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- develops 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 are 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. Food and antacids relieve the pain 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 that normalizes 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 MedAux 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 MedAux 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.
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.