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Peptic Ulcer Disease Pud

 

Peptic Ulcer Disease Introduction

:ulcer-sm.gif Peptic ulcer disease (PUD) is the term used to indicate the presence of erosions in the upper two layers of the stomach (gastric ulcer), and the first segment of the duodenum (duodenal ulcer). These lesions are usually several millimeters to several centimeters in size. Peptic ulcer disease is caused by the hypersecretion of stomach acids (HCL), chronic NSAID use, and H.pylori. [1] Stress, alcohol abuse, and nutrient deficiencies are also known contributors in the development of peptic ulcer disease.

Complications of peptic ulcer disease include hemorrhage, obstruction, and perforation. Peptic ulcer disease is estimated to affect 10-12% of Americans. It is four times more common in men than in women. Duodenal ulcers are more common than gastric ulcers. An estimated 90% of individuals with duodenal ulcers and 70% of individuals with gastric ulcers test positive for H.pylori. [2] Gastric ulcers are associated more with NSAID use, than the duodenal variety.

Peptic Ulcer Disease Signs and Symptoms

Symptoms of peptic ulcer disease can vary significantly from person to person, and often depend on the location of the ulcer. Many elderly patients with peptic ulcer disease present hardly any symptoms. However, when symptoms do occur, the most prominent symptom is often pain. The timing of pain onset helps delineate between a gastric and a duodenal ulcer.

The pain can be described as gnawing, burning, cramp-like, ‘heartburn', or hunger like pains. It is usually located over the epigastrium (stomach area) and can be relieved by certain foods and/or antacids. Pain from peptic ulcer disease is recurrent and can become chronic if left untreated or ignored.

Gastric ulcers will have more of an inconsistent symptom pattern, while duodenal ulcers are very consistent, regarding the specific timing of pain. Gastric ulcer sufferers can have pain before eating, as a result of eating, and eating can also alleviate the pain of a gastric ulcer. Patients with duodenal ulcers will begin having pain in the midmorning and it will be relieved by food, only to appear 2-3 hours after eating. Patients often complain that stomach pains are keeping them up at night. [3]

Patients with peptic ulcer disease will have a positive imaging of the ulcer on x-ray or endoscopic exam. They will also have a positive occult blood test (blood in stool), which may first be recognized as black or tarry stools. They often suffer from tenderness of the abdomen as well. [4]

Peptic Ulcer Disease Treatment

Conventional treatment of peptic ulcer disease is focused on two areas. First is treatment of any underlying H.pylori infection. Current treatment of H.pylori is with a triple or quadruple therapy, using two or more antibiotics and bismuth. If there is not an underlying H.pylori infection, treatment is then focused on reducing and neutralizing the acid production by the stomach cells. This is accomplished with a combination of H-2 blockers (Cimetidine), proton pump inhibitors (Omeprazole), and antacids. Currently, certain prostaglandins (Misoprostol) are also used to reduce the acid production. [5]

Alternate treatment not only focuses on treating the cause, but also repairing the structure and restoring cellular integrity of stomach cells, while providing protective nutrients to prevent further damage.

Supplements helpful for Peptic Ulcer Disease

Bismuth subcitrate

Bismuth is a naturally occurring mineral antacid. It is effective at eradicating H.pylori. Multiple line therapy against H.pylori in patients with peptic ulcer disease using bismuth with a proton-pump inhibitor and two antibiotics, was compared against using no bismuth. Patients were given the treatment for 2 weeks and the group receiving the bismuth had a cure rate of 95%, as opposed to the non-bismuth group who had a cure rate of only 62%. This study concluded that treating H.pylori with bismuth should be included in the first line of treatment. [6]

Zinc

Zinc is very useful in the treatment of peptic ulcer disease. It has several anti-ulcer effects that make it a consideration in first line of PUD therapy. First, zinc decreases the acid output by inhibiting mast cell degranulation, next, it has been shown to increase mucous production and enhance the protective barrier of cellular membranes. Finally, zinc reduces inflammation associated with this condition. [7] In an analysis of 13 studies comparing the efficacy of zinc to an H2 blocker, zinc was shown to be as effective at healing both gastric and duodenal ulcers without the side effects. [8]

Glutamine

Glutamine is a key nutrient for intestinal structure and function. It is considered an essential nutrient for treatment of peptic ulcer disease. Glutamine is involved in the production of mucoproteins, which help form the protective barrier in the stomach and small intestine. In one particular double-blind study, glutamine was shown to accelerate the healing of peptic ulcers. [9]

Vitamin C

Vitamin C is one of the most potent anti-oxidants. It possesses certain anti-histamine and anti-bacterial properties. interestingly, levels of vitamin C in the blood are inversely correlated with H.pylori infection. [10] Also, levels of ascorbic acid in the mucosa of individuals with peptic ulcer disease, regardless of H.pylori status, are often decreased. [11] In a small double-blind study, high doses of vitamin C eradicated H.pylori infection in 30% of patients with peptic ulcer, compared to 0% in the control group. [12]

Vitamin A

Vitamin A is a potent anti-oxidant. Free-radical damage is thought to contribute to the development of peptic ulcer disease, regardless of H.pylori status. Levels of carotenoids in the mucosa of patients with peptic ulcer disease are decreased. [13] Supplementing with vitamin A may help to maintain the integrity of the mucosal barrier of the GI tract in PUD patients.

Vitamin E

Like Vitamin A, vitamin E is an anti-oxidant, and aids in maintaining the integrity of the mucosal barrier. Vitamin E is also decreased in the mucosa of patients with peptic ulcer disease. [14]

Poly-unsaturated fatty acids (PUFA’s)

PUFA’s are anti-oxidants that have been shown to inhibit the growth of H.pylori in vitro. They also have ulcer healing properties and are anti-inflammatory in nature. One study that measured the levels of PUFA’s in patients with duodenal ulcers found that levels were significantly low and were inversely correlated with H.pylori infection [15]

In another small study, patients received 2 g of fish oil and black currant oil a day. Participants exhibited a 53% clearance of H.pylori in conjunction with the resolution of overall symptoms. [16]

Deglycyrrhizinated licorice root (DGL)

DGL is an anti-ulcer agent that has been extensively studied and widely used for peptic ulcer disease. In study, licorice root has been shown to stimulate mucous formation, and prevent aspirin-induced ulceration. Deglycyrrhizinated licorice root contains flavonoids, compounds known to inhibit H.pylori. [17]

References

[1] Beers M and Berkow R. Peptic Ulcer Disease. The Merck Manual 17th Ed. Pp: 250-256.

[2] Pizzorno J, Murray M, and Joiner-Bey H. Peptic Ulcers. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pp: 392-397.

[3] Beers M and Berkow R. Peptic Ulcer Disease. The Merck Manual 17th Ed. Pp: 250-256.

[4] Pizzorno J, Murray M, and Joiner-Bey H. Peptic Ulcers. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pp: 392-397.

[5] Beers M and Berkow R. Peptic Ulcer Disease. The Merck Manual 17th Ed. Pp: 250-256.

[6] Dore MP et al. Colloidal bismuth subcitrate based twice a day quadruple therapy as a primary or salvage therapy for Helicobacter pylori infection. Am J Gastroenterol. 2002 Apr; 97(4): 857-860.

[7] Escolar G and Bulbena O. Zinc compounds, a new treatment in peptic ulcer. Drugs Exp Clin Res. 1989; 15(2): 83-89.

[8] Jimenez E et al. Meta-analysis of efficacy of zinc acexamate in peptic ulcer. Digestion 1992; 51(1): 18-26.

[9] Pizzorno J, Murray M, and Joiner-Bey H. Peptic Ulcers. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pp: 392-397.

[10] Simon JA, Hudes ES and Perez-Perez GI. Relation of serum ascorbic acid to Helicobacter pylori serology in the US: The Third National Health Nutrition Examination Survey. J Am Coll Nutr. 2003 Aug; 22(4): 283-289.

[11] Nair S et al. Micronutrient anti-oxidants in gastric mucosa and serum in patients with gastritis and gastric ulcer: does Helicobacter pylori infection affect mucosal levels? J Clin Gastroenterol. 2000 June; 30(4): 381-385.

[12] Jarosz M et al. Effects of high dose vitamin C treatment on H.pylori and total vitamin C concentration in gastric juice. Eur J Cancer Prev. 1998; 7: 449-454.

[13] Nair S et al. Micronutrient anti-oxidants in gastric mucosa and serum in patients with gastritis and gastric ulcer: does Helicobacter pylori infection affect mucosal levels? J Clin Gastroenterol. 2000 June; 30(4): 381-385.

[14] Nair S et al. Micronutrient anti-oxidants in gastric mucosa and serum in patients with gastritis and gastric ulcer: does Helicobacter pylori infection affect mucosal levels? J Clin Gastroenterol. 2000 June; 30(4): 381-385.

[15] Manjari V and Das UN. Oxidant stress, anti-oxidants, nitric oxide and essential fatty acids in peptic ulcer disease. Prostaglandins Leukotr Essent Fatty Acids. 1998 Dec; 59(6): 401-406.

[16] Frieri G et al. Polyunsaturated fatty acid dietary supplementation: an adjuvant approach to treatment of Helicobacter pylori infection. Nutr Res. 2000; 20: 907-916.

[17] Pizzorno J, Murray M, and Joiner-Bey H. Peptic Ulcers. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pp: 392-397.