Peptic Ulcer

Peptic ulcers are sores in the lining of either the duodenum (duodenal ulcers) or the stomach (gastric ulcers). The duodenum is located at the beginning of the small intestine. About 10 percent of all people get ulcers and they often recur.

Signs and Symptoms

• Duodenal ulcers often cause pain with burning or gnawing sensations. This pain often occurs after eating and is relieved by antacids and milk. Increased pain vomiting blood tarry or red stools or losing a lot of weight are signs of serious complications.
• Gastric ulcers often cause gnawing or burning pain. One day your pain may be relieved from food or an antacid and the next day these may not help at all. You may have vomiting or nausea.

What Causes It?

When the stomach's natural protections from acid stop working you can get an ulcer. There are a few different ways this happens.

• A kind of bacteria called Helicobacter pylori causes 90 percent of duodenal ulcers and 70 to 80 percent of gastric ulcers.
• Drugs like ibuprofen can cause gastric ulcers.
• Zollinger–Ellison syndrome causes diarrhea and ulcers.
• Certain diseases like alcoholism can cause ulcers.

What to Expect at Your Provider's Office

Your provider may take an X-ray of your stomach. You will drink a liquid called barium which makes your gastointestinal tract show up on the X-ray. Or you may have an endoscopic exam where a thin tube with a small camera-like device on the end explores your stomach. Your provider will also give you a urea breath test or a blood test for H. pylori.

Treatment Options

Treatment Plan

If you have H. pylori you will probably be given two or three different drugs to take together (antibiotics and stomach acid-reducing drugs). You will need to take them for two weeks. If you have a perforated ulcer an obstruction bleeding or do not respond to medical treatments you may need to have surgery.

Drug Therapies

Prescription

• Antibiotics (for example amoxicillin or tetracycline and metronidazole) plus acid-reducing drugs (for example bismuth subsalicylate [Pepto-Bismol])—for H. pylori three drugs are considered most effective but variations are commonly used; H. pylori resistance to antibiotics is problematic worldwide; side effects include diarrhea and colitis
• Colloidal bismuth compounds—antacids that can also destroy H. pylori
• H2 receptor antagonists—inhibit gastric acid secretion; serious side effects are rare (for example reversible hepatitis)
• Proton-pump inhibitors—decrease gastric acid secretion; various side effects

Over the Counter

• Antacids—reduce acid relieve symptoms and help heal the ulcer

Complementary and Alternative Therapies

Nutritional and herbal support help to heal stomach lining fight infection and reduce recurrence.

Nutrition

• Avoid dairy products caffeine alcohol and sugar. Coffee even decaffeinated should be eliminated because of irritating oils.
• Eliminate any known food allergens.
• Include sulfur-containing foods such as garlic onions broccoli cabbage Brussels sprouts and cauliflower in your diet. Sulfur is the basis of glutathione which provides antioxidant protection to the stomach lining. N-acetyl cysteine (200 mg twice a day) is also a precursor to glutathione.
• Bananas contain potassium and plantain both of which yield benefits.
• Acidophilus (one capsule with meals) can help normalize bowel bacteria and inhibit growth of H. pylori.
• Essential fatty acids (1 000 to 1 500 mg two to three times per day) reduce inflammation and inhibit the growth of H. pylori.
• Vitamin C (1 000 mg three times per day) decreases nitrosamines which are linked to stomach cancer and inhibits growth of H. pylori.
• Zinc (30 to 50 mg per day) enhances healing.
• Vitamin E (400 IU per day) enhances healing.
• Vitamin A (50 000 IU per day for 2 weeks followed by 10 000 to 25 000 IU per day) for longer term maintenance
• Glutamine (500 mg three times per day) promotes healing of ulcers. Cabbage juice (1 qt. per day) is high in glutamine.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• DGL (deglycyrrhizinated licorice) 250 mg four times a day 15 to 20 minutes before meals and one to two hours after the last meal of the day increases local circulation and speeds healing of the stomach lining. Safe for people with high blood pressure.
• Quercetin (250 to 500 mg before meals) or catechin (500 to 1 000 mg before meals) are bioflavonoids that reduce gastric inflammation.
• Powders of slippery elm (Ulmus rubra) and marshmallow root (Althea officinalis) may be taken singly or together 1 tsp. two to three times per day to decrease inflammation and encourage healing.
• For a soothing tea combine equal parts of three to six of the following herbs in a tea and sip before meals. Chamomile (Matricaria recutita) lemon balm (Melissa officinalis) catnip (Nepeta cateria) passionflower (Passiflora incarnata) meadowsweet (Filependula ulmaria) peppermint (Mentha piperita) and valerian (Valeriana officinalis).
• Bismuth subcitrate (120 mg four times a day for eight weeks) may be helpful in eradicating H. pylori and reducing recurrence of peptic ulcer disease. Combining it with barberry (Berberis vulgaris) goldenseal (Hydrastis canadensis) or Oregon grape (Berberis aquifolium) may make its antimicrobial effects stronger. Take one or more in tincture form 30 to 60 drops three times a day.

Homeopathy

Some of the most common remedies used for peptic ulcers are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Argentum nitricum for abdominal bloating with belching and pain
• Arsenicum album for ulcers with intense burning pains and nausea; take it if you cannot bear the sight or smell of food and are thirsty.
• Lycopodium for bloating after eating with burning that lasts for hours; take it if you feel hungry soon after eating and wake hungry.

Acupuncture

Acupuncture may improve overall digestive function.

Massage

Therapeutic massage can relieve stress and increase sense of well-being.

Following Up

If you are not better after a month return to your provider. If you are pregnant talk with your health care provider before taking any medications or supplements.

Supporting Research

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:427 432.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998.

Kruzel T. The Homeopathic Emergency Guide. Berkeley Calif: North Atlantic Books; 1992:134–137.

Murray M Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:522–523.

Sabiston DC ed. Textbook of Surgery. 15th ed. Philadelphia Pa: WB Saunders; 1998.

Copyright © 2000 Integrative Medicine Communications

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