Peptic ulcer

The term 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 of gastrointestinal ulcers
are:

• Gastric ulcer- this type of ulcer is found on the lesser
  curvature of the stomach.
• Duodenal Ulcer- this type of ulcer usually occurs on the
  duodenal side of the pyloric region. This is the first part of the
  small intestine. Excess acid may overflow from the
  stomach. 
• Pyloric Ulcer- develop at the point where the muscle ring acts
  as a valve between the stomach and duodenum.
• Peptic Ulcer- is a common name for any of the above. The word
  ‘peptic’ comes from the enzyme pepsin, which digests protein.

DESCRIPTION

Ulcers of the gastrointestinal tract may occur at different
locations but appear to be the result of similar mechanisms. They
are thought to occur when protective substances which line the
stomach and small intestine breakdown. Many factors can affect
either the production of protective mucus or the secretion of
stomach acid or both.

CAUSE

Factors contributing to the development of ulcers in the
gastrointestinal tract include;

• Helicobacter pylori. This bacteria is linked to the development
  of ulcers, particularly duodenal ulcers. Helicobacter pylori is
  found in approximately 90-95 % of people with duodenal ulcers and
  66 % of people with gastric ulcers. The presence of Helicobacter
  pylori can be tested by a direct biopsy of the stomach lining, by a
  blood test or a breath test. – Certain medications and supplements
  may cause Peptic Ulcers. These include, aspirin, non-steroidal
  anti-inflammatory drugs (NSAIDs), tobacco, coffee, acidic forms of
  vitamin C (pure ascorbic acid), antacids (antacids may be
  effective, but carry some risk of toxicity, disrupt the digestive
  process and may alter the structure and function of the cells which
  line the digestive tract), steroids & arthritis
  medication. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common
  cause of peptic ulceration. These drugs inhibit substances known as
  prostaglandins that protect the lining of the gastrointestinal
  tract. 
• Stress, anxiety and smoking are thought to be risk factors for
  the formation of Peptic Ulcers.
• Diet and nutritional factors may affect the formation and
  healing process of ulcers. A diet low in protein and high in
  refined carbohydrates provides little protection for the stomach.
  Coffee, tea, cigarettes and alcohol may also aggravate the
  condition stimulating acid production and irritating the lining of
  gastrointestinal tract (GIT). Overeating or eating when not hungry
  may cause indigestion and may predispose a person to gastritis (
  inflammation of the GIT ) and ulcers. A low fibre diet may also
  contribute to ulcer formation.

Aspirin should not be given to children under 16 years of age
unless specified by a Doctor.

SIGNS AND SYMPTOMS

General symptoms: Localised gnawing and burning pain,
heartburn, local tenderness, nausea and/or vomiting, diarrhoea,
abdominal discomfort, cramping, lower back pain, headaches, and
choking sensation. 

Specific symptoms:

• Duodenal ulcer- The clinical picture of duodenal ulcer is
  characterised by pain and abdominal distress typically occurring 1
  to 4 hours after meals. The pain is relieved by food and antacids
  and the symptoms are chronic and periodic. The patient may wake
  around 2 to 4 am with pain. 
• Gastric ulcer- The signs and symptoms of a gastric ulcer are
  similar to that of a duodenal ulcer although a greater number of
  gastric ulcer patients may be without symptoms. Gastric ulcer
  symptoms usually begin just after eating, or within 20
  minutes.

TREATMENT OPTIONS

As with all conditions your Doctor should be consulted.
Patients with Peptic Ulcers need competent medical care. It is very
important that your Doctor is consulted for the diagnosis of an
ulcer.

 

Peptic Ulcers can be cured in 90 to 95% of patients with a
course of appropriate therapy. The first step is to identify and
eliminate any factors which may be causing the ulcer. When the
causative factors have been controlled, focus should be directed at
healing the ulcer. Antibiotics may be suggested if Helicobacter
pylori bacteria is present. If you are taking NSAIDs ask your
Doctor about the risk factors relating to Peptic Ulcer.

 

Medicine prescribed by your GP can take several weeks to
become effective. Additional medicines may also be recommended to
help provide short-term relief from your symptoms. These
include

Antacids – to neutralise stomach acid on a short-term basis,
and

Alginates – which produce a protective coating on the lining
of your stomach.

 

COMPLICATIONS – Peptic Ulcer complications- haemorrhage,
perforation and obstruction- represent medical emergencies. Dark or
blackish coloured stools may indicate bleeding of the ulcer.

DIET HINTS

• Reduce the intake of processed foods and refined carbohydrates.
  This includes sugars, white breads, white pasta, cakes, biscuits
  etc. Make sure the diet is high in fibre and complex
  carbohydrates.
• Avoid very rough foods such as nuts, hard seeds, grain bread
  and unprocessed bran. Ensure food is in an easily digestible form
  and are thoroughly cooked and chewed completely. 
• Have adequate protein intake. Protein acts as a buffer to the
  stomach. 
• Try to avoid alcohol, caffeine (tea, coffee, chocolate, cola
  drinks), spices, onion, garlic and horseradish.
• Check for food allergies. Food allergies are also thought to
  cause ulcers.
• Try to include foods that have a soothing and healing effect on
  the lining of the stomach. These include:
• Cabbage juice has been found to have remarkable success in
  ulcers. It is high in substance U which normalises and repairs the
  mucous membrane of the stomach and duodenum. The role of glutamine
  in cabbage is thought to be responsible for the healing
  abilities. 
• Soft foods can soothe and provide a protective layer to the
  lining of the GIT. These include bananas, avocados,
  potatoes, 
• Juicing is very beneficial to digestion and provides many
  nutrients. Barley and alfalfa juice are high in chlorophyll and are
  thought to aid healing of ulcers. Aloe vera juice is also
  beneficial.
• Cultured products such as kefir, yoghurt, sauerkraut and
  cottage cheese may also be beneficial to the healing process of
  ulcers.

VITAMINS/MINERALS/HERBS

Vitamins and minerals may only be of assistance if dietary
intake is inadequate.

• Acidophilus supplementation may help altered bacteria levels
  and protect against helicobacter pylori.
• Slippery Elm is probably one of the most important herbs to
  consider when managing ulcer. It is believed to heal and protect
  mucous membranes and be anti-bacterial. Slippery elm may provide
  quick relief for pain. 
• Aloe vera juice or capsules are thought to promote healing,
  soothe Mucous membranes, aid pain relief and protect against
  bacteria.

PHARMACIST’S ADVICE

Ask your Pharmacist for advice.

1. If the ulcer is painful, consider a suitable pain killer. Avoid
   aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs
   to relieve pain. 
2. An antacid to neutralise stomach acid or alginate to provide a
   protective coating on your stomach lining may be
   suggested. 
3. If you need help to stop smoking, ask your Pharmacist for
   suggestions. Studies have proven that smoking irritates Peptic
   Ulcers and interferes with the healing process.
4. Drinking 6 to 8 glasses of filtered water every day is
   recommended. Ask your Pharmacist about water filter jugs.
5. If the diet is inadequate consider the supplements recommended
   in this topic.
    

Aspirin should not be given to children under 16 years of age
unless specified by a Doctor.