ULCERS
Peptic ulcers are sores that develop on the inside lining of the stomach, upper small intestine, or esophagus, causing significant pain and discomfort. Their name is derived from pepsin, an enzyme secreted by glands in the stomach. Along with pepsin, acids are secreted in the stomach to aid digestion. Other glands in the stomach and intestine secrete mucus, which functions to protect the lining of the digestive tract from the corrosive effect of pepsin and acid. If there is damage to the lining of the stomach or intestine and the mucous layer breaks down, an ulcer can develop.
It is estimated that about one in 10 Canadians develops an ulcer at some time in his or her life. Ulcers generally affect people over the age of 30, but children can get them as well.
Years ago stress and poor diet were thought to be the cause of ulcers. In recent years, however, it was discovered that infection with a bacterium called Helicobacter pylori {H. Pylori) is responsible for causing most ulcers. This bacterium lives within the mucous layer that covers and protects the lining of the stomach and small intestine. H. Pylori is a normal inhabitant of this area, and does not always cause problems. However, in certain individuals and under certain conditions, it can disrupt the mucous layer, erode the lining of the digestive tract, and lead to an ulcer.
Stress and diet may still contribute to the problem, causing damage to the lining and making it easier for bacteria to invade and damage the sensitive tissues. Ulcers can also be caused by taking non-steroidal anti-inflammatory drugs (NSAIDs), which erode and inflame the lining of the stomach and intestines.
It is estimated that one in five people under 40 years and half of people over 60 are infected with H. Pylori. It is not known how it spreads, but it may occur with close contact, such as kissing, or through contaminated food and water.
TYPES OF ULCERS
Ulcers have different names, depending on their location:
Duodenal ulcers develop in the duodenum (first part of the small intestine), which is the most common location.
Esophageal ulcers are located in the lower section of the esophagus, and are often associated with chronic gastroesophageal reflux disease (GERD).
Gastric ulcers occur in the stomach.
SIGNS & SYMPTOMS
Chest pain Dark blood in stools Loss of appetite Nausea or vomiting
Pain, which is often worse when the stomach is empty and at night, and is temporarily relieved by eating or taking antacids
• Weight loss
Note: If left untreated, ulcers can lead to serious problems such as bleeding, obstruction of the digestive tract (due to scarring), or serious infection due to leaking of the intestinal contents into the belly.
RISK FACTORS
In addition to H. Pylori, other factors that increase the risk of ulcers include:
• Alcohol: Irritates and erodes the mucous lining of the stomach and increases the amount of stomach acid that is produced
• Food allergies: May cause damage to stomach lining, increasing the risk of ulcers
• NSAIDs (non-steroidal anti-inflammatory drugs)
• Smoking: Nicotine increases the volume and concentration of stomach acid.
• Stress: May aggravate symptoms and delay healing
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND ULCERS
Non-steroidal anti-inflammatory drugs inhibit production of an enzyme (cyclooxy-genase) that produces prostaglandins, hormone-like substances that protect the stomach lining. Without this protection, stomach acid can damage the lining, causing bleeding and ulcers. Examples of these drugs include aspirin, Motrin and Advil (ibuprofen), Naprosyn (naproxen), and Indocid (indomethacin). Taking these drugs with meals may help reduce stomach upset, but will not prevent ulcers. Take only when absolutely necessary at the lowest dosage.
DOCTOR’S ORDERS
For ulcers caused by H. Pylori bacteria, a seven to 14-day course of antibiotics is prescribed to kill the bacteria. Antibiotics commonly used include Amoxil (amoxicillin), Biaxin (clarithromycin), or Flagyl (metronidazole). Two of these are typically prescribed along with an acid-blocking drug, such as Prevacid (lansoprazole), to allow the area to heal. Some companies put the three drugs together in one package, such as the HP-Pak.
Depending on the severity of the ulcer, acid-reducing drugs may be needed for several weeks to months to allow healing. Histamine (H-2) blockers reduce the amount of hydrochloric acid released into the stomach. They work by blocking the action of histamine, a substance that signals acid secretion into the stomach. Examples include Zantac (ranitidine), Pepcid (famotidine), and Tagamet (cimetidine).
Proton pump inhibitors shut down the pumps that secrete acid into the stomach. Examples include Prevacid, (lansoprazole), Nexium (esomeprazole), or Losec (omeprazole).
Antacids may be used along with the above drugs or alone. They provide rapid relief and work by neutralizing stomach acid. Examples include Tums, Rolaids, and Maalox.
Cytoprotective drugs protect the lining of the stomach and intestine. Examples include Sulcrate (sucralfate) and Cytotec (misoprostol). They may be given to protect the stomach when NSAIDS are being used.
Ulcers caused by H. Pylori infection will most likely require medical treatment. The following suggestions may help improve healing and reduce the risk of developing an ulcer.
Dietary Recommendations
Foods to include:
• Cultured and fermented foods such as kefir and yogurt provide friendly bacteria that help to combat H. Pylori.
• Cabbage and aloe vera juice may help improve healing.
• Foods rich in vitamin K (leafy green vegetables) and zinc (whole grains and seeds) can improve healing.
• Bananas are protective to the stomach.
• Drink herbal teas with marshmallow, slippery elm, and chamomile, which can soothe the irritated lining.
• Cranberry juice can prevent the adhesion of H. Pylori to the stomach wall.
Foods to avoid:
• Alcohol, caffeine, and spicy foods can irritate and increase stomach acid.
• Sugar and salt increase stomach acidity and may aggravate symptoms.
Lifestyle Suggestions
• Don’t smoke, as nicotine is very irritating to the stomach lining and slows healing.
• Elevate your pillow to prevent stomach acid from flowing up your esophagus.
• Reduce stress by trying massage, yoga, breathing exercises, or meditation.
Top Recommended Supplements
Deglycyrrhizinated licorice (DCL): Soothes inflamed and damaged mucous lining, promotes healing, and may inhibit growth of H. Pylori. Some research suggests that it might help protect the stomach against NSAID usage. Dosage: 500 mg 15 minutes before meals and at bedtime. Look for a chewable product.
Probiotics: Several studies have found that probiotics (especially those in the Lactobacillus family) can inhibit the growth of H. Pylori. They also improve the ability of antibiotics to destroy bacteria and reduce antibiotic side effects such as diarrhea and yeast overgrowth. Dosage: One to three capsules daily of a product providing 1 billion live cells per capsule or tablet.
Complementary Supplements
Glutamine: An amino acid that provides energy for the cells that line the intestine and stomach. Levels may be depleted in those with ulcers, and supplementing has been shown to offer some benefits to promote healing. Dosage: 500-1,000 mg three times daily.
Zinc: Required for tissue repair. Some evidence suggests that it can promote healing of ulcers. Dosage: 25-50 mg daily. Take copper (1-3 mg) to prevent copper deficiency.
FINAL THOUGHTS
To reduce your risk of ulcers and improve healing:
1. Don’t smoke, reduce stress, and avoid taking NSAIDs.
2. Eat fermented and cultured foods and drink cranberry juice to inhibit H. Pylori.
3. Cabbage, aloe vera juice, and green vegetables promote ulcer healing.
4. Probiotic supplements can inhibit H. Pylori, improve antibiotic treatment of H. Pylori, and reduce antibiotic side effects.
5. Promote healing of an ulcer with zinc, glutamine, and DGL.
