What causes peptic ulcers?

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Understanding Peptic Ulcers

Healthylife Pharmacy13 April 2017|4 min read

It is not unusual to suffer the burning, gnawing pain of a peptic ulcer at some point in life. These ulcers are erosions in the protective lining of the stomach or in the duodenum (the upper part of the small intestine). Until the mid-1980’s, ulcers were believed to be a direct result of stress, excessive stomach acid secretion, overindulging in fatty foods, alcohol, caffeine and tobacco.

Although stomach acid and dietary and lifestyle factors play a role in the development of ulcers, more recent research has revealed bacterial infection to be the primary cause of peptic ulcers. Helicobacter pylori infection has been proven to cause most duodenal ulcers and about two-thirds of stomach ulcers. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are another major contributor as they damage the stomach and intestinal lining. H. pylori and NSAIDs act synergistically to increase the risk of ulcers and bleeding.

What causes peptic ulcers?

Major risk and causative factors that can contribute to the incidence of peptic or duodenal ulcers include:

  • Helicobacter pylori infection
  • NSAID use (including aspirin, ibuprofen and diclofenac)
  • Smoking
  • Alcohol consumption
  • Caffeine
  • Food allergy
  • Antacid overuse
  • Stress, anxiety and other psychological factors
  • Increasing age
  • Family history

Signs you may have a peptic ulcer

Common signs and symptoms of peptic ulcers include the following:

  • Burning or gnawing pain in the stomach.
  • Epigastric pain.
  • Nausea and vomiting.
  • Dyspepsia, belching and bloating.
  • Symptoms are relieved by drinking milk and or taking antacids.

Note: Duodenal ulcers are often relieved by eating food, while eating may exacerbate stomach ulcers.

Warning: Increased pain, vomiting of blood, tarry or red stools, and significant weight loss could indicate perforation, gastric outlet obstruction or haemorrhaging.

What can help

Fibre

Eating a high-fibre diet is often helpful for ulcers and can aid in their repair. Eating wholegrains (rye, wheat, oats, rice, barley and millet) with 7-8 serves of fresh vegetables and 1-2 pieces of fruit can help achieve the recommended 30g of fibre a day. 

  • Slippery elm powder is a gentle muscilageous fibre which can soothe the digestive track, reducing inflammation and pain. It can protect the surface of the ulcer and promote healing. Slippery elm is available as a capsule or tablet which can be swollowed whole, or as a powder which can mixed with water and consumed or added to food. 

Foods rich in isothiocyanates

Foods high in sulphur such as garlic, onions, broccoli (and its sprouts), kale, cabbage and brussels sprouts can help heal ulcers reduce H.pylori infection. In traditional medicine, cabbage juice has been considered an effective remedy for peptic ulcer disease. Make your own fresh juice with cabbage leaves, apple and carrot.

Berry goodness

Berries such as blueberry, raspberry, cranberry, blackberry, strawberry and bilberry have demonstrated antibacterial activity against H.pylori. It is believed the phenolic content gives these berries their antimicrobial activity. In a prospective randomised double-blind trial involving 189 adults with H.pylori infection, those you drank 250mls of blueberry juice for 3 months had a negative result against this bacteria on the 35th day. 

Healing honey

Some types of honey, particularly manuka honey, exhibit potent activity against H.pylori and inhibit urease activity.  Helicobacter pylori release microbial ureases into the stomach. 

H.pylori produce large amounts of urease in an attempt to neutralise the acid in its environment and does this by converting urea to carbon dioxide and ammonia. In one study, honey intake at least once a week was associated with a significantly lower prevalence of H.pylori infection.

Propolis (a flavonoid rich by-product of bees) has also demonstrated anti-bacterial activity.

Anyone for a cuppa?

Although caffeine isn’t usually advised in peptic ulcers the caffeine content in green and black tea has been associated with a lower risk of peptic ulcers. Herbal teas with anti-inflammatory properties such as chamomile, ginger and liquorice can help facilitate healing of ulcers. 

Healthy bowel flora

Repopulating your gut with good bacteria can help to inhibit H.pylori. Consider adding fermented foods such as sauerkraut, kimchi, kefir or natural yoghurt to the diet and supplementing with a probiotic containing Acidophilus and Bifidobacterium for a more therapeutic action. Colostrum is a supplement rich in lactoferrin which can reduce pathogenic microorganisms and support gut immunity.

Spice it up

Extracts of cinnamon, rosemary, turmeric, nutmeg and ginger have been shown to inhibit H.pylori growth and can be easily added to the diet.

Other extracts with similar activity include mastic gum (from the Mediterranean shrub (Pistacia lentiscus), Barberry (Oregon Grape) and Goldenseal (Hydrastis canadensis).

Healthy oils

Supplementing with fish oil, rich in omega 3 is associated with a lower prevalence of duodenal ulcers. 

What to avoid

Avoid consuming large meals, rather try several small meals per day. Some foods, alcohol and caffein-based drinks may aggravate and should be avoided.

Could it be food allergies?

Food allergies can be a cause of ulcers or make them worse. Allergy testing is available through your healthcare provider using IgG food allergy panel test or by conducting an elimination diet. Common food allergens include soy, dairy, eggs, peanuts, tree nuts, wheat, fish and shellfish.

Lifestyle suggestions

If you are feeling the effects of stress, then consider implementing relaxation techniques into your daily routine. Yoga, meditation, tai chi, reading, listening to music or any healthy activity are great stress relievers. 

References

  1. http://www.webmd.com/digestive-disorders/understanding-ulcers-basic-information#1
  2. Mitchell H, Katelaris P. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection. Med J Aust 2016;204(10):376-380
  3. https://www.mja.com.au/journal/2016/204/10/epidemiology-clinical-impacts-and-current-clinical-management-helicobacter
  4. Boyanoya L, et al. Honey and green/black tea consumption may reduce the risk of Helicobacter pylori infection. Diagn Microbiol Infect Dis. 2015 May;82(1):85-6 https://www.ncbi.nlm.nih.gov/pubmed/25779680/
  5. Fahey JW, et al. Dietary amelioration of Helicobacter infection. Nutr Res. 2015 Jun;35(6):461-473 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465045/