A peptic ulcer is a sore in the lining of the stomach, where it is called a gastric ulcer, or the first part of the small intestine, called a duodenal ulcer. In the United States, roughly 4.5 million people suffer from peptic ulcer disease.
Fortunately, integrative interventions including deglycyrrhizinated licorice (DGL), zinc-carnosine, and Lactobacillus reuteri have powerful ulcer-healing effects.
Causes and Risk Factors
- H. pylori infection, the primary cause
- Non-steroidal anti-inflammatory drugs (NSAIDs), the second-leading cause
- Stomach acid
- Cigarette smoking
- Up to 40% of those with ulcers have no symptoms
- A gnawing or burning pain , nausea, vomiting, or heartburn
- Bleeding internally, which is the most common complication.
- Perforation, in which ulcers break through the wall of the duodenum or stomach.
- Note: This is a medical emergency requiring surgical intervention.
- Upper gastrointestinal endoscopy, a camera inserted on a long tube down to the stomach, is necessary for a conclusive diagnosis of peptic ulcer. Endoscopy allows inspection and biopsy of the stomach and duodenum and detection of H. pylori.
- A CBC and stool occult blood tests are recommended for patients suspected of having a bleeding ulcer.
- H. pylori-positive ulcers
- Antibiotics result in a 70‒90% cure rate.
- Note: Antibiotic resistance is a growing problem in Canada and the United States.
- Proton-pump inhibitors (PPIs) block the secretion of stomach acid, allowing ulcers to heal and often relieving pain.
- Note: When used long-term, PPIs are associated with a wide range of serious side effects including kidney and cardiovascular disease.
- Triple-therapy is a standard treatment that combines two antibiotics and a PPI. Bismuth may also be included for “quadruple therapy.”
- H. pylori-negative ulcers
- NSAID use should be discontinued. Antacids and medications that reduce acid secretion are used in these situations.
- Misoprostol (Cytotec) and sucralfate (Carafate) are used to help protect the stomach lining against the damaging effects of NSAIDs in patients who must continue to take them.
Novel and Emerging Strategies
- Silver nanoparticles. Laboratory and animal studies indicate silver nanoparticles have anti-H. pylori activity.
- Note: Silver nanoparticles should not be confused with over-the-counter colloidal silver preparations. Colloidal silver has not been proven effective for treating any condition, and may have several side effects, including argyria—a disorder in which the skin takes on a permanent bluish-gray discoloration.
- Liposomal linolenic acid. Liposomal linolenic acid has been shown to kill H. pylori and markedly reduce its population in the stomach of mice. In addition, liposomal linolenic acid was shown to decrease levels of pro-inflammatory cytokines triggered by H. pylori.
Dietary and Lifestyle Considerations
- A diet rich in fruits, vegetables, and fiber may reduce the risk of ulcers by 50%, and also help heal existing ulcers.
- Fermented dairy products such as yogurt and kefir appear to promote H. pylori eradication.
- Stress management is important as stress and tension is correlated with gastric and duodenal ulcers.
- Deglycyrrhizinated licorice (DGL). In a trial, 100 patients who tested positive for H. pylori were treated with DGL or placebo for 30 days. At the end of the treatment period, 56% of the DGL group and 4% of the placebo group tested negative for H. pylori.
- Zinc-carnosine. In a randomized clinical trial, 86% of subjects treated with triple therapy alone achieved eradication while 100% treated with triple therapy plus zinc-carnosine (150 mg twice daily) were H. pylori-negative four weeks after treatment.
- Lactobacillus reuteri. L. reuteri DSM17648 supplements have been shown to decrease the H. pylori load in healthy H. pylori-positive individuals, and may thus prevent future H. pylori-associated problems, including the need for antibiotic treatment.
- Lactoferrin. A meta-analysis examined five randomized controlled trials that evaluated whether lactoferrin treatment was effective for H. pylori eradication. Those who received lactoferrin had more than 2.2-fold higher odds of eradication compared with controls.
- Flavonoids/polyphenols. Evidence from numerous studies indicate polyphenols, including flavonoids, hold promise in the prevention and treatment of peptic ulcers. Extracts from tea, apples, pomegranate, and grape seed are especially good sources of polyphenols with possible anti-ulcer and anti-H. pylori activity.