Ulcers occur in the stomach and the entrance to the small intestine, and indicate a breakdown in the local mucosal barrier defences. The stomach is a hollow muscular bag which mixes food with enzymes, acid and other secretions, before being metered out into the small intestine (duodenum). The stomach and lining of the duodenum are protected by a thick coat of mucus against the acid and enzymes which would otherwise burn and digest the tissues. Mucus contains salts, protective antibodies, mucins and anti-microbial enzymes.

The common symptoms are a gnawing ache or burning pain felt in the abdomen which may or may not improve with eating, or be worse at night. Other symptoms are nausea, vomiting, coughing up blood,  belching, melena and weightloss. These symptoms are also indicative of oesophagitis, gastritis or gastric carcinoma.

Ulcers are commonly associated with stress, smoking, and Helicobacter pylori infection. They are also associated with pharmaceutical drug use (NSAIDS, anticoagulants, SSRIs, corticosteroids), excess alcohol consumption, Crohn’s disease, pancreatic tumour (gastrinoma), and Zollinger-Ellison syndrome.

The discovery of the role of Helicobacter pylori infection in a significant percentage of ulcers lead to the use of antibiotics as a treatment. It has been found that  H. pylori can directly influence hormones that control acid secretion and balance (gastrin, somatostatin); however, while 50% percent of the population and up to 80% of the elderly have H. pylori, only 10% of the population have peptic ulcers. In fact, many people have peptic ulcers without any infection (H. Pylori-negative ulcer disease).

This bacteria is also considered a carcinogen (adenocarcinoma, gastric lymphoma), and a urea breath test, a urease test at endoscopy, or a gastric string culture can detect it. A comprehensive digestive stool analysis (CDSA) can also determine if this infection, chronic inflammation, tumours or ulcers are present, as well as other indicators of poor digestive health such as pancreatic insufficiency, and the presence of parasites.

The conventional approach to ulcer treatment is ‘triple’ or ‘quadruple therapy’ (several antibiotics, bismuth), and antacids such as PPIs or H2-receptor antagonists. Unfortunately, antibiotic resistance is growing through repeated treatment and up to 13% of patients with ulcers are now resistant to this approach. The possible side-effects of treatment are dysbiosis, altered bowel habit, bacterial overgrowth, chronic malabsorption (protein, iron, B-vitamins, calcium), immune suppression, gastric polyps, headaches, depression, back pain, and osteoporosis.

Treatment

General

It should be obvious that none of the pharmaceutical drugs mentioned above address all the underlying causes. The integrity of the epithelial tissues needs to be improved as well as the quality of the mucus. It is important, therefore, to address diet, nutrient-status, stress, exercise levels, and individual constitutional factors (susceptibility) in order to heal and prevent ulcers recurring.

Alternatives need to be found for chronic NSAID use, and PPIs or H2-receptor antagonists tapered off. NSAIDS can be replaced with anti-inflammatory herbs and nutrients (omega-3, turmeric, Boswelia). A PPI-taper involves a gradual reduction of medicine over about 4 weeks with alternative ant-acids being used such as potato broth.

Chronic stress is a major cause of any problem in the digestive system because it triggers sympathetic arousal which inhibits protective secretions and immunity in general. Smoking needs to be curtailed, and a regime of exercise put in place to build general strength and help dissipate stress. Smoking and heavy alcohol use are associated with ulcer development and gastric cancer.

Diet

The body must be well-hydrated and fed appropriately. Sugar suppresses immunity while refined carbohydrates promote acid secretion. Meals should be simplified to one course and consist of nutrient-dense wholefoods. Cabbage juice is an excellent treatment for ulcers, along with garlic for immunity and the eradication of H. pylori. Kefir and probiotic supplements can also suppress this bacteria (SB). Replace coffee and black tea with green tea.

Food Combining can assist meal planning, and blood typing may be used to match diet to constitution. Our metabolism is designed for a pre-industrial era diet and has made no adaptation to synthetic additives, preservatives, agri-chemicals or microwave cooking; however, a moderate discretionary allowance—organic coffee, wine, chocolate etc.—is possible if the overall diet is healthy.

Nutrients such as vitamins (A, B, C), protein, zinc, glutamine, and omega-3 are necessary for tissue integrity, barrier defences and general immunity. Stress is a nutrient-hungry state and magnesium, potassium and B-vitamins support stress.

Herbs

The treatment approach for stomach or duodenal ulcers is the same as for acid reflux, taking slippery elm, fenugreek, meadowsweet, liquorice, golden seal fibre such as psyllium or alginates, the anti-inflammatory and wound healing herbs aloe vera, calendula, chamomile, yarrow, marshmallow, and plantain. Liquorice root and slippery elm can be made into a protective gruel to coat mucous membranes, or a paste made of aloe vera gel and liquorice root powder. Comfrey was used traditionally. Bitters are not to be used with gastric ulcer because they stimulate acid production.

Infection  in the stomach, or gastritis should be treated with garlic, ginger, aloe vera or golden seal which have activity against helicobacter pylori. If there is a nervous system problem such as stress or anxiety, then calming herbs like chamomile, valerian, skullcap, and hops can be used, while liquorice or withania support the adrenal glands. Korean red ginseng, aloe vera, garlic, turmeric, ginger and green tea are all well-researched for use in ulcer treatment.

Cell Salts

Nat-phos is for acidity and can be used as an ant-acid. Ferrum-phos is anti-inflammatory and will support healing. Calc-fluor is for building tissue integrity.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.