Peptic ulcer disease (PUD) is a chronic disease of acid-induced lesions of the upper digestive tract affecting up to 10% of the world's population. Recent epidemiological studies have shown a decrease in the incidence of PUD, attributed to new therapies and improved hygiene. (2)
Peptic ulcers can be asymptomatic but are often quite painful, causing gnawing pain most often associated with mealtimes. PUD can cause chronic bleeding, intestinal perforation, and increased cancer risk in more severe cases. Fortunately, natural interventions can be quite effective in relieving symptoms and supporting healing.
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What are Peptic Ulcers?
Peptic ulcers are crater-like sores caused by the erosion of the tissue in the upper digestive tract. PUD typically affects the stomach (gastric ulcers) or the upper portion of the small intestine (duodenal ulcers) but may involve the lower esophagus and lower parts of the small intestine. Duodenal ulcers are two to three times more common than gastric ulcers. (3)
Peptic Ulcer Signs & Symptoms
The most common symptom associated with PUD is abdominal pain, described as gnawing or burning. The pain's timing can help differentiate between gastric and duodenal ulcers. Eating with gastric ulcers exacerbates pain within 15-30 minutes of starting a meal. Because eating is associated with increased pain, weight loss is common in these patients. On the other hand, patients with duodenal ulcers will initially experience reduced pain with eating, then experience a recurrence of pain 2-3 hours after mealtime. Because of this, patients with duodenal ulcers may report weight gain. (3, 4)
Not everyone with PUD will experience symptoms, but for those that do, other common symptoms include (4):
- Increased fullness
- Bloating
- Frequent belching
- Heartburn
- Nausea
Rarely, PUD can cause more severe symptoms, like vomiting blood, difficulty breathing, and black tarry stools (4). If these occur, you should seek immediate medical attention.
What Causes Peptic Ulcers?
Helicobacter pylori (H-pylori)
H. pylori bacterial infection is the most common cause of PUD. H. pylori is identified in 90% of duodenal ulcers, 70% of gastric ulcers, and 50% of the world population. H. pylori decreases the stomach's acidic environment and induces chronic inflammation of the stomach lining, leading to ulceration. (2, 3)
NSAIDs
The use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of PUD. NSAIDs suppress the intestines' natural defenses against stomach acid, leading to inflammation and a breakdown of the intestinal lining. Additionally, they can impair blood flow to the stomach's and small intestine's lining, impeding repair of the damaged mucosal lining. (3, 5)
Chronic use of other medications can also increase the risk of developing ulcers. These include steroids, anticoagulants, SSRI antidepressants, and bisphosphonates. (4)
Lifestyle Factors
Tobacco and alcohol can reduce mucus and increase acid secretions in the stomach, leading to ulcer formation (1).
Stress and spicy foods aren't proven to cause ulcers on their own but are well-accepted triggers for exacerbating preexisting ulcers and impairing the healing process (4).
Other Causes
Genetics play a role in peptic ulcer development. More than 20% of patients with PUD have a family history of duodenal ulcers, and children of parents with a peptic ulcer are three times more likely to develop an ulcer later in life.
Less commonly, PUD is associated with the following conditions (3):
- Zollinger-Ellison syndrome, a rare disorder resulting in excess stomach acid
- Cancer
- Crohn's disease
- Celiac disease
- Other infections, including Epstein-Barr virus (EBV) and Candida albicans
Functional Medicine Labs to Test for Root Cause of Peptic Ulcers
The gold standard and most accurate diagnostic test for identifying peptic ulcers is esophagogastroduodenoscopy (EGD), also called an upper endoscopy. This procedure involves inserting a camera into a person's mouth to look into the stomach and the beginning of the small intestine. Ulcers identified during an EGD can be photographed, biopsied, and treated if bleeding.
Your doctor may also order blood work in the initial evaluation of PUD. This may include a CBC, CMP, amylase, and lipase to rule out anemia and other conditions causing abdominal pain.
H. pylori infection should be ruled out, especially in cases of recurrent ulcers. Stool and breath testing are the most accurate diagnostic methods to detect H. pylori infection. This stool test additionally measures virulence factor genes, which, if present, can cause more severe disease, and antibiotic-resistant genes, which guide treatment recommendations.
Functional Medicine Peptic Ulcer Treatment Protocol
The fundamental principles of a functional medicine PUD treatment protocol include the elimination of ulcer triggers and the strengthening of the intestinal mucosal lining.
Eliminate Causes
H. pylori treatment protocols are intensive because H. pylori is resistant to therapy. Conventional treatment protocols involve multiple antibiotics, bismuth, and/or a proton pump inhibitor (PPI) for up to two weeks. Patients may require additional treatment rounds if repeat testing does not confirm infection eradication. Natural protocols also exist, which may be used independently or in combination with conventional therapies. Many human studies on natural H. pylori treatment show inconclusive or negative results. It is important to realize that many of these studies may be underdosing the herbs and/or only using a single agent to treat. Similar to their pharmaceutical counterparts, natural agents must be combined to achieve synergistic antimicrobial effects for successful infection eradication. Natural agents that have proven effective at suppressing and eradicating H. pylori include (1, 2):
- Garlic
- Broccoli sprouts, or their isolated compound sulforaphane
- Green tea, or its isolated compound epigallocatechin gallate (EGCG)
- Licorice
- Ginger
- Honey
- Probiotics
Stopping smoking, abstaining from alcohol, avoiding NSAID use, and managing stress are all important in the acute treatment of ulcers and the prevention of ulcer recurrence. (6)
Implementing a bland diet can help decrease gastrointestinal inflammation during ulcer healing. Foods commonly avoided include citrus fruits, tomatoes, spices, raw vegetables, fried foods, and refined sugars.
Heal the Gut
Conventional protocols routinely implement acid-blocking and protective medications to support the healing of ulcers. These may include a PPI like Prilosec, a histamine receptor blocker like Pepid, or a "liquid bandage" like Carafate or Pepto-Bismol. Your functional medicine provider may also recommend these if a natural therapy approach does not provide the expected results. (6)
Commonly utilized natural herbs and supplements in ulcer-healing protocols include:
- Licorice: Not only can it inhibit H. pylori growth, but licorice root also has a long history of use for soothing excessive inflammation and healing injured mucosal tissues.
- Comfrey: Historically, comfrey is one of the most effective wound-healing herbs, producing results in as little as two days of supplementation.
- Curcumin: Notorious for its potent anti-inflammatory effects, curcumin has also been shown to have mild acid-suppressing and H. pylori-inhibiting effects (2).
- Zinc: Due to its anti-inflammatory and antioxidant properties, zinc carnosine has been shown to accelerate the healing of gastric ulcers.
- Glutathione: Glutathione is a potent antioxidant that can support the immune system and decrease intestinal inflammation.
Summary
Peptic ulcer disease (PUD) is a relatively common condition characterized by ulceration of the stomach and/or small intestine ulceration, most commonly caused by H. pylori infection or chronic NSAID use. If you experience burning upper abdominal pain that changes in severity around mealtimes, speak to your doctor about the possibility of PUD. Quick diagnosis of PUD and identification of underlying H. pylori infection can lead to fast resolution of bothersome symptoms and prevention of more severe complications. By implementing a combination of natural supplements and herbs, lifestyle modifications, and prescription medications as needed, successful treatment and prevention of intestinal ulcers are possible.
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