Gastric/Peptic/Duodenal Ulcers

The pain usually occurs 2-3 hours after a meal and is relieved by antacids or by eating more food.

Most patients with ulcers complain of pain or discomfort that is located in the upper part of the stomach, often in the area immediately below or around the lower part of the breast bone.  This is called epigastric pain.  Symptoms may be associated with meals, or occur in-between meals, or sometimes even occur at night to the point where one can be woken up from sleep.  This pain may be relieved by meals also.

Stomach ulcer symptoms are usually worse on an empty stomach and better after eating – especially foods that help neutralize stomach acid.

If you have a stomach ulcer, the pain usually begins about 15 to 20 minutes after eating, especially after large meals.

Stomach ulcers normally cause pain within 1-1½ hours of eating a meal; duodenal ulcers usually result in pain that starts 1½-2 hours after a meal.

Bleeding from an ulcer may occur in the stomach or the duodenum, and sometimes is the only symptom.  Rapid bleeding causes bowel movements to become black or even bloody.

Rapid bleeding can cause bowel movements to become black or even bloody.

Bleeding ulcers may cause nausea and vomiting of acidified blood resembling "coffee grounds" material.

Patients with a bleeding ulcer may report a sense of passing out upon standing called orthostatic syncope.

'Ruptured' gastric ulcers which have gone through the stomach wall can cause a sharp pain which sometimes can be described as a pain felt in the region between the shoulder blades.

A chronic ulcer causes swelling and inflammation of the gastric and duodenal tissues.  Over time, scarring may close the pylorus, the lower end of the esophagus, thus preventing the passage of food and causing vomiting and weight loss.

There is a relatively high prevalence of GERD amongst patients with duodenal or gastric ulcers.  Persistent dyspepsia/heartburn symptoms after eradication of H. pylori and ulcer resolution might suggest the treatment of GERD as a separate entity. [Am J Gastroenterol 2000;95: pp.101-5]

Sometimes an ulcer eats a hole in the wall of the stomach or duodenum.  Bacteria and partially digested food can spill through the opening into the sterile abdominal cavity, called the peritoneum.  This causes peritonitis, an inflammation of the abdominal cavity and wall.  A perforated ulcer usually requires immediate hospitalization and surgery.

Smoking is associated with the development, delayed healing and recurrence of peptic ulcers, as well as resistance to treatment.

Patients with hyperparathyroidism may be more likely to develop peptic ulcers, high blood pressure, and pancreatitis.

Inflammation may be caused by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs), but the bacterium H. pylori is generally responsible.

The caffeine, oils and acids in coffee irritate the stomach lining, which can cause excessive production of stomach acid and lead to a variety of digestive disorders.  Decaf can also bring on a similar increase in stomach acid.  Research has shown a definite link between coffee drinking and ulcers.  Some anti-ulcer drugs, like cimetidine (Tagamet), slow down the rate at which the body metabolizes caffeine.  So not only does coffee increase the acid, but the drugs extend caffeine's effects by keeping it circulating longer.

Severe inflammation of the stomach lining (gastritis) can result in ulceration.

The average person's lifetime chance of suffering from a peptic ulcer is 5-10%, but this rises to 10-20% in those who are Helicobacter pylori positive.  H. Pylori infection usually persists for many years, leading to ulcer disease in 10-15% of those infected.  H. pylori is found in more than 80% of patients with gastric and duodenal ulcers.

In general the duodenum isn't as well protected with mucus as is the stomach and is more prone to ulcers.  A deficiency of pancreatic juices to neutralize the acid chyme from the stomach, or stress causing sympathetic inhibition of enzyme secretion can lead to duodenal ulcer formation.

Stomach ulcers can cause vomiting, nausea and difficulty drinking, all of which can increase the risk of dehydration.

Preliminary studies have shown that supplements of glutamine may protect against aspirin-induced gastric lesions and enhance healing of painful peptic ulcers.

Fresh cabbage juice has for a long time been used successfully against ulcers, probably due to its glutamine content.  The amino acid glutamine works over time in doses as low as 500mg three times daily (for one month) to heal stomach and small intestine lesions.  A study of ulcers found that 1600mg of glutamine per day had a 50% cure rate within 2 weeks and 92% within 4 weeks.

Robert's Formula is a time-honored herbal preparation for upper GI inflammation.  It sometimes contains bismuth, which kills H. Pylori, usually found in upper GI ulceration, as well as other microorganisms.

Mastic gum has killed H. pylori and cured peptic ulcers after just 2 weeks of use.  500mg to 1gm twice per day for 2 weeks causes structural changes in H. Pylori (of which there are at least 7 strains) resulting in its weakening and death. [Mastic Gum kills H. Pylori, NEJM 1998 Dec 24;339(26): p.1946]

Goldenseal tea.  See the link between Peptic Ulcers and Water Consumption Increase.

Flax seed tea.  See the link between Peptic Ulcers and Water Consumption Increase.

Comfrey leaf tea may be beneficial.

Licorice root, particularly deglycyrrhized licorice, can be a useful adjunct to antibiotic treatment because it accelerates the healing of the stomach lining.  Deglycyrrhized licorice root (DGL) and glutamine have been used to get people off of antacids, H2 blockers and proton pump inhibitors (PPI).

Consuming up to 12 cups of water per day can eliminate the helicobacter infection when present.  Drink lots of water, golden seal tea, and flax seed tea.

Avoid spicy foods when you're having pain, or any other food that adds to the pain.

Try 4 ounces of fresh raw cabbage juice 4 times daily.

No proven relationship exists between peptic ulcer disease and the intake of alcohol.  However, since alcohol can cause gastritis, moderation in alcohol consumption is often recommended.

Since coffee stimulates gastric acid secretion, moderation in coffee consumption is often recommended.

In an extensive study of the effect of bromelain on the stomach lining, it was found that bromelain increased the uptake of sulfur by 50% and glucosamine by 30-90%.  Increased uptake of these substances allows the tissue to heal more rapidly. [Hawaii Med J 1976;2: pp.39-47]

While the mechanism of how H. pylori causes ulcers is not well understood, its elimination by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence.

Prostaglandins are substances that are important in helping the gut linings resist corrosive acid damage.  NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as bleeding, stomach obstruction and perforation.  Cigarette smoking is also a leading cause of ulcer medication treatment failure: smoking slows the healing of ulcers.

In a double-blind study on 18 patients, those taking zinc sulfate supplements had a gastric ulcer healing rate three times that of patients treated with a placebo. [The healing of gastric ulcers by zinc sulfate. Med J Aust 2(21): pp.793-6, 1975]

Cuban doctors are using capsules filled with ozonated oil to treat gastroduodenal ulcers, gastritis, giardia and peptic ulcers.

Decrease your stress level.

In rare cases, niacin has aggravated peptic ulceration.

Active men had one-half to one-third the risk of developing a duodenal ulcer over 20 years compared with their sedentary counterparts.  Men who walked or ran at least 10 miles per week were 62% less likely than inactive subjects to develop an ulcer.  Men who walked or ran less than 10 miles each week had about half the ulcer risk of those with no regular exercise.