Peptic Ulcer

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Peptic Ulcer
What we call an ulcer, doctors call a peptic ulcer, to distinguish it from other forms of ulcer that can affect many parts of the body. Peptic ulcers are erosions in the stomach or duodenum (the first part of the small intestine); these ulcers often bleed and have many causes. Many peptic ulcers are caused by an infection. The responsible bug is Helicobacter pylori. While at least one herb (licorice root, see below) may help kill these bacteria, until more is known, if your ulcer is due to infection it s wise to discuss treatmenta combination of antibiotics and bismuthwith your medical doctor. Ulcers can also be caused or exacerbated by stress, alcohol, smoking and dietary factors. Dietary changes that may be helpful: Those with ulcers appear to eat more sugar,1 and sugar increases stomach acid.2 Salt is a stomach and intestinal irritant. The higher the intake of salt, the higher the risk of stomach (though not duodenal) ulcer.3 It s best to restrict the use of both sugar and salt. Many years ago, researchers found that cabbage juice accelerated healing of peptic ulcers.4 5 Drinking a quart per day is necessary, but pain relief may occur in just a few days. Carrot juice can be added to improve the flavor. Fiber slows the movement of food and acidic fluid from the stomach to the intestines, which should help those with duodenal ulcer.6 When people with recently healed duodenal ulcers were put on a long-term (six months) high-fiber diet, the rate of ulcer recurrence was dramatically reduced.7 Ayurvedic doctors in India have traditionally used dried banana powder to treat ulcers. A research trial studying those with ulcers confirmed that it helps.8 Bananas and unsweetened banana chips are probably good substitutes, although ideal intake remains unknown. Years ago, food allergies were linked to peptic ulcer.9 Exposure to allergic foods can actually cause stomach bleeding.10 If an ulcer is not from an infection and does not respond to natural treatment, ask a nutritionally oriented doctor about the possibility of an allergytriggered ulcer. Lifestyle changes that may be helpful: Aspirin and related drugs,11 alcohol,12 coffee13 (even decaf),14 and tea15 increase stomach acidity, which can interfere with the healing of an ulcer. Smoking also slows ulcer healing.16 Whether or not an ulcer was caused by infection, all of the above should be avoided. Nutritional supplements that may be helpful: Vitamin A and zinc, both needed in the healing process, may help people with peptic ulcers.17 18 While the zinc research used 150 mg per day in adults (a very high amount), many people take 15-40 mg per day. Even at these doses, it s necessary to take 1-3 mg of copper per day to avoid a copper deficiency. Very

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Peptic Ulcer

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high amounts of vitamin A (100,000 IU per day) have also been used successfully, but such amounts can be quite toxic and require the supervision of a nutritionally oriented doctor. A safe dose for women of child-bearing age is 10,000 IU (3,000 mcg) per day and probably 25,000 IU (7,500 mcg) for other adults. Glutamine, an amino acid, is the principal source of energy for the cells that line the small intestine and stomach and helps them heal. Glutamine may help treat ulcers.19 Some nutritionally oriented doctors suggest 500-1000 mg of glutamine two to three times per day. Research has shown that some bioflavonoidssuch as quercetin, catechin, and apigenin, which is found in chamomileinhibit the growth of H. pylori bacteria.20 Bioflavonoids have also been used for ulcers because of their anti-inflammatory activity.21 A reasonable amount is 500-1,000 mg of the bioflavonoid quercetin two to three times per day. Are there any side effects or interactions? (Refer to the individual supplement for complete information.) Women who are or could become pregnant should take less than 10,00 IU per day of vitamin A to avoid the risk of birth defects. For other adults, intake above 25,000 IU per day canuncommonlycause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage. Zinc intake in excess of 300 mg per day may impair immune function; seek guidance from a nutritionally oriented doctor. No consistent toxicity has been linked to the bioflavonoids; the exception is for a bioflavonoid called cianidanol, which is not found in supplements. Herbs that may be helpful: Licorice root has a long history of use for soothing inflamed and injured mucous membranes in the digestive tract. Licorice may protect the stomach and duodenum (two areas where ulcers most commonly occur) by increasing production of mucin, a substance that protects the lining of these organs against stomach acid and other harmful substances.22 Licorice also appears to inhibit Helicobacter pylori. 23 For ulcers, many physicians use licorice root in its deglycyrrhizinated form (DGL). This removes the portion of licorice root associated with increasing blood pressure and causing water retention in some people, while retaining the mucous membrane-healing part of the root. In studies, DGL has compared favorably to the popular drug Tagamet for treatment of peptic ulcer disease.24 Doctors often suggest taking one to two chewable tablets of DGL (250-500 mg) fifteen minutes before meals and one to two hours before bedtime. Chamomile has a soothing effect on inflamed and irritated mucous membranes. It is also high in the bioflavonoid apigenin. Many people drink two to three cups of strong chamomile tea each day, which can be made by combining 3-5 ml of chamomile tincture with hot water. Chamomile is also available in capsules. Marshmallow is high in mucilage. High-mucilage containing herbs have a long history of use for irritated or inflamed mucous membranes in the digestive system.

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Are there any side effects or interactions? (Refer to the individual herb for complete information.) Licorice products without the glycyrrhizin removed may increase blood pressure and cause water retention. Some people are more sensitive to this effect that others. Long-term intake of products containing more than 1 g of glycyrrhizin (which is the amount in approximately 10 g of root) daily is the usual amount required to cause these effects. As a result of these possible side effects, long-term intake of high levels of glycyrrhizin are discouraged and should only be undertaken if prescribed by a qualified health care professional. Deglycyrrhizinated licorice extracts do not cause these side effects because there is no glycyrrhizin in them. Though rare, allergic reactions to chamomile have been reported. These reactions have included bronchial constriction with internal use and allergic skin reactions with topical use. While such side effects are extremely uncommon, persons with allergies to plants of the Asteraceae family (ragweed, aster, and chrysanthemum) should avoid use of chamomile.

Checklist for Peptic Ulcer

Nutritional Supplements Fiber Vitamin A Zinc Glutamine Bioflavonoids (Quercetin, catechin, apigenin)
References: 1. Katchinski BD, Logan RFA, Edmond M, Langman MJS. Duodenal ulcer and refined carbohydrate intake: a case-control study assessing dietary fiber and refined sugar intake. Gut 1990;31:993-6. 2. Yudkin J. Eating and ulcers. BMJ Feb 16, 1980:483 [letter]. 3. Sonnenberg A. Dietary salt and gastric ulcer. Gut 1986;27:1138-42. 4. Cheney G. Rapid healing of peptic ulcers in patients receiving fresh cabbage juice. Cal Med 1949;70:10. 5. Doll R, Pygott F. Clinical trial of Robaden and of cabbage juice in the treatment of gastric ulcer. Lancet 1954;ii:1200. 6. Grimes DS, Goddard J. Gastric emptying of wholemeal and white bread. Gut 1977;18:725-9. 7. Rydning A, Berstad A, Aadland E, Odegaard B. Prophylactic effect of dietary fiber in duodenal ulcer disease. Lancet 1982;ii:736-9. 8. Sikka KK, Singhai CM, Vajpcyi GN. Efficacy of dried raw banana powder in the healing of peptic ulcer. J Assoc Phys India 1988;36(1):65 (abstr). 9. Kern RA, Stewart G. Allergy in duodenal ulcer: incidence and significance of food hypersensitivities as observed in 32 patients. J Allergy 1931;3:51. 10. Reimann HJ, Lewin J. Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol 1988;83:1212-9. 11. Allison MC, Howatson AG, Caroline MG, et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med 1992;327:749-54. 12. Lenz HJ, Ferrari-Taylor J, Isenberg JI. Wine and five percent ethanol are potent stimulants of gastric acid secretion in humans. Gastroenterol 1983;85:1082-7.

Herbs Deglycyrrhizinated Licorice Chamomile Marshmallow

Homeopathic Remedies No homeopathy commonly used for this condition

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13. Cohen S, Booth GH Jr. Gastric acid secretion and lower-esophageal-sphincter pressure in response to coffee and caffeine. N Engl J Med 1975;293:897-9. 14. Feldman EJ, Isenberg JI, Grossman MI. Gastric acid and gastrin response to decaffeinated coffee and a peptone meal. JAMA 1981;246:248-50. 15. Dubey P, Sundram KR, Nundy S. Effect of tea on gastric acid secretion. Dig Dis Sci 1984;29:202-6. 16. Korman MG, Hansky J, Eaves ER, Schmidt GT. Influence of cigarette smoking on healing and relapse in duodenal ulcer disease. Gastroenterol 1983;85:871-4. 17. Patty I, Benedek S, Deak G, et al. Controlled trial of vitamin A therapy in gastric ulcer. Lancet 1982;ii:876 [letter]. 18. Frommer DJ. The healing of gastric ulcers by zinc sulphate. Med J Aust 1975;2:793. 19. Shive W, Snider RN, DuBilier B, et al. Glutamine in treatment of peptic ulcer. Texas State J Med Nov 1957:840. 20. Beil W, Birkholz C, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneim-Forsch Drug Res 1995; 45:697-700. 21. Wendt P, Reiman H, et al. The use of flavonoids as inhibitors of histidine decarboxylase in gastric diseases: Experimental and clinical studies. Naunyn-Schmeidbergs Arch Pharmakol 1980; 313(Suppl):238. 22. Goso Y, Ogata Y, Ishihara K, Hotta K. Effects of traditional herbal medicine on gastric mucin against ethanol-induced gastric injury in rats. Comp Biochem Physiol 1996; 113C:17-21. 23. Beil W, Birkholz W, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneim Forsch 1995;45:697-700. 24. Brogden RN, Speight TM, Avery GS. Deglycyrrhizinated licorice: A report of its pharmacological properties and therapeutic efficacy. Drugs 1974; 8:330-9.

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The information presented in HealthNotes Online is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

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