Peptic Ulcers

By Dr. Loretta Lanphier, ND, CN, HHP, CH

The stereotypical ulcer sufferer is usually seen as a stressed out individual who exists on a terrible diet of high-fat, spicy foods, and never seems to have time to take care of himself. Well, that may not be too far from the truth, but there is more to the story. Ulcers can be caused by numerous factors, including diet and lifestyle, and there is much we can learn that can help us to prevent and lessen the effect of these corrosive sores.

What Are Peptic Ulcers?

Peptic ulcers are open sores that may develop in the gastrointestinal system, specifically in the esophagus, stomach, or small intestines. The term ulcer is defined as “any area of eroded skin or mucous membrane that is marked by tissue disintegration.” Peptic ulcers are those found within the above areas of the body.

Peptic ulcers are quite common, especially in our high stress, poor lifestyle culture here in the United States. It is thought that most ulcers are the result of a bacterial infection, but the choices one makes in diet and other foolish health habits such as smoking and alcohol consumption are definitely contributing factors. It is estimated that at any given time, about 2% of the adult U.S. population is currently experiencing one or more peptic ulcers, and approximately 10% will suffer from a peptic ulcer some time during their lives. This amounts to about half a million new cases annually. However, the recurrence rate of peptic ulcers is very high, and approximately four million individuals will suffer from a returning ulcer each year. Men are about three times more likely to get peptic ulcers than are women.

There are three main types of peptic ulcers: gastric, duodenal, and esophageal.

  • Gastric ulcers are found in the stomach. They are responsible for about 16% of all cases of peptic ulcers, but they are becoming more common. This is most likely due to the increased use of certain medications (more on that in a moment). Gastric ulcers most commonly occur in men between the ages of 55-70.
  • Duodenal ulcers are the most common type, accounting for about 80% of all peptic ulcers. They develop in the duodenum, which is the first part of the small intestine. Duodenal ulcers typically afflict younger men, between the ages of 20 and 45.
  • Esophageal ulcers are generally located in the lower portion of the esophagus, which is also called the “food pipe,” and serves to carry food and beverages from the throat to the stomach. Esophageal ulcers are often found in conjunction with gastroesophageal reflux disease (GERD), a chronic condition that allows stomach acids to back up into the esophagus.

What Are the Causes of Peptic Ulcers?

There are four major causes of peptic ulcers: food allergies, bacterial infection, certain medications, and conditions that cause excess secretion of stomach acids.

  • Food allergies are considered a major factor in most gastric and duodenal ulcers. If you suffer with either of these types of peptic ulcers, one of the first things that you might want to do is try an elimination diet that can help determine what foods, if any, you are allergic to. One of the most common food allergies overall, and in relation to peptic ulcers, is milk. Other dairy products may play a role as well. Studies have proven that the more milk a person drinks, the greater their risk is for developing an ulcer. Milk has often been pushed on folks with peptic ulcers, with the theory being that it coats the lining of the stomach and helps to alleviate pain or even actually heal ulcers. In reality, milk stimulates the production of stomach acid, and should be religiously avoided by folks with ulcers. Caffeinated drinks, especially coffee, should also be avoided for the same reason. Food allergies are also a likely explanation, at least in part, for the very high recurrence rates of peptic ulcers. If the underlying cause (allergic foods) is not dealt with, the ulcers will easily return.
  • Bacterial infection:  A corkscrew-shaped bacterium called Helicobacter pylori (H. pylori) is commonly found in the mucous membranes that line and protect the stomach and small intestine, in both ulcer patients and those without ulcers. H. pylori may be present in some folks, and never cause any problems. However, it has the capability to irritate and inflame the membranes, and may eventually lead to peptic ulcers in many individuals. Some studies have shown that people who already have a damaged gastrointestinal system are at greater risk of H. pylori-related ulcers because their pre-existing conditions make it easier for the bacteria to invade the membranous lining of the digestive tract. H. pylori infections are common worldwide. In the United States, some 20% of those under the age of 40 are infected, and the percentage rises to about 50% for folks over 60. H. pylori is contagious, and can be passed from one person to another by intimate contact, such as kissing. It can also be contracted through contaminated food or water. About 95% of patients with duodenal ulcers test positive for H. pylori, and the same is true for about 70% of gastric ulcer sufferers.
  • Certain medications that are often used for pain called nonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for a great number of peptic ulcer cases. These drugs include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and ketoprofen (Orudis KT). They are commonly taken for aches and pains, fever, arthritis, menstrual cramps, and other minor pains. Most are available without a prescription, and their use has skyrocketed over the last several decades. NSAIDs are very caustic to the stomach lining, and therefore make one more susceptible to peptic duodenal and gastric ulcers. The way they work is by blocking or reducing the production of a substance called cyclooxygenase, which is an enzyme that helps manufacture other substances known as prostaglandins. These members of the hormone family are involved with a process that naturally protects the gastrointestinal linings from chemical and physical injury. Chronic usage of NSAIDs can cause a multitude of health problems, including increasing one’s chances of getting a gastric ulcer by a whopping 40%!  NSAIDs also greatly increase the risk of complications from ulcers, such as internal bleeding. Bleeding ulcers are a medical emergency, and can even be life-threatening in some cases. Of all the NSAIDs, aspirin is the most likely to cause ulcers.
  • Other conditions that result in increased production of gastric juices are responsible for a small percentage (about 5%) of all peptic ulcers. They include Crohn’s disease, some types of cancer, and Zollinger-Ellison syndrome. This syndrome results in small tumors of the gastric system (gastrinomas)that secrete a hormone called gastrin that stimulates stomach acid production. Disorders such as these are often called hypersecretory syndromes.
  • Other risk factors that may increase your risk of peptic ulcers include:
    • Smoking:  The nicotine in tobacco is a stimulant that results in a greater volume and concentration of gastric juices. The smoke also irritates the gastric lining, and makes it harder for existing ulcers to heal. Just another good reason to kick the habit.
    • Alcohol:  Drinking, especially to excess, acts in a way that is similar to nicotine. Alcohol aggravates the stomach lining and boosts the production of gastric juices as well. It also has a very negative impact on the body’s ability to absorb nutrients, and therefore makes it harder for ulcers to heal.

What Are the Signs and Symptoms of Peptic Ulcers?

In general, the most common symptom of peptic ulcers is a burning type of pain. This occurs when gastric juices come into contact with the open wounds associated with ulcers. Many patients experience pain that is:

  • Found between the navel and breastbone
  • Worse on an empty stomach
  • Temporarily relieved by using antacids or eating foods that neutralize stomach acid
  • Worse at night
  • Cyclical in nature, coming and going, and lasting anywhere from several minutes to several hours.

More severe cases may also exhibit symptoms such as:

  • Vomiting of blood—often appearing as red or black
  • Bloody stools that may be black or tarry
  • Chest pain
  • Nausea
  • Regular vomiting
  • Unusual or unexpected weight loss

Gastric ulcers have some distinctive signs associated with them. These may include: indigestion, heartburn, gastrointestinal bleeding, a dull, aching pain that is sometimes compared to “hunger pangs,” and insomnia due to ulcer pain.

Duodenal ulcers may also exhibit some unique symptoms:  unexplained weight gain, burning pain at the back of the throat, discomfort about 2-4 hours after eating, extra sensitivity to such foods as citrus fruits or coffee, and waking up at regular times throughout the night due to pain, often between midnight and three A.M. Approximately 50% of folks with duodenal ulcers report this phenomenon.

What Complications Can Occur Due to Peptic Ulcers?

There are several common complications to watch out for:

  • Bleeding or ulcer hemorrhage is the most common complication of peptic ulcers. It can result in serious conditions such as anemia (low levels of red blood cells), hematemesis (vomiting of blood), or melena (passing of blood through the rectum). Approximately 6-10% of ulcer hemorrhage cases are fatal.
  • Perforation occurs when holes develop in the duodenal or gastric walls at the site of an ulcer, and gastric juices are allowed to leak into the abdominal cavity. This can lead to a serious medical emergency called peritonitis, which is an infection in the lining of the abdomen.
  • Penetration is similar to perforation, except digestive fluids do not enter the abdominal cavity in this case. With penetration, the ulcer penetrates adjoining organs such as the liver or pancreas, which can result in serious consequences.
  • Obstruction is a critical condition that is caused by scar tissue from an ulcer blocking or narrowing a structure called the pylorus, which is the opening between the stomach and the duodenum. This can result in chronic vomiting of undigested or under digested food, and can cause malnutrition, dehydration, and weight loss.

What Treatments Are Available for Peptic ulcers?

First the bad news: stay away from the traditional treatments for ulcers that typically include antacids and acid-blockers such as Tagamet or Zantac. These medications have a slew of bad side effects, and antacids actually stimulate the production of more gastric juices due to a “rebound” effect. Many antacids also increase your exposure to aluminum, and worsen your risk for Alzheimer’s disease. Acid-blockers are expensive and addictive (the “perfect drugs” for the pharmaceutical industry?), and can lead to liver problems, breast development in men, and nutritional deficiencies.

What does help and won’t hurt you in the process? In addition to a healthy diet and avoiding such things as tobacco and alcohol, one of the most promising treatments that I am aware of is cabbage juice. Consuming about a quart daily, in small amounts all day long, has been very affective for many ulcer patients. Many folks find that their ulcers totally disappear after several weeks of cabbage juice.

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