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Health Topics
Peptic Ulcers

Peptic ulcer is used to describe a group of ulcerative disorders of the upper gastrointestinal tract. An ulcer is an erosion of the mucous membrane which may be accompanied by inflammation and infection and may occur at different locations. The major forms if ulcers are gastric ulcers (in the lesser curvature of the stomach), duodenal ulcers (on the duodenal side of the pyloric region) and pyloric ulcers (where the muscle ring acts as a valve between the stomach and the duodenum). The word peptic comes from the enzyme pepsin which digests protein.

Ulcers are thought to occur when protective substances which line the stomach and small intestine breakdown and there are various factors which cause the breakdown. The bacterium, helicobacter pylori, is linked to the development of ulcers, particularly duodenal ulcers. It is found in approximately 90-95% of people with duodenal ulcers and 66% of people with gastric ulcers. The presence of the bacteria can be tested by biopsy, a blood test or a breath test. Some medicines such as aspirin, non-steroidal anti-inflammatories can cause ulcers as can coffee, tobacco, antacids, steroids and arthritis drugs. The non-steroidal anti-inflammatory drugs inhibit substances called prostaglandins that protect the lining of the gastrointestinal tract. Stress, smoking and anxiety are also thought to be risk factors for the formation of peptic ulcers. A diet that is low in protein and high in refined carbohydrates will not protect the stomach. Coffee, tea, cigarettes and alcohol may stimulate acid production and hence aggravate the condition. A low fibre diet may also contribute to ulcer formation.

The general symptoms of peptic ulcers are localised burning pain, tenderness, nausea, vomiting, cramping, lower back pain, headaches and a choking sensation. A duodenal ulcer is usually characterised by pain and abdominal distress between one and four hours after meals. The pain is relieved by food and antacids but the symptoms are chronic. The patient may wake with pain during the night. The gastric ulcer symptoms are similar but many people with gastric ulcers can be symptomless. If there are symptoms they generally begin just after eating or within twenty minutes.

Peptic ulcers can be cured in 90 to 95% of cases. The first step in treatment is to identify the causative factors and eliminate them. A specific course of antibiotics (sometimes referred to as the triple therapy) may be used if helicobacter pylori is present. Haemorrhage, perforation and obstruction are complications arising from peptic ulcers.

The intake of processed foods and refined carbohydrates (sugars, white breads, white pasta, cakes, biscuits etc.) should be reduced. Food should be in an easily digestible form, thoroughly cooked and chewed completely. There should be adequate intake of protein as this acts a s a buffer in the stomach. Alcohol, caffeine, spices, onion, garlic and horseradish should be avoided. Cabbage juice has been found to be very beneficial in ulcers. It is high in substance U which helps to repair the mucous membrane of the stomach and the duodenum. Soft foods such as bananas, avocados and potatoes are soothing. Aloe vera juice helps as do barley and alfalfa juices. Cultured products such as yogurt, sauerkraut and cottage cheese may also be beneficial in the healing process.

Acidophilus supplementation may help altered levels of bacteria and protect against helicobacter pylori. Slippery elm is a useful herb in treating ulcers as it heals and protects the mucous membranes. It may provide quick relief for pain.

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Kevin McCormack B.Sc. Pharm. MPSI