How Susceptible Are You to Ulcers? By: Sheeva Aboutaleb

     In the United States today, around 20 million Americans will develop ulcers each year. Four million will be affected by them. 40,000 will require surgery due to the unbearable symptoms or complications. And 6,000 will die from ulcer-related complications.

     Lifestyle choices in the U.S., such as smoking and consuming caffeine, attribute to these numbers. Although many need the relaxing effects of nicotine, they are ignoring the many health risks. Aside from the fact that nicotine is one of the most dangerous substances on the market, it can decrease the stomach's ability to defend itself. With low defenses the stomach's healing process will slow, allowing existing ulcers to become stronger and recurrence to be almost definite. Caffeine can cause increased acid secretion, which also lowers the defense system and agitates existing ulcers.

     Another choice that has made us Americans susceptible to ulcers is our constant need to self medicate. Many of the over-the-counter pain relievers are NSAIDS (nonsteroidal anti-inflammatory drugs) which make the stomach vulnerable to the harmful effects of acid and pepsin, the two dominant digestive fluids. The stomach produces bicarbonate and mucus as its defense against digestive fluids. When NSAIDS are introduced to the body, they interfere with the stomach's ability to produce these.

     The most common cause of ulcers today is a bacterium called H. Pylori (Helicobacter Pylori). It is a spiral-shaped bacterium found in the stomach transferred through a fecal->oral route. H. Pylori survives in the stomach by releasing urease, an enzyme that generates substances which neutralize the stomach's acid. The bacterium can then penetrate the stomach's mucus lining and weaken its defenses. With defenses down, inflammation occurs and tissue damage results. The bacterium is most common in elderly, African-Americans, Hispanics, and those exposed to poor living conditions (drinking water, especially).

References:                                                                                                                    

1. http://www.gastro.com/Gastro/ulcer.aspx

2. http://www.emedicinehealth.com/peptic_ulcers/article_em.htm

Ulcer Surgery by Amy Ton

      Ulcer surgery is used to cure peptic ulcer disease when medications and other methods have failed.  Surgery is typically performed on bleeding or perforated ulcers and in cases where the stomach outlet or the duodenum has become deformed and restricted by scar tissue. There are three types of common surgeries for ulcers: vagotomy, gastrectomy, and pyloroplasty. Vagotomy is a treatment where the nerves to the stomach are cut. Partial gastrectomy  is a surgical procedure that involves removing a part of the stomach. Pyloroplasty, along with vagotomy, is a procedure that widens the base of the stomach.

      Vagotomy is a good way to reduce the acidity of the stomach. By removing the peptic cells that produce acid, it transmits messages from the brain to the stomach that the nerves have been cut. With this comes the hope that it would treat or prevent peptic ulcers. The newest variation of vagotomy involves cutting only parts of the nerve that control the acid secreting cells of the stomach. Side effects of this include persistent abdominal pain, vomiting, dumping, or diarrhea.

      Gastrectomy is a partial or full surgical removal of the stomach. This is done to treat cancer. However, in a severe case of ulcer, it may be necessary to remove the lower portion of the stomach called the pylorus. Side effects obviously include the loss of a storage place for food while it is being digested. Since a small amount of food can be allowed into the small intestine at a time, the patient will have to eat regularly in small amounts to prevent gastric dumping syndrome.

      Pyloroplasty is a surgery that includes a cut around the belly button or in the upper right part of the belly. It involves cutting through some of the thickened muscle to relieve the narrowing. The cut through the muscle is then closed horizontally to keep the pylorus open and allow the stomach to empty. Risks to this procedure include the damage to the intestine, leakage of stomach contents, and long term diarrhea.

References:                                                                                                                                                  

"Different Types of Ulcers Explained." Treating Stomach Ulcers, Ulcer Symptoms or H. Pylori? Do It the Right Way, Naturally! Web. 25 Nov. 2011.
 <http://www.ulcer-cure.com/Types/types-of-ulcers.php>.

Draper, Ricard. "Ulcer Surgery and Its Complications | Doctor | Patient UK." Health Information and Advice | Medicines Guide | Patient.co.uk. 09 May 2008. Web. 25 Nov. 2011. <http://www.patient.co.uk/doctor/Ulcer-Surgery-and-its-Complications.htm>.

Nathan, Torben, Carl J. Brandt, and Ove Schaffalitzky. "Peptic Ulcers - Treatment." NetDoctor.co.uk - The UK's Leading Independent Health Website. 08 Jan. 2005. Web. 25 Nov. 2011. <http://www.netdoctor.co.uk/diseases/facts/pepticulcertreatment.htm>.

Vann, Madeline. "When Ulcer Surgery Is Required - Ulcer Center - EverydayHealth.com." Health Information, Resources, Tools & News Online - EverydayHealth.com. 12 Aug. 2009. Web. 25 Nov. 2011.
<http://www.everydayhealth.com/ulcer/surgery-for-ulcers.aspx>.

Way, Lawrence W., editor. “Stomach and Duodenum." In Current Surgical Diagnosis and Treatment. 10th ed. Stamford: Appleton & Lange, 1994.

Parasites to Treat Ulcers by Lacie Cates

     There are a number of different reasons that can cause one to develop ulcers. Ulcers generally will form because of bacterial infections caused by the gram negative bacterium H. pylori (this is probably the most common cause of ulcers) or an over-production of stomach acid. Another reason that some ulcers can form is due to the body’s inability to secrete an effective amount of mucus that lines the gastrointestinal tract which protects it from the acids that are required for digestion. There are a variety of medications that can be used to treat the painful effects of having ulcers, from over the counter acid reducers, to antibiotics (depending on the diagnosis). However, there is one method that is being used to treat people with ulcers who have found these medications ineffective. This method involves the ingestion of parasitic worms such as hookworms and whipworms in order to enhance the secretion of mucus in the gastrointestinal tract.

    There have been a number of cases in which patients who suffer from various types of ulcers have used these parasitic worms with satisfactory results. Particularly patients with Ulcerative Colitis (a type of inflammatory bowel disease) have seen a major decrease in the painful symptoms of the disease. This is because ulcerative colitis is classified as an autoimmune disorder in which there is an over-reaction of the immune system, which causes white blood cells to attack the walls of the large intestine thereby making it bleed. This causes the ulcers to form in the large intestine. The parasitic worms come into play after they are ingested, in the form of eggs, by the patient. Once the parasite eggs are in the digestive tract, they will hatch and attach themselves to the intestinal wall, living off of the host’s blood. This seems somewhat contradictory to the disease itself; however, the body will try to combat the attached parasites by substantially increasing the production of mucus in the gastrointestinal tract, thereby decreasing the painful symptoms of ulcerative colitis and other various ulcers. In order to obtain long-term results from the parasitic worms, they must be replenished every two to three weeks as they will pass normally through the digestive system.

    Even though this treatment seems to be somewhat archaic, it has shown to be a worthy treatment for patients when all other treatments have failed. And although it is not a very common form of treatment for ulcers, it still can be used in cases when appropriate.

References                                                                                                                                                        

Eat your Worms; The Upside to Parasites: By John Hamilton Via www.npr.org

Eat Worms-Feel Better: By Matt Ellsworth Via www.news.bbc.co.uk

Good for the Gut: By Cindy Sacco via www.scientificamerican.com

Prevention of Ulcers by Nick Astorga

      The common misconception is that peptic ulcers are mainly brought on by stress, spicy foods and acid. These may contribute to the development of ulcers or agitate an underlying condition, but we now know that roughly 9 out of 10 peptic ulcers are caused by Helicobacter pylori (H. pylori), a bacteria that lives on the stomach lining. Unfortunately, the source for H. pylori is not yet known. There's no proven way to prevent ulcers, but your greatest chance at reducing your risk is through lifestyle changes. 

Healthier eating: The previous thread listed a couple of modifications that may be of some benefit in the prevention of ulcers, such as eating a balanced diet that is high in fiber, reducing or eliminating the consumption of dairy, caffeine and high fat foods, along with taking vitamins A, E, and zinc.

Protect from infections: Frequently washing hands with soap and water, eating completely cooked foods and drinking water from safe, clean sources may help protect from H. pylori bacteria.

Stop smoking: Smoking and chewing tobacco may increase your susceptibility to H. pylori and it increases your chance of developing ulcers two fold compared to nonsmokers.

Alcohol intake: Consume no more than two alcoholic beverages daily.

Be cautious with pain relievers: The regular consumption of NSAIDs (non-steroidal anti-inflammatory drugs), like aspirin, naproxen, and ibuprofen make you more susceptible to peptic ulcers through inhibition of the body's production of prostaglandins, hormones that promote gastric mucus secretion to protect stomach lining. To help reduce this risk you should take your medication with  meals. Also, avoid the consumption of alcohol when taking your medication. 

      Another way to reduce your risk is through talking to your doctor about finding the lowest possible dose of NSAIDs that still allows for pain relief. A possible replacement would be an acetaminophen like Tylenol instead. If you must take these medications, have your doctor test for H. pylori bacteria first. Your doctor may have you take acid blockers or proton pump inhibitors (PPI). There have been some recent studies on proton pump inhibitors showing that they might do more intestinal damage than what they're prescribed to prevent. You may also have to take misoprostal, which helps to prevent ulcers by protecting the stomach lining and decreasing stomach acid secretion.

      There is no guarantee that you'll be able to prevent an ulcer from occurring, but your best bet for staying healthy would be to make smarter lifestyle choices on a daily basis. 

References                                                                                                                                                    

(2008). U.S. National Library of Medicine

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000886/

MedicineNet.com

http://www.medicinenet.com/peptic_ulcer/article.htm

George F. Longstreth, MD, (2011). Medline Plus

http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm

(2011). Mayo Clinic

http://www.mayoclinic.com/health/peptic-ulcer/DS00242/DSECTION=prevention

(2009). U.S. News Health Hospitals with Johns Hopkins Medicine

http://health.usnews.com/health-conditions/digestive-disorders/peptic-ulcer/prevention

Kristine Novak, PhD, Science Editor , (2011). American Gastroenterological Association

http://agajournals.wordpress.com/2011/10/21/how-do-proton-pump-inhibitors-increase-intestinal-damage-from-nsaids/

(2010). American Gastroenterological Association

http://www.gastro.org/patient-center/digestive-conditions/peptic-ulcer-disease#Prevention of Peptic Ulcer Disease 

(2005). Centers for Disease Control and Prevention

http://www.cdc.gov/ulcer/partners.htm

Alternative Treatment for Ulcers by Charlene Paras

      A small percentage of people get ulcers from the continual use of aspirin, other pain relievers, chemotherapy drugs, and other medication. Recent incredible discovery was known that 80 percent of all ulcers were caused by the only bacteria that can survive the hydrochloric acid in our stomach, the Helicobacter pylori.

      The natural approach to healing ulcers is to first identify and then eliminate or reduce all the factors that can contribute to their development: food allergies, coffee, sodas, cigarette smoking, stress, stomach irritant drugs like erythromycin (a macrolide antibiotic) and other NSAIDs like aspirin and ibuprofen.

      Holistic medicine promotes excellent healing and prevents recurrence of ulcers, especially through a balanced diet, lifestyle changes, and the use of herbal formulas. A high fiber alone may decrease the recurrence of ulcers by as much as 50% which is as effective as the use of cimetidine. Naturopathic physicians also recommend elimination of dairy and high fat from the diet.

      Stress does not cause ulcers, but is a contributing factor. Some ulcer patients find that when they are stressed, they feel an increased ulcer pain.

      Emphasizing specific nutrients can also prevent ulcer. Vitamins A and E have been shown to inhibit the development of ulcers and have been recognized as important factors in maintaining the integrity of the stomach lining. According to clinical studies, zinc also has a protective effect against ulcers.

Home Remedies for Stomach Ulcers:

Note: It is always best to consult your doctor before trying any alternative therapies.

• Extra-virgin olive oil: taking 1 tbsp in the morning and 1 tbsp in the evening may soothe and heal the mucous membranes that line the stomach.
• Cabbage juice is a traditional naturopathic ulcer remedy. Cabbage is rich in the amino acid glutamine that helps the healthy stomach cells regenerate and stimulates the production of mucin, a mucoprotein that protects the stomach lining.
• Barley and barley water help rebuild the stomach lining.
• Aloe Vera juice aids in pain relief and speed healing.
• Licorice root has a long history of healing gastric and duodenal ulcers.
• White oak bark and yarrow can be used to treat irritations caused by ulcer. These help decrease the bleeding of the stomach lining.
• Herbal combinations, such as PLS II, have been discovered useful in treating ulcer.
• Demulcent herbs like marshmallow root and slippery elm can soothe the irritated mucus membrane of the stomach.
• Omega 3 oil can help protect the stomach lining from ulcer.
• Green tea, cat’s claw, reishi mushroom, olive leaf, DGL licorice, mastic, and peppermint are use for relieving ulcer symptoms.
• Bitter herbs: Some ulcers may be due to the weakness of the protective factors in the gut wall. Bitter herbs help to tone the mucosa. They encourage production of digestive enzymes needed to digest and assimilate food.
• Astringent herbs such as geranium can shrink swollen tissue and control bleeding and helps in toning the mucosa.
• Antiseptic herbs such as Echinacea or Baptisia may kill the bacteria that caused the infection.
• Nervines like chamomile, hops, and cinnamon give soothing effect on ulcer patients.
• Bilberry is used in Russia to treat ulcers. It reduces inflammation in the stomach and intestine. It also protects the mucous membrane of the stomach.
• Cayenne Pepper stimulates digestion and muscle movement in the intestine and stomach.
• Rhubarb has shown to be effective in treating intestinal bleeding caused by ulcers.

Other herbs and supplements for the treatment of ulcer include:

• Alpha-Linolenic Acid (ALA)
• Astralagus
• Calendula
• Cranberry
• Devil’s Claw
• Dong Quai
• Evening Primrose
• Flaxseed and Flaxseed Oil
• Gamma-Linolenic Acid (GLA)
• Lactobacilus Acidophilus
• Turmeric

The natural approach is safer, less expensive, available in the garden or almost in all stores, and just as effective as the synthetic drugs.

References:            

Koop E., Surgeon General’s Report on Nutrition and Health. 1988

Merck Manual. 15^th Edition. 1987

Oxford Textbook of Medicine. Oxford University Press.

Physicians Desk Reference. 1984

Reimann HJ, Lewin J. “Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol 1988; 83:1212-1219

Rydning, A et al. “Prophylactic effect of dietary fibre in duodenal ulcer disease. Lancet. 1982 ii:736-9

Sherman, J. Complete Botanical Prescriber. 1978. Natuional College of Naturopathic Medicine.

Textbook of Natural Medicine. Pizzorno and Murray. John Bastyr College Publications.

Weiss, RF. Herbal Medicine. 1988 Beaconsfield Publishers, Beaconsfield, England.

U.M.M.C. (2011).Herbs and Supplements for Peptic Ulcer.

(http://www.umm.edu/altmed/articles/peptic-ulcer-002603.htm) retrieved on November 4,2011

Westcoff,M (2010). Alternative Remedies for Stomach Ulcers.

(http://www.over50web.net/health-beauty/natural-remedies-health-beauty/alternative-remedies-for-stomach-ulcers/) retrieved on November 04, 2011

Wilen, J. & Wilen, L.(2008). Healing Remedies. New York: The Random House Publishing Group. pp. 263-265.

Maier, K.S. Healing Herbs for Ulcers.

( http://herbalmusings.com/ulcers.htm) retrieved on November 04,2011

Murray, M.T.,ND. Healing Ulcers Naturally.

(http://www.naturodoc.com/library/lifestyle/ulcers.htm) retrieved on November 05,2011

Bergner, P., & Tilgner, S.,N.D. (2001). Gastrointestinal-Herbal treatment for ulcers. Medical Herbalism 3(3):1,4-6

Conventional Treatments Of Ulcers by Aaron Boyer

          As we further investigate peptic and digestive ulcers, it is important to understand what the common conventional treatments for the condition are. Today in the United States the most common treatments are through “Conventional Medicine”, which is the most abundant and common theoretical practice of western medicine. In other words, the majority of the time that you go to see your physician for your ulcer, he will usually recommend or prescribe a medicine or drug to treat it. The physician will do so by following western medicine or allopathic guidelines as opposed to homeopathic which will be talked about later. The allopathic drugs prescribed are usually of a synthetic blend and non-organic, and are used as active agents or physical interventions to treat or suppress symptoms for pathophysiological processes of diseases or conditions.

            In more detail, the most common conventional treatments are usually prescribed drugs. These drugs could either be utilized as an antibiotic for H. Pylori, a condition that is known major cause for ulcers; or could be used for shutting down acid production in the stomach, creating a better environment for ulcer healing.  Here are some examples of common treatments and interventions for peptic and digestive ulcers.

-Antibiotic meds to kill H. Pylori: A non-common bacterium that dwells in your digestive tract can be killed by a combination of antibiotics such as amoxicillin, clarithromycin (Biaxin), metronidazole (flagy) and tetracycline.

-Medications that block acid production: They call this class of drugs “proton pump inhibitors”. They work by blocking the parts on the cells that produce acid in the stomach and help promote healing of the ulcer. Some names of these drugs include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Although it is said that overuse of these types of drugs can extract a significant amount of calcium from the bone, and therefore, the one taking the drug can become more susceptible to skeletal fractures.

-Antacids that neutralize stomach acid: Theses drugs are usually found over the counter and used as an instant acid reducer in the stomach. They work by neutralizing stomach acid, which will provide instant relief of ulcers. Some include TUMS & Rolaids.

-Medications that protect the lining of your stomach:  They call this class of drugs “cytoprotective agents”. It is used to protect epithelial tissue especially the intricate lining of the stomach and intestines from strong acids attacking or creating any ulcers. These drugs include prescription medications such as sucralfate (Carafate) and misoprostol (Cytotec). A usual non-prescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).

            There are some who may or may not agree with conventional medicine and have found other alternative treatments. Today, these drugs, medications and other interventions are used as the mainstream allopathic intervention to treat ulcers in the United States.

References                                                                                                                                                     

“H. pylori and peptic ulcers.” National Institute for Diabetes and Digestive and Kidney Diseases.
Web 27 October 2011 http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.htm.

“Peptic Ulcer: Treatment and drugs” Mayo Clinic Online Medical Education and Research. Web 27 October 2011
  http://www.mayoclinic.com/health/pepticulcer/DS00242/DSECTION=treatments-and-drugs 

“Allopathic medicine emerges as the primary western medical model” The New Medicine. Web 27 October 2011 http://www.thenewmedicine.org/timeline/allopathy

“Peptic Ulcer: Medications” University of Maryland Medical Center Online Reference. Web 27 October 2011 http://www.umm.edu/altmed/articles/peptic-ulcer-000125.htm

Rare Symptoms of Ulcers by Jon Fisher

     As was mentioned in the last article, there are many people who suffer from ulcers,
both gastric and duodenal. One could assume that apart from the more common and
well known symptoms, there could be less common symptoms as well. While these
symptoms might be less common, for the most part, they are also more dangerous.


     The first that I would like to talk about isn't so much a symptom of ulcers but rather a rare underlying cause of ulcers. It is estimated that about one million people every year begin having ulcers that are actually caused by a tumor growing in either the pancreas or the duodenum. This is a condition known as ZES. The tumor forces extra production of the hormone gastrin, which stimulates the production of excess gastric acid. The only way to treat is for a doctor to recognize that the ulcer is caused by a tumor, and have it removed. Once the tumor is removed, the ulcer can be treated using any normal ulcer treatments. Nowadays, most doctors screen for cancer when diagnosing the ulcer.


     One very dangerous symptom, that is extremely rare is, ironically, to have no symptoms of ulcers. This is know as a silent ulcer. As you might expect due to the lack of symptoms, it is very hard to catch this. Scientists do not know why no typical symptoms occur such as heart burn or lack of appetite, but they seem to be more common among the elderly who frequently take NSAIDs (aspirin, ibuprofen, etc.) who have been treated in the past for ulcers. If not noticed accidentally, or by routine endoscopic examination, it usually ends up being the cause of death.


     The last uncommon symptom I will talk about is having blood in your stool. This is usually a sign that the ulcer is in the duodenum and is larger than normal. This usually happens if the ulcer goes untreated for a long period of time. Treatment for this symptom would be the usual treatment of a normal ulcer.


     The key to avoid these more serious symptoms is to have the symptoms diagnosed by a doctor and then to promptly treat the ulcer. Also it is important to be screened for ulcers regularly after the ulcer goes away, as those who have had an ulcer in the past are more likely to get another one.




References                                                                                                                                                     

Zollinger RM, Ellison EH (1955). "Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas". Ann. Surg. 142(4): 709–23; discussion, 724–8

Pounder R, Royal Free Hospital School of Medicine, Academic Department of Medicine,
London, United Kingdom (1989). “Silent peptic ulceration: deadly silence or golden silence?” Gastroenterology. 1989 Feb;96(2 Pt 2 Suppl):626-31. http://www.ncbi.nlm.nih.gov/pubmed/2642448


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