If your patients frequently use antacids or mention that eating between meals helps with stomach discomfort or heartburn, this article may offer some helpful insights. One in ten people may experience peptic ulcers. This condition can lead to behaviors aimed at managing digestive discomfort. While ulcers might sometimes heal on their own, they can be a sign of potential health concerns. With appropriate testing, you can assist in identifying the underlying factors contributing to your patient’s ulcers to help manage them effectively.
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What is Peptic Ulcer Disease?
Peptic ulcer disease (PUD) refers to painful sores or ulcers in the stomach (gastric ulcers) or a part of the small intestine (duodenal ulcers) caused by erosion of the lining that usually protects this area. The digestive lining is typically protected by a thick layer of mucus that can shield it from stomach acid. However, this layer can be disrupted and lead to ulcerations.
What Causes Peptic Ulcer Disease?
There are several causes of PUD. These include H. Pylori, medications such as NSAIDs, tobacco or alcohol use, genetics, and other conditions. Many people may develop PUD due to the overgrowth of Helicobacter pylori (H. pylori) bacteria. In fact, this is a common cause, with 90% found in duodenal ulcers and 70% found in gastric ulcers.
People who take pain relievers such as NSAIDs are also more likely to develop ulcers, which is another common cause of PUD. Regularly using NSAIDs can affect the intestine's defenses, leading to inflammation that breaks down the lining. Other medications that can increase the risk include steroids, anticoagulants, SSRI antidepressants, and bisphosphonates.
Genetics has also been associated with PUD as it tends to run in families. Although less common, other conditions include Zollinger-Ellison syndrome (condition of excess stomach acid), cancer, Crohn's disease, celiac disease, and infections like Epstein-Barr virus (EBV) and Candida albicans can contribute to ulcers.
Lifestyle factors also play a part in developing ulcers, such as smoking or alcohol use, which can reduce mucus production and increase stomach acid. While stress and spicy foods are not proven to cause ulcers, they can worsen existing ulcers and slow the healing process.
Peptic Ulcer Disease Symptoms
It's important to note that not everyone with ulcers experiences symptoms. However, ulcers can present with the following symptoms:
- Lingering or burning stomach pain between meals or in the evening
- Relieved pain after food or taking an antacid
- Abdominal distension
- Heartburn
- Nausea
Symptoms that may be red flags include:
- Vomiting
- Black stools
- Weight loss
- Pain that is severe
What Are The Benefits of Regular Lab Testing For Patients With Peptic Ulcer Disease?
Not everyone experiences symptoms even though they have ulcers. Therefore, it's important for individuals who may be at risk to get tested, as ulcerations can lead to serious health issues without management, such as perforation, gastric outlet obstruction, or bleeding. For those experiencing symptoms, it is suggested that retesting be completed regularly to determine if the management was sufficient or if any adjustments need to be made. Functional medicine labs also provide insight into the underlying factors contributing to ulcers so approaches can be personalized, often resulting in better health outcomes.
Top Labs To Run Bi-Annually On Patients With Peptic Ulcer Disease
The top labs used by functional medicine clinicians to assist their patients with PUD are the following:
H. Pylori Testing
H. Pylori is the bacteria that may contribute to PUD and is a primary reason for its development. This bacteria has been shown to affect the protective layer of the digestive tract, allowing stomach acid to create ulcerations. This H. Pylori stool test measures the bacteria and antibiotic-resistant genes, which allows for more precise guidance in management protocols for practitioners. This test can be a helpful tool to monitor H. Pylori levels after management and to help with decreasing the risk of PUD and supporting existing ulcers.
Gut Zoomer
The gut zoomer measures various pathogens in the gastrointestinal tract that can contribute to chronic disease. Disruptions in the gut microbiome due to the overgrowth of these microbes can indicate conditions such as Crohn's (a form of IBD), candida overgrowth, or celiac, all of which are implicated as a possible cause of PUD. The results of this stool test can help clinicians investigate underlying factors of PUD for their patients, and retesting after management protocols can help monitor the effectiveness of approaches.
Cortisol Stress Test
Cortisol is a key stress hormone produced by the body. In appropriate amounts, it is vital and beneficial. Yet, excessive and prolonged cortisol levels can be harmful. Cortisol release follows our circadian rhythm, but chronic stress can disrupt this pattern, potentially leading to health issues. By testing cortisol levels throughout the day, we can understand its production and timing. Although stress hasn't been indicated to cause ulcers, it can exacerbate its symptoms. Thus, regular monitoring of stress levels through this saliva test is suggested to help balance stress levels and reduce the severity of symptoms in PUD patients.
Additional Labs to Check
An upper endoscopy is the standard to confirm the presence of PUD. Although less common, other imaging tests such as CT scans and X-rays may also be used to determine the occurrence of ulcerations after drinking a special liquid that makes the ulcers more visible on imaging. These should be ruled out if other conditions are suspected of contributing to PUD. Conditions like EBV infection can be tested by an antibody serum test or Zollinger Ellison by fasting serum gastrin levels. These conditions are rare causes of ulcers but should still be ruled out.
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Summary
PUD can be asymptomatic in some people but can cause lingering pain in others. Whether your patients have symptoms or not, they may benefit from regular testing to assess for ulcers if you suspect they are at risk or have a history of PUD. If left unaddressed, these ulcerations can lead to more serious issues, including cancer in more severe cases. Functional medicine labs can be completed easily, helping you to explore your patient’s underlying factors that may be increasing their risk of ulcers while providing guidance on how to individualize management protocols to help effectively support PUD.
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