Peptic Ulcer Disease Causes Symptoms and Treatment (Gastric and Duodenal Ulcers)

What is peptic ulcer disease (PUD) and what is the most common manifestation of peptic ulcer disease?

Peptic ulcer disease (PUD) is a condition characterized by superficial gastric erosions (superficial mucosal breaks) and gastric mucosal ulcerations (gastric or duodenal ulcers). This is caused by an imbalance between gastric or duodenal mucosal injury and repair

In most cases, peptic ulcers develop in the lining of the stomach, lower esophagus, or small intestine (duodenum).

What is the most common site for peptic ulcer formation and which is the most common site for duodenal ulcers?

Peptic ulcers occur most frequently in the gastric cardia and pylorus (pyloric antrum and pyloric canal), in the first portion of duodenum within 3 cm of the pylorus, and in the lesser curvature near the incisura angularis, which is the most common site of peptic ulcer in the stomach. Occasionally peptic ulcers occur in the lining of the lower esophagus.

Classical sites for peptic ulcers include:

1) Distal or lower third of stomach  (the antrum)

2) Pylorus of the stomach

3) The lesser curvature near the incisura angularis

4) The upper or proximal third of the stomach (the gastric cardia)

5) Greater curvature of stomach

6) The first part of the duodenum (superior part SD)

7) The second part of the duodenum (descending part DD)

An ulcer occurring outside these locations should be evaluated for the presence of malignancy

Peptic ulcers are open sores that extend deeper beyond the lamina propria, involving the entire mucosal thickness, and penetrating through the lamina muscularis mucosae

How do you know if you have an ulcer from stress?

Peptic ulcers may cause severe signs or symptoms; however, the most common symptom is a burning sensation or midepigastric pain that can last from a few minutes to several hours, recurring ache.

Epigastric pain can occur with or without food and is often worse on an empty stomach (hunger pain), especially after going without food for a prolonged period. Pain usually occurs one to three hours after meals or at night. In most cases, pain can be relieved or controlled with food or Antacids

Individuals with gastric ulcers experience dyspepsia (indigestion) and abdominal discomfort that occurs after meals. In patients with gastric ulcers (peptic ulcers), pain is felt immediately after having a meal. However, individuals with duodenal ulcers complain of upper abdominal burning or hunger pain that resolves by food intake

In patients with peptic ulcers, pain is not relieved by changing position

Other common symptoms include loss of appetite and weight loss

Is stomach ulcer cancerous?

Scientists still do not fully understand why some people develop gastric cancer and others do not; however, risk factors that may increase the risk of developing stomach cancer include: chronic H. pylori infection, chronic NSAIDs use, obesity, smoking, chronic alcohol abuse, hypergastrinemia, low socioeconomic status, and regular consumption of red meat, especially processed meat

Chronic Helicobacter pylori infection is the strongest known risk factor for gastric cancer. H. pylori is the primary cause of peptic ulcers and recurrent ulceration; however, the recurrence rate of peptic ulcers without H. pylori infection have not yet been studied

Helicobacter pylori are known to be implicated in the development of stomach cancers.

NSAIDs such as diclofenac sodium, naproxen, etodolac, loxoprofen, mefenamic acid, or meloxicam, may cause ulcers, bleeding, or perforation

Symptoms

What are the symptoms of peptic ulcer disease?

The main symptom of a gastric or duodenal ulcer is upper abdominal pain just below rib cage or chest, which can be sharp, dull, or burning

The vast majority of individuals with gastritis are asymptomatic (have no symptoms of gastritis), while others may complain of gastralgia and indigestion (dyspepsia).

Individuals with gastric ulcers experience dyspepsia along with abdominal discomfort that occurs immediately after having a meal, whereas individuals with duodenal ulcers experience epigastric pain that resolves by food intake (hunger pain) along with heartburn (acid reflux), which is caused by pyloric stenosis (outlet obstruction).

Pyloric stenosis is caused by ulcers within the pyloric channel and first portion of the duodenum.

Other common yet nonspecific symptoms include: nausea, vomiting, poor appetite, weight loss, bloating and burping

What does it feel like when you have an ulcer?

Individuals with peptic ulcers experience epigastric pain (pain between the navel and the breastbone) that can last from a few minutes to a few hours and that can be temporarily relieved or controlled with food or antacids (acid reducers). The pain sometimes radiates to the back.

In most cases, pain usually goes away for a while after you take an antacid.

What is the first sign of stomach cancer?

Individuals with gastric cancer experience nausea, upper abdominal bloating and discomfort after eating small meals (feeling full). Other symptoms include frequent heartburn, indigestion and vomiting.

Causes

What are the causes of peptic ulcer disease and what is the most common cause of stomach ulcers?

Different factors can cause peptic ulcers; however, chronic H. pylori infection and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin), diclofenac sodium (Zorvolex®), and naproxen (Aleve, Anaprox), are the primary causes of peptic ulcers and recurrent ulceration. Factors that can contribute to gastritis and ulcer formation include stress and bad habits, such as eating unhealthy food, eating too much spicy foods, smoking cigarettes, chronic inflammation, hypergastrinemia, obesity, alcohol abuse, poor personal hygiene habits, poor kitchen hygiene and poor food hygiene practices

Idiopathic peptic ulcer disease (IPUD) is a condition characterized by the presence of peptic ulcers without clearly identifiable causes

NSAIDs such as naproxen, ibuprofen, diclofenac sodium, etodolac, loxoprofen, mefenamic acid, or meloxicam, may cause peptic ulcers, bleeding, or perforation

What is an ulcer and how is it caused?

An ulcer is an erosion that extends deeper through the gastrointestinal wall, potentially causing a perforation, regardless of the cause, peptic ulcers can cause gastralgia (stomach ache), bleeding, or even cause gastrointestinal perforation (GP). In most cases, Stomach and duodenal ulcers are usually caused by chronic Helicobacter pylori infection or NSAIDs, especially in women and people over the age of 60

Are stomach ulcers caused by stress?

There is no clear evidence to suggest that the stress in our everyday life or unhealthy eating habits cause peptic ulcers, but they are common in our society. About 10% of Americans will experience some level of gnawing or burning abdominal pain of a peptic ulcer at some point in their lives

Can stress cause an ulcer to flare up?

Ulcers can be caused by a chronic inflammation or due to increased acid production in the stomach.

They also can be a side effect of long-term NSAID use or the result of an injury that causes physical damage to the gastrointestinal tract. Stress can make symptoms worse. However, it does not actually cause ulcers.

Diagnosis

How to diagnose peptic ulcer disease and how do you get tested for stomach ulcers?

Diagnosis is made based on symptoms and diagnostic endoscopy

An upper gastrointestinal endoscopy or EGD is the best confirmatory test to diagnose Peptic Ulcer Disease.

During endoscopy, your doctor passes an endoscope (a hollow tube equipped with a lens) down your throat and into your esophagus, stomach and duodenum. Using the endoscope, your doctor examines the lining of your esophagus, stomach, and duodenum and looks for peptic ulcers. If your doctor detects an ulcer, a biopsy is performed in which a small tissue sample is removed for examination in lab to help diagnose Peptic Ulcer Disease.

Can a blood test detect stomach ulcer and how do you test for an ulcer?

To diagnose peptic ulcer disease, your doctor will review your symptoms along with your medical history and any medications you’re taking. The urea breath test (UBT) is used to detect Helicobacter pylori infection. Alternatively, an H. pylori antigen stool test may be ordered to rule out H. pylori infection

Other diagnostic tests include:

A barium swallow (upper GI series), which may be used to diagnose peptic ulcer disease.

A complete blood count (CBC) may be done to look for anemia, which may be caused by a bleeding ulcer.

A serologic test for H. pylori is used to detect if your body has H. pylori antibodies.

Treatment

How to cure stomach ulcer permanently at home and how long does it take for a stomach ulcer to heal?

If you have a stomach ulcer, your treatment will depend on the cause and severity of the condition. If you have an H. pylori infection, you will also need to take a course of antibiotics for one to two weeks; however, most people need to take a proton pump inhibitor (PPI) for up to 8 weeks to reduce the amount of acid in the stomach. With treatment, most ulcers heal in a month or two. Additionally, your doctor will recommend eliminating or reducing use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Naprosyn), if possible, to help heal ulcers

While symptoms can go away completely in a short time, you may still have an ulcer, so the full course of antibiotics must be completed by a patient in order to cure stomach ulcer permanently!

With treatment, it usually takes about 2 to 3 weeks to get rid of H. pylori infection. If left untreated, an ulcer can cause life-threatening problems.

What is the best medicine for peptic ulcers?

Peptic ulcers are treated with antibiotics and medications that can decrease acid production in the stomach. Common medications for peptic ulcers include: antacids (Gaviscon), proton pump inhibitors (Aciphex or Nexium), and H-2-receptor blockers, such as ranitidine (Pepcid, Tagamet, Zantac)

A standard triple H. pylori regimen including a proton pump inhibitor and a combination of clarithromycin and amoxicillin is often used in the eradication of H. pylori and H. pylori-induced gastrointestinal disorders. Alternatively, a bismuth-containing quadruple therapy can be employed as a second-line treatment after the failure of standard triple therapy

A bismuth-containing quadruple therapy combining tetracycline, metronidazole, bismuth, and a PPI is the universal treatment used in the eradication of H. pylori.

A 14-day quinolone-containing triple therapy can be employed as a second-line treatment. Quinolone-containing H. pylori eradication regimens can provide a 90% H. pylori eradication rate

Can Stomach Ulcer be cured completely?

If you have an H. pylori infection, immediate antibiotic therapy for one to two weeks is mandatory because eliminating H. pylori with antibiotics increases cure rates over 90%

Combination therapy is indicated for the treatment of individuals with an active peptic ulcer associated with H. pylori infection.

The most commonly used combinations for peptic ulcers include:

1- Helidac Therapy (bismuth subsalicylate/metronidazole/tetracycline) is prescribed as a 14-day course to reduce the development of drug-resistant bacteria

2- Prevpac Therapy (Lansoprazole, Amoxicillin and Clarithromycin) is indicated for H. pylori eradication to reduce the risk of duodenal ulcer recurrence

Prevpac Therapy consists of a daily administration of two Prevacid (Lansoprazole) 30 mg delayed release capsules, two Biaxin (clarithromycin) 500 mg tablets, and four amoxicillin 500 mg capsules. All drugs are administered twice daily (morning and evening) for 14 days

Bismuth subsalicylate (Pepto-Bismol®) is used to protect the stomach lining from gastric acid. Alternatively, antacids like Maalox Advanced Regular Strength, Mylanta, Rolaids, Magaldrate Riopan, or Maalox Advanced Maximum Strength are often used for relieve of acid reflux and to protect the stomach lining from gastric acid, as they contain alkaline ions that chemically neutralize stomach gastric acid

H. pylori infection is detected in over 90% of individuals with gastric ulcers

Certain anti-ulcer drugs such as carbenoxolone, colloidal bismuth, cimetidine, and sucralfate are used for the treatment of peptic, esophageal and oral ulceration and inflammation. These medications can speed up healing of peptic ulcers, as they increase the release of endogenous prostaglandins (PGs).

How to treat stomach ulcers without medication?

If you have an H. pylori infection, a naturopathic doctor will recommend herbal antibiotics, such as goldenseal.

Take Goldenseal root extract (Hydrastis canadensis L.) at recommended doses. Crude methanol extracts of H. canadensis rhizomes are often used for gastrointestinal issues, as they contain active isoquinoline alkaloids (Berberine and β-hydrastine) that have antidiarrheal and antimicrobial activities

The major alkaloid constituents of goldenseal products are:

1. Hydrastine (1.5–4%)
2. Berberine (0.5–6%)
3. Canadine (0.5–1%)

Goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), goldthread (Coptis chinensis), and oregon grape (Berberis aquifolium) are effective against protozoa, bacteria, and fungi, including Candida albicans, as they contain broad-spectrum antibiotic alkaloid berberine.

Berberine is highly effective at destroying certain types of microorganisms, in fact, its action against some pathogens is stronger than that of common antibiotics.

Berberine prevents the yeast overgrowth. Berberine has remarkable antidiarrheal activity in even severe cases of giardiasis, Shigella, E. coli, Klebsiella, Salmonella, cholera, amebiasis, and chronic candidiasis.

Due to its potent anti-inflammatory effects on H. pylori-induced chronic gastritis, Berberine containing plants are still widely used for the treatment of H. pylori-induced chronic gastritis.

Dose is based on berberine content. Dose (t.i.d.):

1- Dried root or as tea (infusion) at a dose of 2 to 4 g daily

2- Tincture (alkaloids at a ratio of 1:5) at a dose of 6 to 12 mL (1.5 to 3 tsp) daily

3- Fluid extract (alkaloids at a ratio of 1:1) at a dose of 2 to 4 mL (0.5 to 1 tsp) daily

4- Dried Berberine extract powder – Solid extract with medium-high alkaloid content (8-12%, alkaloids at a ratio of 4:1): Pure Berberine HCL Powder or 95% Berberine Extract Powder at a dose of 250 to 500 mg daily

Note: Recommended dose for berberine:

Recommended daily dose of berberine for adults: 25 to 50 mg t.i.d. or up to 150 mg for adults.

For children, dose is based on body weight. Recommended daily dose of berberine for childern: 5 to 10 mg/kg (2.2 pounds) body weight.

Berberine and berberine-containing plants are nontoxic at recommended doses, but avoid during pregnancy.

Higher doses of Berberine and berberine-containing plants may interfere with B vitamin metabolism.

How to cure stomach ulcers fast naturally at home and what should you eat if you have an ulcer?

Stomach Ulcer Treatment

Are bananas good for stomach ulcers?

Dried unripe bananas can help to prevent peptic ulcers, as they contain sitoindosides. These compounds help increase mucus production in the stomach and provide a strong protective coating to help heal and prevent ulcers. Moreover, bananas contain water-soluble non-starch polysaccharides that possess antiulcer activity in the stomach, these compounds are also found in Carafate, a medication used to treat active duodenal ulcers

Stay hydrated, drink at least 8 glasses of water a day

Drink herbal teas that can help you to feel more comfortable, especially herbs such as liquorice root, chamomile, marshmallow root, and peppermint.

Slippery elm foods

Eat high-antioxidant foods, like slippery elm.

Slippery elm is the inner bark of slippery elm tree. Slippery elm supplementation will speed up the healing process due to its antioxidant and anti-inflammatory properties. Moreover, slippery elm bark is an important ingredient in the essiac formula tea used to support people with gastric cancer (There’s no evidence it is beneficial to health).

People should take slippery elm bark (Ulmus fulva bark powder) before every meal in order to treat stomach ulcers and to protect the stomach lining. Slippery elm foods are mixed with other herbs or antioxidants that benefit and protect the stomach lining. When consumed in recommended amounts, slippery elm bark forms a viscous mucilage that lines the gastric and intestinal mucosa, calming inflammation, destroying free radicals, and absorbing toxins.

Tea: Drink three cups of slippery elm bark powder tea per day, to make slippery elm bark powder tea simply place 2 tablespoons (roughly 4 g ) of powdered slippery elm bark (ulmus fulva bark) in a small teapot, pour 2 cups of boiling water over the powder, stir well and cover, steep for 5 minutes, then pour into a teacup.

Tincture: take 5 mL of slippery elm bark tincture three times a day. Note: Contains alcohol.

Capsules: take three slippery elm bark 400 – 500 mg capsules per day, for 4 to 8 weeks. Take with a full glass of water.

External application: Mix powdered slippery elm bark (ulmus fulva bark) with a small amount of boiling water to make a poultice. Add water gradually, stirring constantly to give the mixture a consistency of cream; Allow the herbal paste to cool down to room temperature and apply on the tummy for fast stomach ache relief. Always place the herbal paste on a sterile gauze pad and apply topically. Never apply slippery elm paste directly on an open wound.

Lozenges are used for sore throats: slippery elm bark lozenges are often mixed with other ingredients, such as sorbitol, natural cherry flavor, maple syrup (pure maple sugar), and vegetable stearate (as a binder). Follow dosing instructions on label.

Slippery Elm Tea

How to make Slippery Elm Tea?

Ingredients

1. Two tablespoons of slippery elm bark powder
2. Two cups of boiling water
3. Two teaspoons of honey or maple syrup (optional)
4. Six ounces coconut or almond milk
5. One teaspoon of raw cacao powder (optional)
6. Sprinkle of cinnamon

Method:

To make Slippery Elm Tea, simply place two tablespoons of slippery elm bark powder in a small teapot, pour 2 cups of boiling water over the powder and mix well, let stand for a couple of minutes, then pour into a mug. Add two teaspoons of honey or maple syrup and one teaspoon of raw cacao powder and mix well. Finally, pour in 6 ounces of coconut or almond milk and stir. Sprinkle some cinnamon on top and drink warm!

Eat foods that are high in Vitamin E, like hazelnuts, wheatgerm, soybean oil, and cold pressed unrefined sunflower seed oil

Eat foods that are high in zinc, such as whole grains and seafood, like oysters, shellfish, mussels, crab and shrimp

Eat foods high in Amino acids, like seaweed, almonds, cheddar cheese, wheatgerm, sesame seeds and sunflower seeds. Alternatively, Try L-Glutamine supplementation to help an ulcer heal, take 5g of L-glutamine after getting up and another 5g before going to bed

Eat white meats, such as skinless chicken breast or turkey and fish.

Fruit and vegetables

Eat more vegetables and fruits that are high in beta carotene and vitamin C, such as carrots, kale, bell peppers, broccoli, cabbage juice, carrot juice, broccoli juice, apricots, grapes and kiwi fruit, in order to help protect the gastric mucosa from acid.

Eat fruits that are high in antioxidants, such as blueberries, raspberries, blackberries, dates, strawberries, to ease symptoms and prevent or allow healing of ulcers

Eat oily fish that are high in omega-3 fatty acids, like mackerel, sardines, salmon, and herring, in order to reduce the risk of ulcers. Alternatively, take a krill oil, cod liver oil or flaxseed oil supplement that is high in EPA and DFA, especially if you are not eating enough fish!

Omega-3 fatty acids increase the release of endogenous prostaglandins that help to protect the lining of the stomach and intestines.

Endogenous prostaglandins appear to have a similar effect as omeprazole, but without the drug’s side effects!!!

Eat foods that increase the release of endogenous prostaglandins (PGs), like fresh pineapple and seaweed. Take 4 to 12 g of seaweed powder daily for up to 60 days. If seaweed powder is hard to incorporate you can take seaweed capsules. Alternatively, exogenous prostaglandin E (PGE) and its stable analogs can be used in the treatment of gastric and duodenal ulcers, as they significantly increase the ulcer healing rate.

Eat foods that contain probiotics, like yogurt, kefir, tempeh, miso, and soy-based foods.

What foods to avoid when you have stomach ulcers?

Carefully control your diet. Avoid spicy and sour foods until the ulcers heal. Avoid chili and black peppers, curry, mustard and other strong spices.

Avoid lime or lemon juice (citric acid) until ulcers heal, drinking lemon juice would only exacerbate the

Salt and salty foods

Limit the total amount of sodium you eat or drink per day to less than 2 grams. Exposure to N-nitroso compounds (NOCs) that are found in processed meat and a high salt or a low fiber diet could modulate H. pylori colonization of the stomach and could increase the risk of gastric cancer in patients with chronic H. pylori infection. Use seaweed instead of salt to provide flavor.

Avoid Foods that are high in sodium, like pickled vegetables, canned soup, blue cheese, salted nuts, cornflakes, tortilla chips, potato chips, corn chips, soy sauce, pre prepared meals, preserved or canned vegetables, processed foods, bacon and other salted meats.

Avoid eating large meals. Ideally, you should be having 6 to 8 small meals a day to make sure that your stomach produces less acid when digesting your food.

Avoid hard to digest fatty foods that can actually worsen your condition. Low fat foods can speed up your recovery.

Fatty foods can stimulate acid secretion independent of gastrin release

Your meals should be high in fiber and low in fat and sugar. Ideally, your diet should be based on vegetables, fruits and whole grains.

Cutting down on red meat

Avoid red meat and other high-protein foods that take longer to digest until your ulcer has healed. Ideally, cut off any visible fat before eating and stick to very lean cuts of meat, poultry, fish, and seafood and eat tiny portions of meat every 4 to 5 hours (4 oz or less) to make it easier for your body to digest

Limit protein (meat, poultry, fish) intake to less than 6 oz. per day

Red meat takes longer to digest, as it contains a lot of protein and thus more acid is released to digest it, which will make your ulcer worse.

Avoid eating the meat before bedtime, as you may feel worse when you lie down. Eat the meat at least three hours before bedtime to give your body a chance to digest it.

Caffeinated foods

Avoid caffeinated soft drinks that contain caffeine, like sodas, tea, hot chocolate, coffee, ice cream, and soft drinks. Caffeinated beverages can make your ulcer worse.

Dairy products

Avoid dairy products that are high in fat. You can use low-fat alternatives, like low-fat yogurt, cheese, and peanut butter, as well as tofu and other soy products.

Other irritants

Cut out smoking and limit alcohol intake. Stop drinking alcohol entirely until your stomach lining heals. Drinking alcohol can increase production of stomach acid and can also interfere with the healing process of peptic ulcers

Verified by: Dr.Diab (June 29, 2018)

Citation: Dr.Diab. (June 29, 2018). What is Peptic Ulcer Disease? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 49(2). urn:medcoi:article19927.