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Health Protocols

Peptic Ulcers


A peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. Ulcers in the stomach are called gastric ulcers, and those in the upper small intestine are called duodenal ulcers. Symptoms include pain, nausea, vomiting, and heartburn; in serious cases, ulcers may cause bleeding into the stomach or perforation of the gastrointestinal wall (Ferri 2016; DiMarino 2016a; Kuipers 2012).

In the United States, roughly 4.5 million people suffer from peptic ulcer disease, and about 500,000 new cases are reported each year (Ferri 2016; Anand 2017).

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs (NSAIDs) (Kuipers 2015).

Uncomplicated ulcers associated with H. pylori infection are usually treated with antibiotics plus a proton-pump inhibitor (PPI), which reduces gastric acid secretion and allows the ulcer to heal. Treatment of bleeding ulcers may require endoscopic surgery (Kuipers 2015; Lee 2013).

Increasing use of antibiotics in children over the past several decades has led to a decline in the prevalence of H. pylori infection among younger generations, and combination therapy with antibiotics and PPIs is very effective in treating peptic ulcers (Malfertheiner 2009; Kuipers 2012). However, antibiotic resistance now represents a critical factor in the failure of ulcer treatment (Homan 2015; Yaxley 2014). Thus, new methods for eradicating H. pylori and treating ulcers are needed.

The good news is that new scientific discoveries may improve the efficacy of ulcer treatment. For instance, integrative interventions including deglycyrrhizinated licorice (DGL), zinc-carnosine, and vitamin C have powerful anti-H. pylori and ulcer-healing effects (Puram 2013; Watari 2013; Pal 2011). Probiotics, particularly a strain called Lactobacillus reuteri DSM17648, appear to help control H. pylori and reduce the inflammatory response to infection with this organism. Treatment with probiotics can also enhance the ability of antibiotics to eliminate H. pylori infection, while reducing drug side effects (Boltin 2016; Homan 2015; Holz 2015).

In addition, lifestyle and dietary changes can have a profound impact on ulcer risk and promote ulcer healing. Smoking cessation, stress reduction, and avoidance of NSAIDs and excess alcohol all help promote ulcer healing and prevent recurrence (Lee 2013; Han 2002; Ferri 2016). A diet rich in fiber and plant phytonutrients called polyphenols can protect against development of peptic ulcers as well (Farzaei 2015; Ryan-Harshman 2004).

In this protocol, you will learn about the causes of peptic ulcers and how they are typically treated. Several emerging treatment techniques will be reviewed, and a number of dietary and lifestyle changes that may reduce ulcer risk will be discussed. In addition, many natural integrative interventions that may help keep the gastric and intestinal mucosa healthy will also be reviewed.