Peptic Ulcers

Question 1

Peptic ulcers

Answer 1

Peptic ulcers = ulcers of the stomach (gastric) or duodenum characterised by a breakdown of the mucosal barrier and erosion of the regions wall by HCl

Question 2

Peptic ulcers: Symptoms

Answer 2

Epigastric pain (may radiate to the back), gnawing / pain between meals, nausea, vomiting, ↓ appetite, dyspepsia.

Question 3

Peptic ulcers: Complications

Answer 3

GIT bleed (persistent small loss of blood or large haemorrhage), perforation (→ peritonitis).

Seek urgent medical attention if: Sudden sharp worsening abdominal pain, haematemesis or melaena.

Question 4

Peptic ulcer risk factors

Answer 4

• Stress (sympathetic dominance) — can lead to vasoconstriction and inadequate blood supply which interferes with mucus production and reduces the secretion of protective prostaglandins.
• Low antioxidant status and low gastric output may predispose H. pylori colonisation.
• NSAID use (↓ gastric prostaglandin synthesis, ↓ gastric mucosal blood flow and mucus production; interferes with the repair of superficial injury).
• Smoking, caffeine, alcohol (damage the mucosa).

Question 5

Helicobacter pylori (H. pylori)

Answer 5

• H. pylori infection in the stomach is (refers to pyloric valve). associated with peptic ulceration, chronic gastritis and gastric cancer. 80% of peptic ulcer cases have H. pylori colonisation.
• Its corkscrew shape enables it to burrow through the protective mucus layer into the stomach lining, causing inflammation.
• H. pylori secretes cytotoxins and enzymes; e.g., protease, phospholipase and urease (releases ammonia) and damages the mucosal barrier.
• Numerous strains vary in their ability to trigger inflammation (virulence factors CagA and VacA carry greatest risk).

Question 6

Natural approach to peptic ulcers

Answer 6

• Avoid alcohol, smoking, fizzy drinks, spicy foods and caffeine (potential GI mucosal irritants). Avoid NSAID use.
• Increase fibre — especially for duodenal ulcers as fibre slows gastric emptying.
• Address stress. Consider calming nervine teas (e.g., chamomile, passionflower).
• Supporting the mucosal / mucin barrier:

‒ Demulcent herbal powder — slippery elm, marshmallow, liquorice (see Nutrition 2, Herbal Medicine Lecture).

‒ ↑ dietary polyphenols and seaweeds / algaes (fucoidan content)

• Raw cabbage juice — a traditional remedy for healing stomach ulcers. Contains vitamin C and ‘substance U’ which stimulates mucin production (250 ml 4 x / day showed ulcers healed in 7‒10 days).
• Turmeric — anti-inflammatory (↓ inflammatory cytokines and pro-inflammatory PGs). A study found that 600 mg given 5 x / day showed 76% were ulcer-free after 12 weeks.
• Aloe vera juice — 20–30 ml 3 x daily. Inhibits COX (antiinflammatory), speeds up wound healing (↑ collagen synthesis).
• Identify and address H. pylori (next slide)

Question 7

Eradicating H. pylori

Answer 7

• Saccharomyces boulardii (↑ SIgA and mucosal barrier; inhibits colonisation and adhesion of H. pylori; inhibits IL‐8 and TNF‐α).
• Mastic gum — dried sap from the mastic tree with ulcer-healing properties. It is anti-bacterial; thought to relate to its triterpenic acid content. 2 x 500 mg capsules before bed (30 days), then 1 x 500 mg capsule before bed (60 days).
• Liquorice — contains flavonoids that inhibit H. pylori protein synthesis; it is anti-adhesive.
• Cinnamon (inhibits urease); berberine containing herbs e.g., barberry bark; curcumin from turmeric inhibit H. pylori growth.