Peptic Ulcer Disease
What are ulcers?
Peptic ulcers or stomach ulcers are painful, open sores that develop on the lining of the stomach, small intestine and esophagus. Peptic ulcer disease (PUD) is a common disorder that affects between four and five million people in the United States each year, accounting for roughly 10% of medical costs for digestive disorders. Not long ago, it was thought that peptic ulcer disease (PUD) was primarily a result of lifestyle and dietary factors, typically too much stress or spicy food. However, over the past 20 years, major advances have been made in the understanding of peptic ulcers such that we now know that ulcers of the stomach and small intestine (specifically the upper portion, called the duodenum) develop in response to many factors, including bacterial infection and the use of certain medications, as well as lifestyle and dietary factors. Ulcers in the esophagus can also be associated with gastroesophageal reflux (GERD). These discoveries about peptic ulcers have led to important changes in diagnostic and treatment strategies, with oftentimes successful treatment taking just a few weeks.
What are the symptoms of ulcers?
The most common symptom of PUD is pain that is burning or searing in nature and can be felt anywhere from the top of the sternum all the way down to the navel. Peptic ulcer or stomach ulcer pain can last from minutes to several hours, and can come and go for a few days to weeks. It is typically aggravated by excess stomach acid, which can happen especially at nighttime, when one's stomach is empty or in relation to eating or drinking certain foods. Pain can be reduced by eating other foods that help neutralize stomach acid or by taking acid-suppressing medications.
Complications of an ulcer are uncommon but include chronic nausea or vomiting; internal bleeding that can be heralded by vomiting blood (hematemesis), which can appear bright red or with a dark, coffee-ground appearance, or having dark, tarry stools; perforation; and unexplained weight loss.
What are the causes of peptic ulcers?
We now know that many ulcers are caused by a bacterium called Helicobacter pylori (H. pylori). This discovery won the Nobel Prize for Medicine in 2005. H. pylori can cause both peptic ulcers and stomach cancer, or it may cause no symptoms at all. It is a common gastrointestinal infection with 20 percent of people younger than thirty and 50 percent of individuals over sixty harboring the bacteria in their digestive tracts. And yet, fewer than half of all people infected with H. pylori ever develop PUD.
Although it isn't exactly clear how H. pylori spreads from one person to another, it is thought that it can be transmitted via food, water and close physical contact . Results of a study from the Aug. 1, 2003 issue of the Journal of the American College of Nutrition showed that infection with H. pylori was more likely in individuals with low blood levels of vitamin C. Although cause and effect was not clear, the researchers who conducted the study did recommend increased vitamin C consumption.
Additional causes of ulcers besides H. pylori include excess digestive acids that damage the lining of the digestive tract and, sometimes, long-term use of anti-inflammatory drugs - both non-steroidal drugs (NSAIDS) like Ibuprofen and Naproxen in addition to the use of steroid medications like Prednisone. Smoking and excess alcohol consumption can increase the risk of ulcer formation as well as slow down healing of already existing ulcers. Although stress isn't considered a sole cause of PUD as it once was thought, unmanaged stress induces changes in immune system function, blood flow, and acid secretion that can lead to upper digestive tract mucosal injury, as well as aggravate symptoms and delay healing.
What is the conventional treatment of ulcers?
Ulcers can sometimes be identified with an upper GI X-ray, but are most often visualized directly with the use of an endoscope, a long narrow tube that is threaded down the esophagus of an anesthetized patient and into the stomach and upper small intestine. If necessary, a biopsy of tissue can be taken close to the ulcer to check for the presence of H. pylori and to rule out cancer. Blood, breath and stool tests can also detect the presence of H. pylori and are a good way to monitor treatment progress.
The conventional treatment of PUD focuses on killing the bacteria and reducing the level of acid in the stomach to relieve pain and encourage healing. This is done with a combination of two antibiotics ( most commonly amoxacillin or metronidazole together with clarithromycin ) plus a drug to reduce or neutralize stomach acid (such as omeprazole ), so-called "triple therapy." The duration of treatment is typically only two weeks, yet the approach is often very effective.
Ulcers that do not heal with treatment may indicate a resistant form of H. pylori or the presence of other factors interfering with the healing process like smoking, alcohol or NSAID use. Rare causes of ulcers include extreme overproduction of stomach acid (Zollinger-Ellison syndrome), stomach cancer, or Crohn's disease.
What therapies does Dr. Weil recommend for peptic ulcers?
- Peptic ulcer dietary changes: As a general guideline, follow the anti-inflammatory diet. Specifically:
- Avoid all coffee and other sources of caffeine, including decaffeinated coffee, as well as alcohol and tobacco.
- Avoid milk and milk products as well, they increase acid secretion. Eat smaller amounts of foods more frequently.
- Don't let your stomach go empty for long periods of time.
- Drink peppermint tea and chamomile teas frequently. Both soothe the lining of the digestive tract; however, if you have been diagnosed with GERD it is best to avoid peppermint, which may worsen symptoms of GERD.
- Try taking one teaspoon of aloe vera juice after meals.
- Sip red pepper tea (one quarter teaspoon of cayenne pepper steeped in a cup of hot water) or a small capsule of the powder. Cayenne pepper has a good local anesthetic effect.
- For prevention, be sure to eat foods high in vitamin C. If acidic sources like citrus fruits and tomatoes are bothersome, try apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, kiwi, fortified foods (breads, grains, cereal), dark leafy greens (kale, spinach), peppers (especially red bell peppers), and potatoes.
- Supplements: Avoid frequent use of aspirin and other salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs). Use acetaminophen (Tylenol) or an herbal anti-inflammatory for the treatment of mild pain instead, but even acetaminophen may not be safe for long-term use. Don't take steroids unless your doctor insists.
To protect the lining of your stomach and duodenum take deglycyrrhizinated licorice (DGL), which has excellent soothing and healing properties. The dose is one half teaspoon of DGL powder or two tablets of DGL extract (chew these slowly) before or between meals. You can continue taking DGL as long as you have symptoms.
- Mind/Body Medicine: Make serious efforts to neutralize stress in your life by practicing healthy stress management techniques such as breathing exercises and meditation, learning visualization or hypnotherapy (or both) to heal your ulcer, or by taking a course of biofeedback training. As necessary, create positive changes in whatever in your life causes you the most stress - your job, living situation, or relationships.