Peptic Ulcers
(stomach ulcers)

A stomach ulcer can be caused by a variety of factors, including:

• Helicobacter pylori - these bacteria is thought to be responsible for around 60 per cent of stomach ulcers and at least 90 per cent of duodenal ulcers.
• Certain medications - including aspirin, taken regularly to help prevent heart attack or stroke, and drugs for arthritis. Anti-inflammatory medications (NSAIDS) are thought to cause around two fifths of stomach ulcers.
• Cancer - stomach cancer can present as an ulcer, particularly in older people.
• stress, alcohol, smoking, and dietary factors.

Helicobacter pylori

The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers. It is thought that about one in three people over the age of 40 years are infected with this strain of bacteria in Australia. The germs live in the lining of the stomach, and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers, and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion). Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people.

The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations.

Peptic ulcers are typically treated with antibiotics (e.g., amoxicillin [e.g., Amoxil®, Trimox®], clarithromycin [Biaxin®], tetracycline [e.g., Achromycin®, Sumycin®]), metronidazole [e.g., Flagyl®]) and bismuth subsalicylate (e.g., Pepto-Bismol®) to eliminate infection with Helicobacter pylori. In addition, other medications may be prescribed to control stomach acidity, including histamine H2 inhibitors (e.g., cimetidine [Tagamet®], famotidine [Pepcid®], nizatidine [Axid®], ranitidine [Zantac®]), proton pump inhibitors (e.g., lansoprazole [Prevacid®], omeprazole [Prilosec®]), and antacids (e.g., Maalox®, Mylanta®, Rolaids®, Tums®).

• Vitamin A*: Vitamin A is needed in the healing of mucosal tissue, including linings of the stomach and intestines. However, the amount used in clinical studies (150,000 IU per day for four weeks) has the potential to cause significant toxicity and may also cause birth defects. Therefore, that amount of vitamin A should never be taken by a woman who is or could become pregnant, nor by anyone else without careful supervision from a doctor. The effect of lower amounts of vitamin A has not been studied in people with peptic ulcer.
• Zinc: Zinc is needed in the repair of damaged tissue. Some doctors suspect that the exceptionally high amount used in studies may be unnecessary, suggesting instead that people with ulcers wishing to use zinc supplements take only 25-50 mg of zinc per day. Even at these lower levels, 1-3 mg of copper per day must be taken to avoid copper deficiency.
• Zinc-L-Carnosine: 150 mg twice daily.

• Licorice (DGL): (two chewable tablets of DGL [380 mg per tablet] three to four times per day [e.g., 15 minutes before meals and one to two hours before bedtime]) DGL is an extract of licorice (Glycyrrhiza glabra) root. It may protect the stomach and duodenum by increasing production of mucin, a substance that protects the lining of these organs against stomach acid and other harmful substances. In making DGL, the portion of licorice root that can increase blood pressure and cause water retention is almost completely removed, while the mucous membrane.healing part of the root is retained. Though not every trial has reported efficacy, most studies find DGL, as well as the anti.ulcer drug cimetidine (Tagamet®), to facilitate healing of peptic ulcer in some cases.
• Mastic*: The gummy extract of Pistacia lentiscus, also known as mastic, has been shown in one preliminary study and one double.blind study to heal peptic ulcers. This may be related to its ability to kill Helicobacter pylori in test tubes.

• Banana powder (Musa paradisiaca): two capsules of dried raw banana powder taken four times per day for eight weeks.

• Aspirin and related drugs (non.steroidal anti-inflammatory drugs): Aspirin and related drugs can aggravate or interfere with the healing of peptic ulcers.
• Avoid alcohol: Alcohol is known to increase stomach acidity, which can interfere with the healing of an ulcer.
• Avoid coffee (including decaf) and tea: These beverages are known to increase stomach acidity, which can interfere with the healing of an ulcer.
• Quit smoking: Smoking is known to slow ulcer healing.

• Avoid sugar: Sugar may exacerbate peptic ulcers in susceptible individuals.
• Restrict salt intake: Salt is a stomach and intestinal irritant. Higher intakes of salt have been linked to higher risk of stomach (though not duodenal) ulcer. However, the amount of benefit obtainable by restricting dietary salt remains unknown.
• Drink cabbage juice: Many years ago, researchers reported that cabbage juice accelerated healing of peptic ulcers. Although only preliminary modern research supports this approach, many doctors claim considerable success using one quart per day for 10 to 14 days, with ulcer symptoms frequently decreasing in only a few days. Carrot juice may be added to improve the flavor.
• Eat foods high in fiber: Although results of studies are mixed, people with recently healed duodenal ulcers may be able to reduce the rate of recurrence by increasing fiber intake long.term (i.e., one year or more).
• Avoid food allergens: The relationship between food allergies and peptic ulcer was reported as many as 70 years ago. Exposing the lining of the stomach to foods a person was known to be allergic to has caused bleeding in the stomach. Although additional research is needed, avoiding food allergens may be helpful for people with peptic ulcers. Consultation with a doctor is needed to discover to which foods a person is sensitive.

• Stress reduction techniques or psychological counseling: Emotional stress has been shown to increase acid production in the stomach. The reported association between stress and peptic ulcer might possibly be attributable to a stress.induced increase in gastric acidity. Whether stress reduction techniques or psychological counseling helps prevent ulcers or ulcer recurrence has not been adequately studied in medical research.

See research details