorice (DGL): a form of licorice from which the compound glycyrrhetinic acid has been removed (it causes elevations in blood pressure in some cases), DGL is a very effective antiulcer agent with no known side effects:
• DGL stimulates and/or accelerates the factors that protect against ulcer formation, and is composed of several flavonoids that have been shown to inhibit H. pylori.
• DGL may promote the release of salivary compounds that stimulate the growth and regeneration of stomach and intestinal cells. DGL is therefore given as a chewable tablet, so it can promote and mix with saliva.
• DGL has been shown to reduce the gastric bleeding caused by aspirin and is recommended for prevention of gastric ulcers in patients who require long-term treatment with ulcer-causing drugs, such as aspirin, other NSAIDs, or corticosteroids
• DGL is also very effective in treating duodenal ulcers. In a study of 40 patients with duodenal ulcers of 4–12 years’ duration, all of whom had been referred for surgery, initially half of the patients, then the other half were given DGL. All 40 showed substantial improvement, usually within 5–7 days of beginning DGL, and none required surgery during the 1-year follow-up.
• In several head-to-head comparison studies, DGL has been shown to be more effective than Tagamet, Zantac, or antacids in both short-term and maintenance treatment of peptic ulcers:
• Aloe vera and rhubarb: in over 90% of 312 cases of active intestinal bleeding, alcohol-extracted tablets of rhubarb (Rheum species) stopped active bleeding in under 60 hours:
• Both aloe vera and rhubarb contain similar flavonoids that act as astringents (i.e., drying agents), but aloe vera juice is recommended since it is more accessible.

Drug–herb interaction cautions

None.

Psychological medicine

• Develop an effective stress-reduction program: eliminate or control stressors and design a regular relaxation plan.

ICIM Medics Approach

If you feel that this article relates to you and you suffer from a Peptic Ulcer then please make an appointment to see one of ICIM Medics Natural Medical Practitioners.

Some tests may be prescribed depending upon your individual case for example breath test to help confirm the presence of H-Pylori infection. The results from these can be used by one of our Natural Medical Practitioners who will help you with your individualised treatment plan. This may include dietary, nutritional and/or botanical advice.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  Both appointments can be arranged for you.

Tags: Duodenal Ulcer, Gastric Ulcer, Peptic Ulcer