January 8, 2017

Stomach Ulcers

An ulcer is a sore a broken exposed area of the skin or internal lining (mucous membrane) which is slow healing or fails to heal at all. Some common sites for ulcers are mouth, stomach, small intestines and legs.

What is a stomach ulcer?

Ulcers of the gastro-intestinal tract are called peptic ulcers. These peptic ulcers develop on the inside lining of your stomach (Gastric ulcer) and the upper portion of the small intestine (Duodenal ulcer). Stomach pain is the predominant symptom.

 

What causes stomach ulcers?

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.

The digestive tract is protected from the gastric acid by a coating of mucous membrane. Two conditions can weaken this barrier: 1) an increase in the amount of acid or a decrease in the layer of mucus membrane. Either condition lends itself to the development of an ulcer.

Common causes include:

  • The Helicobacter pylori bacteria which commonly live in the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, the H. pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer.

H. pylori may be transmitted from person to person by close contact, such as kissing. People may also contract H. pylori through food and water.

  • Ongoing use or abuse of certain analgesics (pain relievers).
    • Aspirin (ASA)
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • Ibuprofen
      • Advil
      • Aleve
      • Motrin
      • Naproxen sodium (such as Aleve, Anaprox)

These drugs can irritate or inflame the lining of your stomach and small intestine.  It is therefore not surprising that peptic ulcers are more common in the elderly who take these pain medications frequently or in people who take these medications for osteoarthritis.

There are other medications which when taken with NSAIDs can increase the risk of developing peptic ulcers. They are:

  • steroids
  • anticoagulants
  • low-dose aspirin
  • selective serotonin reuptake inhibitors (SSRIs)
  • Fosamax (alendronate)
  • Actonel (risedronate)

Risk factors for Peptic Ulcers

There are lifestyle habits which may increase the risk of peptic ulcers if you are also taking medication for pain:

  • Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
  • Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
  • Sustained mental and physical stress.
  • Spicy foods which irritate the gut.

Alone, these factors do not cause ulcers, but they can make them worse and more difficult to heal.

Complications

There are serious complications which could occur from having an untreated pepti ulcers. Here are a few:

  • Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  • Infection. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  • Obstruction. Peptic ulcers can lead to swelling, inflammation or scarring that may block passage of food through the digestive tract. A blockage may make you become full easily, vomit and lose weight.


Symptoms of stomach ulcers

  • Burning stomach pain
  • Heartburn
  • Feeling of fullness, bloating or belching
  • Fatty food intolerance
  • Nausea, vomiting

The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.

It must be noted that almost 75% of persons with peptic ulcers are asymptomatic (have no symptoms). Severe signs or symptoms of Peptic ulcer which require urgent medical attention include:

  • Vomiting or vomiting blood (hematamesis) which may appear red or black
  • Dark blood in stools, or stools that are black or tarry (melena stool)
  • Trouble breathing
  • Feeling faint
  • Nausea or vomiting
  • Unexplained weight loss
  • Changes in appetite

Be sure to see your doctor if you have the severe signs or symptoms listed above. Also, see your doctor if over-the-counter antacids and acid blockers relieve your pain but the pain returns.

Diagnosing Peptic Ulcers

In order to detect an ulcer, your doctor will take a medical history and perform a physical exam. These are the diagnostic tests which may be requested:

  • Laboratory tests for H. pylori

Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. He or she may look for H. pylori using a blood, stool or breath test. The breath test is the most accurate. Blood tests are generally inaccurate and should not be routinely used.

For the breath test, you drink or eat something containing radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you’re infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide.

  • Endoscopy

An endoscope is a “telescope-like” instrument used to visualize internal organs. During the procedure, your doctor passes an endoscope down your throat and into your esophagus, stomach and small intestine. The procedure allows your doctor to looks for peptic ulcers.

If your doctor detects an ulcer, a biopsy is done i.e. removal of a tiny piece of the ulcerated tissue.

  • Serial x-rays of the Upper gastrointestinal GI tract

This series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.


Treatment

Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of aspirin and similar pain medications, if possible, and helping your ulcer to heal with medication.

Medications can include:

  • Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).

  • Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).

Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.

  • Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).

  • Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.

Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.

  • Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.

Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

Follow-up after initial treatment

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

Refractory Ulcers (Ulcers that fail to heal)

There are many reasons why an ulcer may fail to heal, including:

  • Not taking medications according to directions
  • The fact that some types of H. pylori are resistant to antibiotics
  • Regular use of tobacco
  • Regular use of pain relievers —  including aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, Anaprox, others) — that increase the risk of ulcers
  • Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome
  • An infection other than H. pylori
  • Stomach cancer
  • Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn’s disease

Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotic.

Surgical Treatment

If you have a serious complication from an ulcer, such as acute bleeding or a perforation, you may require surgery. However, surgery is needed far less often than previously because of the many effective medications now available.

Alternative medicine

Over-the-counter medications that contain calcium carbonate (Tums, Rolaids), may help treat peptic ulcers but should not be used as the primary treatment. There is also some evidence that zinc can help heal ulcers.

Among botanicals recommended to treat peptic ulcers are turmeric, mastic, cabbage, deglycyrrhizinated licorice, and neem bark extract.

While over-the-counter and alternative medications may be helpful, evidence on effectiveness is lacking. Therefore they are not recommended as the primary treatment for peptic ulcers.

Recommended diets foods for stomach ulcers and gastritis?

A diet for ulcers and gastritis is a meal plan that limits foods that irritate your stomach. Certain foods may worsen symptoms such as stomach pain, bloating, heartburn, or indigestion.

Avoid the following foods

You may need to avoid acidic, spicy, or high-fat foods. Not all foods affect everyone the same way. You will need to learn which foods worsen your symptoms and limit those foods. The following are some foods that may worsen ulcer or gastritis symptoms:

  • Beverages:
    • Whole milk and chocolate milk
    • Hot cocoa and cola
    • Any beverage with caffeine
    • Regular and decaffeinated coffee
    • Peppermint and spearmint tea
    • Green and black tea, with or without caffeine
    • Orange and grapefruit juices
    • Drinks that contain alcohol
  • Spices and seasonings:
    • Black and red pepper
    • Chili powder
    • Mustard seed and nutmeg
  • Other foods:
    • Dairy foods made from whole milk or cream
    • Chocolate
    • Spicy or strongly flavored cheeses, such as jalapeno or black pepper
    • Highly seasoned, high-fat meats, such as sausage, salami, bacon, ham, and cold cuts
    • Hot chiles and peppers
    • Tomato products, such as tomato paste, tomato sauce, or tomato juice

Incorporate the following foods in your diet

Eat a variety of healthy foods from all the food groups. Eat fruits, vegetables, whole grains, and fat-free or low-fat dairy foods. Whole grains include whole-wheat breads, cereals, pasta, and brown rice. Choose lean meats, poultry (chicken and turkey), fish, beans, eggs, and nuts. A healthy meal plan is low in unhealthy fats, salt, and added sugar. Healthy fats include olive oil and canola oil. Ask your dietitian for more information about a healthy meal plan.

Other helpful actions are:

  • Avoid eating before bedtime. Stop eating at least 2 hours before bedtime.
  • Eat small, frequent meals every 2-3 hours. Your stomach may tolerate small, frequent meals better than large meals.


Complications associated with stomach ulcers

Peptic ulcers are usually not life-threatening, but can result in serious complications if not treated. Ulcers may erode nearby blood vessels and cause massive internal bleeding. A perforated ulcer may penetrate an adjoining organ, causing infection.


Prevention of stomach ulcers

Peptic ulcers can be caused by a number of factors. Stress increases the stomach’s output of acid, which can erode the stomach’s lining. Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), a type of pain killer, can also increase acid production, and it’s well known that a diet of spicy and citric foods can result in ulcers. Some factors are outside of lifestyle changes, however. Many peptic ulcers are caused by a bacterial infection known as Helicobacter pylori.

Although the abdominal pain resulting from an ulcer will likely deter your appetite, one of the best roads to recovery is with a healthy diet in small portions. Here are five foods which are helpful

1. Leafy greens (and cabbage!) contain high amounts of vitamin K, which can help heal damage done by ulcers. Vitamin K speeds up the healing process and aids in blood clotting. Eat several servings of vitamin K-rich foods daily.

2. Chamomile tea works two-fold to fight ulcers. First, chamomile is a soothing herb, helping to induce calm and relieve stress. Second, chamomile has anti-inflammatory properties that can help speed up the healing process and fight the H. pylori bacteria. Drink up to four cups of chamomile tea a day.

3. Probiotics help restore the balance of bacteria in the body, making them useful for fighting off the H. pylori bacteria that commonly causes ulcers. Probiotics also aid digestion, which can be helpful in bringing the stomach’s juices under control. Take a supplement with at least 4 billion active cultures twice daily, or eat probitoic-rich foods such as yogurt.

4. Aloe vera, known for its soothing properties, can help heal damaged mucus linings. Aloe’s antibacterial properties also make it useful for fighting off the H. pylori bacteria. Drink ¼ cup of aloe vera juice three time daily.

5. Oats and whole grains contain soluble fiber and zinc, which promotes tissue repair and can help heal ulcers.

Aromatherapy as therapy for Peptic Ulcer

A popular type of alternative and complementary treatment is aromatherapy, in which certain substances (essential oils) obtained from plants are inhaled or absorbed by a patient to alleviate symptoms of disease. More than 100 different essential oils are used in aromatherapy. The specific oil selected for a particular disorder is determined by the properties of that oil. Some oils are effective to reduce inflammation, have antibacterial, antiviral and antifungal properties to eliminate disease causing microorganisms, still others stimulate the nervous system, and some act as sedatives, calming the nervous system.

A well trained experienced aromatherapist is able to analyze the patient’s symptoms and determine which the essential oil would best treat the symptoms.

Some oils that are commonly recommended for digestive disorders include:

  • Lavender: an oil which calms the nervous system and is helpful to relieve some types of digestive disorders
  • Peppermint: an oil which has a calming influence on the body, but also because of its carminative properties.
  • German chamomile: this essential oil reduces muscular and nervous spasms and relieves the pain with which they are associated
  • Clary sage: acts as an antispasmodic and also has sedative properties; relieves tension that may be associated with a digestive disorder
  • Fennel which acts both as an antispasmodic and a carminative; it also has strong laxative effects

For centuries, the use of essential oils to treat simpler forms of digestive disorder has been known. Popular herbal teas for digestive symptoms are peppermint and ginger. Symptoms that may be helped are nausea, stomach ache, bloating, morning sickness, and simple forms of food poisoning. Only a drop or two of the essential oils is used as the oils provide a much more concentrated dose of the material than do the leaves, flowers, or stems used usually dried to make tea.

More Home remedies

  • Bananas contain an antibacterial substance that may inhibit the growth of ulcer-causing H. pylori.
  • Cabbage juice can often heal their ulcers in five days. If chugging a quart of cabbage juice turns your stomach inside out, researchers also found that those who eat plain cabbage have quicker healing times as well. Time for some coleslaw!
  • Plums inhibit the growth of H. pylori. Like plums, berries too can help you fight the good fight.
  • Cayenne pepper stimulates blood flow to bring nutrients to the stomach.
  • Licorice has ulcer-healing abilities by reducing the ability of stomach acid to damage stomach lining.
  • Slippery elm is used for its ability to soothe the mucous membranes that line the stomach and duodenum.
  • Selected minerals such as bismuth subcitrate, have antibacterial properties and can be effective in treating ulcers that are attributed to the Helicobacter pyloric.

Using the home remedies for peptic ulcers along with changing your diet and proper stress management could all help to ease the pain. Do not hesitate to see the doctor if pain persists or worsens.

Research Paper References

1. The role of gastric acidity in the pathogenesis of peptic ulcer.

     AH James, GW Pickering – Clinical Science, 1949 – cabdirect.org

2. Occupational factors in the aetiology of gastric and duodenal ulcers with an estimate of their incidence in the general population. R Doll, FA Jones – Special Report Series. Medical Research, 1951 – cabdirect.org

3. Schorstein Lecture on the Precursors of Carcinoma of the Stomach. AF HURST – Lancet, 1929 – cabdirect.org

4. Treating helicobacter infections, such as gastritis, stomach ulcers, duodenal ulcers and gastric cancer

J Heeres, RA Stokbroekx, JH Mostmans – US Patent , 1997 – Google Patents

5. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind, placebo-controlled trial

DY Graham, NM Agrawal, SH Roth – The Lancet, 1988 – Elsevier

6. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration.

CP Armstrong, AL Blower – Gut, 1987 – gut.bmj.com

7. Peptic ulcer disease

P Malfertheiner, FKL Chan, KEL McColl – The Lancet, 2009 – Elsevier

8. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis

JQ Huang, S Sridhar, RH Hunt – The Lancet, 2002 – Elsevier

9. Prophylactic aspirin and risk of peptic ulcer bleeding

J Weil, D Colin-Jones, M Langman, D Lawson – Bmj, 1995 – bmj.com

10. Aspirin use in patients with major upper gastrointestinal bleeding and peptic-ulcer disease: a report from the Boston Collaborative Drug Surveillance Program, Boston …

M Levy – New England Journal of Medicine, 1974 – Mass Medical Soc

11. Cure of duodenal ulcer associated with eradication of Helicobacter pylori

EAJ Rauws, GNJ Tytgat – The Lancet, 1990 – Elsevier

12. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer: a randomized, controlled study DY Graham, GM Lew, PD Klein –  of Internal Medicine, 1992 – Am Coll Physicians

13. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori

BJ Marshall, JR Warren, ED Blincow, M Phillips – The Lancet, 1988 – Elsevier

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