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Peptic ulcer

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Related Terms
  • Acetaminophen, achalasia, alcohol, antacid, antibody, antigen, aspirin, breath test, caffeine, calcium carbonate, cancer, duodenal ulcer, duodenum, endoscopy, enteritis, esophageal ulcer, esophagus, gastric ulcer, gastrointestinal, GI, H. pylori, Helicobacter pylori,hemorrhage, hydrochloric acid, marginal ulcer, nicotine, non-steroidal anti-inflammatory drugs, NSAIDs, obstruction, penetration, pepsin, perforation, smoking, stress ulcer, tobacco, ulcer, upper GI, x-ray.

Background
  • A peptic ulcer is a sore in the lining of the stomach, esophagus, or the first portion of the small intestine. Peptic ulcers may also be referred to as an ulcer.
  • Ulcers are crater-like sores, generally one-fourth to three-fourths inch in diameter, but sometimes one to two inches in diameter. Ulcers that form in the lining of the stomach are called gastric ulcers. Ulcers that form just below the stomach at the beginning of the small intestine in the duodenum are called duodenal ulcers. Less common ulcers occur in the esophagus and are called esophageal ulcers.
  • A burning stomach pain is the most common symptom of an ulcer. The pain may come and go for a few days or weeks or may bother the individual more when the stomach is empty. The pain usually goes away after eating, but may return when the stomach becomes empty again.
  • Peptic ulcers occur when the digestive juices that help food digest damage the walls of the stomach or duodenum. The most common cause is infection with a bacterium called Helicobacter pylori, or H. pylori. Another cause is the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Motrin® or Advil®). Spicy foods do not cause ulcers, but can aggravate them and make them worse.
  • Peptic ulcers will become more severe if not treated. Treatment may include medicines to block stomach acids or antibiotics to kill ulcer-causing bacteria. Avoiding smoking and alcohol can help decrease symptoms of ulcers. Surgery may help for ulcers that do not heal. Peptic ulcers may also heal on their own without treatment.
  • The American College of Gastroenterology estimates that about 20 million Americans develop at least one ulcer during their lifetime.
  • Although ulcers may cause discomfort, they are rarely life threatening. By understanding the causes and symptoms of ulcers and getting a diagnosis and proper treatment, most people can find relief.
  • The names given to specific ulcers identify their location in the digestive tract or the circumstances under which they develop. Duodenal ulcers, the most common type of peptic ulcer, occur in the first few inches of the duodenum. The duodenum is the first portion of the small intestine. Gastric ulcers, which are less common, usually occur along the upper curve of the stomach. Marginal ulcers can develop when part of the stomach has been removed surgically at the point where the remaining stomach has been reconnected to the intestine. Stress ulcers, like acute stress gastritis, can occur as a result of the stress of severe illness, skin burns, or trauma. Stress ulcers occur in the stomach and the duodenum. An esophageal ulcer is usually located in the lower section of the esophagus. Esophageal varices (veins) are dilated blood vessels within the wall of the esophagus and may have similar symptoms of esophageal ulcers such as burning.
  • Individuals with gastroesophageal reflux disease (GERD) are at an increased risk for developing ulcers. GERD occurs when the lower esophageal sphincter (the valve separating the esophagus and stomach) does not close properly, allowing acid to back up into the esophagus.

Risk factors and causes
  • Infection: Although stress and spicy foods were once thought to be the main causes of peptic ulcers, doctors now know that the cause of most ulcers is the corkscrew-shaped bacterium Helicobacter pylori (H. pylori). H. pylori lives and multiplies within the mucous layer that covers and protects tissues that line the digestive tract. H. pylori usually does not cause problems, but sometimes the bacteria can disrupt the mucous layer and inflame the lining of the stomach or duodenum, producing an ulcer. Individuals who develop peptic ulcers may already have damage to the lining of the stomach or small intestine, making it easier for bacteria to invade and inflame tissues. H. pylori is a common digestive tract infection around the world. In the United States, one in five people younger than 30 and half the people older than 60 are infected with H. pylori. Although it's not clear exactly how H. pylori spreads, the bacteria may be transmitted from person to person by close contact, such as kissing. Individuals may also contract H. pylori through food and water. H. pylori is the most common, but not the only, cause of peptic ulcers.
  • Pain relievers: Pain-relieving drugs called non-steroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of the stomach and small intestine. The medications are available both by prescription and over-the-counter. Nonprescription NSAIDs include aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and ketoprofen (Orudis KT®). Individuals vary in sensitivity to these medications. Some individuals may develop ulcer symptoms with occasional use of NSAIDs, others with long-term. To help avoid digestive upset, take NSAIDs with food. NSAIDs inhibit production of an enzyme that produces hormone-like substances called prostaglandins. Prostaglandins help protect the stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining causing bleeding and ulcers.
  • Smoking and Caffeine: Individuals who smoke and those exposed to second hang smoke have an increased risk of developing an ulcer. Smoking may also slow healing during ulcer treatment. Caffeine stimulates acid secretion in the stomach, thus aggravating the pain of an existing ulcer. Drinking coffee or tea daily may also increase the chances of developing a peptic ulcer.
  • Excessive alcohol consumption: Alcohol can irritate and erode the mucous lining of the stomach and it increases the amount of stomach acid that is produced. It is uncertain, however, whether alcohol consumption alone can cause an ulcer or whether other contributing factors must be present, such as H. pylori bacteria or ulcer-causing medications.
  • Stress: Although stress is not a direct cause of peptic ulcers, it is a contributing risk factor. Stress may aggravate symptoms of peptic ulcers and, in some cases, delay healing. Stress can be caused by a number of reasons, including emotionally disturbing circumstances or events, surgery, or a physical injury, such as a severe burn. Stress ulcers can occur as a result of the stress of severe illness, skin burns, or trauma. Stress ulcers occur in the stomach and the duodenum.
  • Other conditions: Achalasia is a rare disease of a muscle of the esophagus, the body's swallowing tube. The term achalasia means "failure to relax" and refers to the inability of a ring of muscle between the lower esophagus and the stomach called the esophageal sphincter to open and let food pass into the stomach. As a result, patients with achalasia have difficulty swallowing food. Gastroesophageal reflux disease (GERD) can develop as a result.

Signs and symptoms
  • Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may be felt anywhere from the navel to the breastbone. The pain may last from a few minutes to many hours and may flare up a night. Peptic ulcers also tend to be worse when the stomach is empty. Ulcers are often temporarily relieved by eating certain foods that buffer stomach acid, such as milk, or by taking acid-reducing medications, such as calcium carbonate (Tums®). Burning pain may come and go for a few days or weeks. Ulcer pain may also return after years of absence.
  • Less often, ulcers may cause severe signs or symptoms, such as the vomiting of blood (which may appear red or black) and dark blood in stools or stools that are black or tarry. Other severe signs of an ulcer include nausea or vomiting, unexplained weight loss, and chest pain.
  • An ulcer is not generally something that should be treated at home. A doctor can help with prescribed medications or advise the individual the over-the-counter (OTC) medications that may be best. OTC antacids and acid blockers may relieve the burning pain, but the relief is usually temporary. When signs or symptoms of a peptic ulcer exist, a doctor should perform a physical examination to determine if a peptic ulcer exists.

Diagnosis
  • Upper gastrointestinal (upper GI) X-ray: If an individual has signs and symptoms of a peptic ulcer, the doctor may begin with an upper gastrointestinal x-ray, also known as an upper GI. An upper GI allows the doctor to visualize the esophagus, stomach, and duodenum. During the x-ray, the individual swallows a white, metallic liquid (containing barium) that coats the digestive tract and makes an ulcer more visible. An upper GI x-ray can detect some ulcers, but not all.
  • Endoscopy: An endoscopy may follow an upper GI X-ray if the x-ray suggests a possible ulcer. Doctors also may use the endoscopy as the first choice of diagnosis. In this more sensitive procedure, a long, narrow tube with a small attached camera is threaded down the throat and esophagus into the stomach and duodenum. With this instrument, the doctor can view the upper digestive tract and identify an ulcer. If the doctor detects an ulcer, they may remove small tissue samples near the ulcer. These samples are examined under a microscope to rule out cancer. A biopsy can also identify the presence of H. pylori in the stomach lining by using laboratory tests. Depending on where the ulcer is found, the doctor may recommend a repeat endoscopy after two to three months to confirm that the ulcer is healing. Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure. The procedure takes 20-30 minutes. Because the individual will be sedated, they will need to rest at the endoscopy facility for one to two hours until the medication wears off. It is recommended to have a friend or loved one drive.
  • Blood test: A blood test can check for the presence of H. pylori antibodies. The body's immune system produces antibodies specific for H. pylori when the bacteria exists in the body. A disadvantage of this test is that it sometimes cannot determine if the antibodies are from a past exposure to H. Pylori bacteria or a current infection. After H. pylori bacteria have been destroyed, the individual may still have a positive test result for many months.
  • Breath test: A breath test uses a harmless radioactive carbon atom to detect H. pylori. First, the individual blows into a small plastic bag, which is then sealed. Then, the person drinks a small glass of clear, tasteless liquid. The liquid contains radioactive carbon mixed with urea. This combination will be broken down by H. pylori if it is present in the body. Thirty minutes later, the person blows into a second bag, which is then also sealed. If the individual is infected with H. pylori, the second breath sample will contain the radioactive carbon in the form of carbon dioxide.
  • The advantage of the breath test is that it can monitor the effectiveness of treatment, such as antibiotics, used to eradicate H. pylori, detecting when the bacteria have been killed. With the blood test, H. pylori antibodies may sometimes still be present a year or more after the infection is gone.
  • Stool antigen test: The stool antigen test checks for H. pylori in stool samples. This test is useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment.

Complications
  • Most ulcers can be cured without complications. However, in some rare cases, peptic ulcers can develop potentially life-threatening complications, such as penetration, perforation (holes), bleeding (hemorrhage), and obstruction. Depending upon the individual, life-threatening complications usually develop over time.
  • Penetration: An ulcer can penetrate (go through) the muscular wall of the stomach or duodenum and continue into a nearby organ, such as the liver or pancreas. This penetration causes an intense, piercing, persistent pain, which may be felt outside of the area involved. Sometimes the back may hurt when a duodenal ulcer penetrates the pancreas. The pain may intensify when the person changes position. If drugs do not heal the ulcer, surgery may be needed.
  • Perforation: Ulcers on the front surface of the duodenum, or less commonly the stomach, can perforate or go through the wall of the organ. Perforating ulcers create an opening to the free space in the abdominal cavity. The pain resulting from this perforation is sudden, intense, and steady, and rapidly spreads throughout the abdomen. The individual may also feel pain in one or both shoulders, which may intensify with deep breathing. Changing position worsens the pain, so the person often tries to lie very still. The abdomen is tender when touched, and the tenderness worsens if a doctor presses deeply and then suddenly releases the pressure. Symptoms may be less intense in older individuals, in individuals taking corticosteroids, or in very ill individuals. A fever indicates an infection in the abdomen. If the condition is not treated, shock may develop. This emergency situation requires immediate surgery and intravenous (IV) antibiotics.
  • Hemorrhage: Hemorrhage (bleeding) is a common complication of ulcers, even when they are not painful. Symptoms of a bleeding ulcer may include vomiting bright red blood or reddish brown clumps of partially digested blood that look like coffee grounds. Small amounts of blood in the stool may not be noticeable but, if persistent, can still lead to anemia, or the deficiency of hemoglobin (the oxygen-carrying component of the blood). Bleeding may result from other digestive conditions as well, but doctors begin their investigation by looking for the source of bleeding in the stomach and duodenum. Unless bleeding is massive, a doctor performs a procedure called an endoscopy. An endoscopy is an examination using a flexible viewing tube. If a bleeding ulcer is seen, the endoscope can be used to cauterize, which is the use of heat to close the bleeding opening. A doctor may also use the endoscope to inject a material that causes a bleeding ulcer to clot. If the source cannot be found and the bleeding is not severe, treatments include taking ulcer drugs, such as cimetidine (Tagamet®) or omeprazole (Prilosec®). The individual also receives intravenous (IV) fluids and takes nothing by mouth, so the digestive tract can rest. If these measures fail, surgery is needed.
  • Obstruction: Swelling of inflamed tissues around an ulcer or scarring from previous ulcer flare-ups can narrow some parts of the duodenum. An individual with this type of obstruction may vomit repeatedly, often regurgitating large volumes of food eaten hours earlier. A feeling of being unusually full after eating, being bloated, and a lack of appetite are symptoms of obstruction. Over time, vomiting may cause weight loss and dehydration. Treating the ulcers relieves the obstruction in most cases, but severe obstructions may require endoscopy or surgery.
  • Enteritis: Enteritis is an inflammation of the small intestine caused by a bacterial or viral infection. H. pylori infections can cause enteritis with symptoms including gas, bloating, and pain.
  • Zollinger-Ellison syndrome: Zollinger-Ellison syndrome (ZES) is a rare disorder that causes tumors in the pancreas and duodenum. ZES may also cause ulcers in the stomach and duodenum. The pancreas is a gland located behind the stomach. It produces enzymes that break down fat, protein, and carbohydrates from food and hormones such as insulin that break down sugar. The duodenum is the first part of the small intestine. ZES can occur sporadically or may be genetic. The tumors secrete a hormone called gastrin that causes the stomach to produce too much acid, which in turn causes peptic ulcers in the stomach and duodenum. The ulcers caused by ZES are less responsive to treatment than ordinary peptic ulcers. What causes people with ZES to develop tumors is unknown, but approximately 25% of ZES cases are associated with a genetic disorder called multiple endocrine neoplasia type 1. The symptoms of ZES include signs of peptic ulcers, including gnawing, burning pain in the abdomen, diarrhea, nausea, vomiting, fatigue (extreme tiredness), weakness, weight loss, and bleeding. Doctors diagnose ZES through blood tests to measure levels of gastrin and gastric acid secretion. They may check for ulcers by performing an endoscopy, which involves looking at the lining of the stomach and duodenum through a lighted tube.
  • Cancer: Individuals with ulcers caused by H. pylori have three to six times the chance of developing stomach cancer later in life. There is no increased risk of developing cancer from ulcers that have other causes. Some evidence also links H. pylori infection to gastric cancer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and perhaps pancreatic cancer and cardiovascular disease.

Treatment
  • Because many ulcers stem from H. pylori bacteria, doctors use an approach to peptic ulcer treatment that kills or eradicates the bacteria and reduces the level of acid in the digestive system. The result of the treatment is pain relief and ulcer healing.
  • Antibiotic medications: Doctors use combinations of antibiotics to treat H. pylori infections because one antibiotic alone is not usually sufficient to kill the organism. For the treatment to work, it is essential that the individual follows the doctor's instructions on the medicine bottle precisely. Antibiotics commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil®), clarithromycin (Biaxin®), and metronidazole (Flagyl®). Some companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent specifically for treatment of H. pylori infection. These combination treatments are sold under the names Prevpac® and Helidac®. The individual will likely need to take antibiotics for two weeks, depending on the type prescribed. Antibiotics may cause diarrhea and upset the balance of natural bacteria (including Lactobacillus acidophilus) in the gastrointestinal tract. A healthcare provider may recommend taking probiotic supplements after treatment with antibiotics.
  • Acid blockers: Acid blockers, also called histamine or H2 blockers, reduce the amount of hydrochloric acid released into the digestive tract. This decrease in acid helps relieve ulcer pain and encourages healing. Acid blockers work by keeping histamine from reaching histamine receptors. Histamine is a substance normally present in the body. When it reacts with histamine receptors, the receptors signal acid-secreting cells in the stomach to release hydrochloric acid. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).
  • Antacids: A doctor may include an antacid in the drug therapy. An antacid may be taken in addition to an acid blocker or in place of one. Instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief. Antacids include calcium carbonate (Tums®, Titralac®), aluminum hydroxide and magnesium hydroxide combinations (Mylanta®, Maalox®), and aluminum hydroxide alone (Alternagel®). Antacids should be taken one hour before or two hours after taking other prescribed medications.
  • Proton pump inhibitors: Another way to reduce stomach acid is to shut down the "pumps" within acid-secreting cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. These drugs include the prescription medications omeprazole (Prilosec®), lansoprazole (Prevacid®), rabeprazole (Aciphex®), and esomeprazole (Nexium®). The drug pantoprozole (Protonix®) can be taken orally or administered intravenously (IV) in the hospital. Proton pump inhibitors are frequently prescribed to promote the healing of peptic ulcers. Proton pump inhibitors also appear to inhibit H. pylori. However, long-term use of proton pump inhibitors, particularly at high doses, may increase the risk of hip fracture. The risk was 2.6 times higher for long-term users of proton pump inhibitors at high doses.
  • Cytoprotective agents: In some cases, the doctor may prescribe cytoprotective medications that help protect the tissues that line the stomach and small intestine. They include the prescription medications sucralfate (Carafate®) and misoprostol (Cytotec®). Another non-prescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol®). In addition to protecting the lining of the stomach and intestines, bismuth preparations appear to inhibit H. pylori activity.

Integrative therapies
  • Strong scientific evidence:
  • Calcium: As an antacid, calcium carbonate (Tums®, Rolaids®) is a U.S. Food and Drug Administration (FDA) approved over-the-counter (OTC) drug used to treat gastric hyperacidity (high acid levels in the stomach).
  • Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with hypercalcemia (high levels of calcium in the blood), hypercalciuria (high levels of calcium in urine), hyperparathyroidism (high levels of parathyroid hormone), bone tumors, digitalis toxicity, ventricular fibrillation (ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or arrhythmia (irregular heartbeat). Calcium appears to be safe in pregnant or breastfeeding women; a healthcare provider should be consulted to determine appropriate dosing during pregnancy and breastfeeding.
  • Probiotics: Probiotics are beneficial bacteria (sometimes referred to as "friendly germs") that help to maintain the health of the intestinal tract and aid in digestion. They also help keep potentially harmful organisms in the gut, such as those that cause ulcers, under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be consumed as capsules, tablets, beverages, powders, yogurts, and other foods. Antibiotics are the main treatment to eradicate Helicobacter pylori, the cause of most stomach ulcers. Side effects commonly include bloating, diarrhea, and taste disturbances. Probiotics reduce these side effects and generally help people tolerate the treatment. They may also reduce levels of Helicobacter pylori in children and adults. Yogurt-containing probiotics suppresses Helicobacter pylori infection and may lead to more complete eradication during antibiotic treatment.
  • Probiotics are generally regarded as safe for human consumption. Long-term consumption of probiotics is considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Zinc: The healing process of gastric ulcers may be enhanced through treatment with zinc, although further studies will be needed to determine to what extent zinc may be beneficial for patients with this condition.
  • Zinc is regarded as relatively safe and generally well tolerated when taken at recommended doses and few studies report side effects. Zinc should only be given to pregnant or breastfeeding women under the supervision of their qualified healthcare providers.
  • Good scientific evidence:
  • Cranberry: Based on early research, cranberry may reduce the ability of Helicobacter pylori bacteria to live in the stomach and cause ulcers. Further research is needed to better determine the effects of cranberry on Helicobacter pylori infection.
  • Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium genus. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
  • Peppermint: There is preliminary evidence that a combination of peppermint oil and caraway oil may be beneficial for dyspepsia (heartburn) and indigestion. It should be noted that heartburn might actually be a side effect of taking oral peppermint oil. Enteric-coated peppermint oil (which decreases gastrointestinal side effects) has been used in clinical studies for peptic ulcer and other stomach problems. A qualified healthcare provider should evaluate patients with chronic heartburn.
  • Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: Currently, there is insufficient available evidence to recommend for or against the use of acupuncture in functional dyspepsia. More research is needed in this area.
  • Needles must be sterile in order to avoid disease transmission. Avoid with heart valve disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Asparagus: Asparagus (Asparagus racemosus, or Shatavari) is used in Ayurvedic medicine for dyspepsia (upset stomach). Additional study is needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to asparagus or other members of the Liliaceae family. Use cautiously with edema (accumulation of fluid) caused by impaired kidney or heart function. The safety of asparagus for pregnant or breastfeeding mothers has not been determined.
  • Berberine: Berberine has been compared with antibacterial drugs and ranitidine (Zantac®) in stimulation of ulcer healing and Helicobacter pylori clearance. Berberine was suggested to be less effective at ulcer healing than ranitidine, but potentially more effective at eliminating Helicobacter pylori infection. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric)), or to members of the Berberidaceae family. Avoid in newborns. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leucopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or hypotension. Use cautiously in children. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
  • Bilberry: Bilberry (Vaccinium myrtillus) extract has been suggested as a treatment to help stomach ulcer healing. There is some support for this use from laboratory and animal studies, but reliable human evidence for use of bilberry for peptic ulcer disease (PUD) is currently lacking.
  • Avoid if allergic to plants in the Ericaceae family or to anthocyanosides (a component of bilberry). Avoid with a history of low blood pressure, heart disease, bleeding, diabetes, blood clots, or stroke. Avoid if pregnant or breastfeeding. Stop use before surgeries/dental or diagnostic procedures involving blood tests.
  • Blessed thistle: Blessed thistle (Cnicus benedictus) is traditionally believed to stimulate stomach acid secretion and has been used as a treatment for dyspepsia, indigestion, or flatulence. However, there is limited scientific study in these areas. Additional research is needed before a firm conclusion can be reached.
  • Avoid if allergic to blessed thistle, mugwort, bitter weed, blanket flower, chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed, Echinacea or any plants of the Asteraceae or Compositae families. Use cautiously with peptic ulcer disease. Avoid with a history of bleeding diseases or gastroesophageal reflux disease (GERD), or if taking drugs for blood thinning, stroke, stomach diseases, or to control stomach acid. Avoid if pregnant or breastfeeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures.
  • Bovine colostrum: Colostrum is the first milk lacteal secretion produced by mammals after birthing. The importance of colostrum in the development of the human infant's immune system is well recognized. Laboratory studies suggest that bovine (cow) colostrum may help improve immune system function and also may inhibit the growth of Helicobacter pylori in the gastrointestinaltract. Bovine colostrum has been clinically studied in a placebo-controlled trial for treatment of peptic ulcers, but there was no apparent benefit when used for Helicobacter pylori infection. Further studies are required before recommendations can be made.
  • Avoid if allergic or hypersensitive to dairy products. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE) may be found in bovine colostrum. Avoid with, or at risk of, cancer. Use cautiously with immune system disorders and atherosclerosis (hardening of the arteries) or if on medications, such as anti-diarrheal agents (e.g. immodium), insulin, and CNS agents (amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Carob: Carob (Ceratonia siliqua) gum is a common food thickener and may be helpful in gastroesophageal reflux disease in infants. However, additional study is needed in this area.
  • Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders, with chromium, cobalt, copper, iron, or zinc disorder or deficiency, renal disorders, or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia, known allergy to peanuts and other nuts, complications with powdered, bulk forming laxative drinks, diabetes, or hyperlipidemia (high cholesterol). Use cautiously if taking oral herbs or drugs. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
  • Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of duodenal ulcer.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, and migraines. Use cautiously with a risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid if taking drugs that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
  • Cinnamon: Laboratory studies have found that cinnamon extract does not appear to be effective in curing Helicobacter pylori infection. Further studies are warranted.
  • Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or Balsam of Peru. Use cautiously if prone to atopic reactions or if taking cytochrome P450 metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, or cardiovascular agents. Avoid if pregnant or breastfeeding.
  • Corydalis: Early studies suggest that corydalis may be of benefit for Helicobacterpylori infection with chronic atrophic gastritis. However, more evidence is needed before a recommendation may be made.
  • Corydalis is generally considered safe. Avoid if allergic or sensitive to corydalis. Avoid if taking sedative or hypnotic drugs, drugs that treat abnormal heart rhythms (including bepridil), pain relievers, and anti-cancer drugs. Avoid if pregnant or breastfeeding.
  • DMSO: When used with acid blocking drugs (like ranitidine), dimethyl sulfoxide (DMSO, a sulfur containing compound) may help treat gastritis. More research is needed. Cases of nausea, vomiting, constipation, garlic-like breath, garlic taste, and diarrhea have been reported.
  • Avoid if allergic DMSO. Use cautiously with urinary tract cancer, liver disorders, or kidney disorders. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
  • Gamma oryzanol: Little research has been done on the effects of gamma oryzanol on gastritis. Additional study is needed to assess its potential use for this indication.
  • Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs that alter blood sugar levels, immunomodulators, luteinizing hormone or luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering agents, thyroid drugs, and herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, hyperglycemia, or high cholesterol. Avoid if pregnant or breastfeeding.
  • Globe artichoke: Several clinical studies report benefit when using globe artichoke (Cynara scolymus) for dyspepsia. One proposed cause of non-ulcer dyspepsia is bile duct dyskinesia or sluggishness. Because globe artichoke extract has been studied as a choloretic (bile stimulant), it has been hypothesized that it may also function as an antidyspeptic agent. Preliminary evidence supports this hypothesis, although more study is needed.
  • Use cautiously if allergic/hypersensitive to members of the Asteraceae or Compositae families (e.g. chrysanthemums, daisies, marigolds, ragweed, or arnica), due to possible cross-reactivity. Use cautiously with gallstones, bile duct obstructions, or kidney disease. Avoid if pregnant or breastfeeding.
  • Honey: Early research suggests that honey may be used for the treatment of infantile gastroenteritis.
  • Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered safe in the recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hypnotherapy: Early research indicates that gut-oriented hypnosis may have a beneficial effect on shortening gastric emptying both in dyspepsia and in healthy subjects and in improving symptoms of duodenal ulcer. There is inconclusive evidence from preliminary research in this area. Additional study is needed before a firm conclusion can be drawn.
  • Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
  • Lemon balm: Clinical evidence of varying quality suggests that lemon balm (Melissa officinalis), as a component of combination products, may help reduce dyspepsia. However, further research is necessary before a conclusion can be drawn.
  • Avoid if allergic or hypersensitive to lemon balm. Avoid with Grave's disease or thyroid hormone replacement therapy. Use cautiously in glaucoma. Use caution when operating heavy machinery. Lemon balm preparations may contain trace amounts of lead. Avoid if pregnant or breastfeeding.
  • Licorice: There has been some study of deglycyrrhizinated licorice (DGL) in gastrointestinal bleeding, but it is not clear what effects DGL has on bleeding stomach ulcers caused by aspirin. Early studies indicate that the herbal preparation STW 5, which contains licorice among many other herbal extracts, may help improve symptoms in patients with functional dyspepsia. Additional research is needed.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities. Licorice contains a chemical called glycyrrhizic acid, which is responsible for many of the reported side effects. DGL (deglycyrrhizinated licorice) has had the glycyrrhizic acid removed and therefore is considered safer for use.
  • Mastic: Mastic is the resin of Pistacia lentiscus and has been used by traditional Mediterranean healers to treat intestinal ulcers since the 13th Century. Mastic has been shown to have antibacterial action against Helicobacter pylori in vitro, which may help to explain its potential role in duodenal ulcer and gastric ulcer healing. Additional research is needed. Mastic may also decrease the severity of induced gastric ulceration, but its exact mechanism of action is unknown.
  • Well-designed studies evaluating the effects of mastic ingestion beyond four weeks are lacking. Therefore, the long-term use of mastic cannot be recommended. Avoid if allergic to any members of the Anacardiaceae family (the cashew family; trees and shrubs and vines with sticky juice). Use cautiously with gastric or duodenal ulcer or if taking ACE inhibitors. Avoid if pregnant or breastfeeding.
  • Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. An herbal preparation containing milk thistle may be effective in decreasing symptoms of functional dyspepsia. However, milk thistle alone has not been researched for this use.
  • Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Neem: Neem (Azadirachta indica) has been reported to have protective and healing effects on gastroduodenal ulcers in preliminary human study. However, comparisons to other agents used for this purpose such as proton pump inhibitors or H2-antagonsits have not been conducted. Therefore, there is currently insufficient evidence for the use of neem for gastroduodenal ulcers. More studies are needed.
  • Avoid if allergic or hypersensitive to neem (Azadirachta indica) or members of the Meliaceae family. Use cautiously with liver disease. Avoid in children and infants. Avoid if pregnant or breastfeeding.
  • Probiotics: Early research suggests that probiotics may help prevent peptic ulcers. However, more research is needed to determine if this is an effective therapy.
  • Probiotics are generally regarded as safe for human consumption. Long-term consumption of probiotics is considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Propolis: Animal and laboratory studies suggest that propolis may help treat various types of infections. Initial human research reports possible benefits against bacteria in the mouth, genital herpes, urine bacteria, intestinal giardia infections, and Helicobacter pylori infection. Additional research is needed before a recommendation can be made.
  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Psychotherapy: Psychodynamic-interpersonal psychotherapy therapy or cognitive psychotherapy may improve dyspepsia symptoms, both short- and long-term, in patients with mild to moderate dyspepsia, but further evaluation is required. There is currently insufficient evidence to confirm the efficacy of psychological intervention in non-ulcer dyspepsia (NUD). Additionally, short-term cognitive psychotherapy may not reduce the long-term recurrence of duodenal ulcer. More research is needed in these areas.
  • Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire about the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. There is some evidence supporting the use of internal Qi gong in the treatment of gastritis. Further research is needed.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Sea buckthorn: Poor quality study has indicated that sea buckthorn oil may be beneficial when added to other therapies for gastric ulcers. More high-quality research is needed in this area.
  • Avoid if allergic or hypersensitive to sea buckthorn, its constituents, or members of the Elaeagnaceae family. Use cautiously if taking angiotensin converting enzyme (ACE) inhibitors, anticoagulants and antiplatelet agents (blood thinners), antineoplastics (anticancer agents), or cyclophosphamide or farmorubicin. Avoid higher doses than food amounts if pregnant or breastfeeding.
  • Thymus extract: Preliminary clinical evidence suggests that thymus extract speeds healing of gastritis (gastric inflammation). Further well-designed clinical trials are still required.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Turmeric: Turmeric (Curcuma longa) has traditionally been used to treat stomach problems (such as indigestion from a fatty meal). There is preliminary evidence that turmeric may be of benefit for dyspepsia and peptic ulcer disease. However, at high doses or with prolonged use, turmeric may actually irritate or upset the stomach. More research is needed.
  • Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
  • Vitamin C: Vitamin C (ascorbic acid) is a water-soluble vitamin, which is necessary in the body to form collagen in bones, cartilage, muscle, and blood vessels, and aids in the absorption of iron. Dietary sources of vitamin C include fruits and vegetables, particularly citrus fruits such as oranges. Early evidence suggests that vitamin C may help bleeding stomach ulcers caused by aspirin. Also, adding vitamin C to triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori infection may allow the dose of clarithromycin to be lower. Further research is needed in this area.
  • Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods and if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder).
  • White horehound: In Germany, white horehound is approved for the treatment of heartburn and poor appetite, based on historical use. There is currently not enough information from scientific studies to evaluate the effectiveness of white horehound for these conditions.
  • Avoid if allergic or hypersensitive to white horehound or any member of the Lamiaceaefamily (mint family). White horehound is generally considered safe when used to flavor foods. Use cautiously with diabetes, high/low/unstable blood pressure, high levels of sodium in the blood, irregular heartbeats, or gastrointestinal diseases. Use cautiously if taking diuretics. Avoid if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Beta-carotene: Dietary supplementation with beta-carotene has not been found to be effective for Helicobacter pylori infection.
  • Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
  • Garlic: Early studies in humans show no effect of garlic on gastric or duodenal ulcers associated with Helicobacter pylori infection.
  • Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
  • Licorice: Licorice extracts, DGL, and carbenoxolone, have been studied for treating peptic ulcer disease. DGL (but not carbenoxolone) may offer some benefits. However, most studies are poorly designed and some results conflict. Therefore, it is unclear whether there is any benefit from licorice for this condition.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities. Licorice contains a chemical called glycyrrhizic acid, which is responsible for many of the reported side effects. DGL (deglycyrrhizinated licorice) has had the glycyrrhizic acid removed and therefore is considered safer for use.
  • Urine therapy: An oral urea preparation (carbamine) has been used in therapy for peptic ulcers. However, there is insufficient evidence from clinical studies to support the use of urine or urea in the treatment of this condition. Additional study is needed to draw any firm conclusions.
  • Avoid if allergic or hypersensitive to urine or any of its metabolites. Use cautiously in children because there is insufficient data on the use of urine therapy in this population. Use cautiously if taking medications, especially antidepressants, antipsychotics and/or sedative/hypnotic agents, because some medications are excreted as active metabolites in the urine; and thus, urine consumption in large quantities may increase serum levels of the drug. Use cautiously with gastrointestinal problems because urine therapy may increase diarrhea and vomiting. Avoid with urinary tract or kidney infection because the urine will contain bacteria. Avoid if pregnant or breastfeeding.

Prevention
  • Smoking: Smoking may interfere with the protective lining of the stomach making the stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid. Stopping smoking may help reduce the symptoms and causes of peptic ulcers.
  • Alcohol: Excessive use of alcohol can irritate and erode the mucous lining in the stomach and intestines, causing inflammation and bleeding. Decreasing consumption of alcohol may help reduce the symptoms and causes of peptic ulcers.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): If pain relievers are used regularly, such as aspirin or nonsteroidal anti-inflammatory drugs (including ibuprofen or Advil®), acetaminophen (Tylenol®) can be used instead. Acetaminophen may offer pain relief without damaging the gastrointestinal lining, which results in ulcers.
  • Acid reflux: Controlling acid reflux, if an esophageal ulcer is present, is important. Several steps to help manage acid reflux can be taken including avoiding spicy and fatty foods, avoiding reclining after meals for at least three hours, raising the head of the bed, and reducing weight. Avoiding smoking, alcohol, and NSAIDs also may help to control acid reflux.
  • Diet: Some individuals with peptic ulcers can eat whatever they want with no problems. For many others, however, eating certain foods can cause irritation, excessive acid production, and heartburn. These individuals need to know what foods are safe and what foods to avoid. It is recommended by healthcare professionals that individuals with an ulcer make dietary changes, including eating more whole grains, fresh fruits and vegetables and less red meats and fatty foods, such as fried foods and baked goods. It is best to avoid spicy foods.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. The American College of Gastroenterology. . Accessed May 6, 2009.
  2. American Gastroenterological Association. . Accessed May 6, 2009.
  3. Centers for Disease Control and Prevention. . Accessed May 6, 2009.
  4. El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54(1):11-7. .
  5. Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4):439-44. .
  6. Martin B. Prevention of gastrointestinal complications in the critically ill patient. AACN Adv Crit Care. 2007;18(2):158-66. .
  7. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 6, 2009.
  8. Olafsson S, Berstad A. Changes in food tolerance and lifestyle after eradication of Helicobacter pylori. Scand J Gastroenterol. 2003;38(3):268-76. .
  9. Vonkeman HE, Fernandes RW, van de Laar MA. Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers. Int J Clin Pharmacol Ther. 2007;45(5):281-8. .

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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