Peptic ulcers and GORD

Question 1

Peptic Ulcers

Answer 1

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).

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 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
• Address stress.
• 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)

Question 7

GORD

Answer 7

Gastro-oesophageal reflux disease (GORD) = the reflux of gastric juice (HCl, bile, pepsin) back into the oesophagus.

Question 8

GORD Symptoms

Answer 8

• The most common symptom is heartburn (retrosternal pain).

Question 9

GORD aetiology

Answer 9

• GORD is associated with transient lower oesophageal sphincter (LOS) relaxation episodes and a decreased lower oesophageal sphincter pressure.
• Often treated conventionally with chronic PPI use. What are the side effects of these?

Question 10

GORD risk factors

Answer 10

• ↑ intra abdominal pressure: Obesity, pregnancy.
• Hiatus hernia (stomach protrudes through the diaphragm into the thoracic cavity).
• Eating large amounts of fatty foods (acid remains in stomach
• Smoking, alcohol, coffee; peppermint, tomatoes and chocolate relax the LOS.
• Certain medications : Calcium channel blockers, nitrates, NSAIDs, diazepam.
• Stress, anxiety and family history.

Question 11

Natural approach to GORD

Answer 11

• Consider testing for H.pylori
• Consider low stomach acid (test
  ‒ Poor gastric digestion due to low HCl leads to fermentation of undigested food creating gas in the stomach and increasing pressure on the LOS.
  ‒ Correct low stomach acid using digestive bitters, ACV, bitters, betaine HCl. Consider digestive enzymes.
• Avoid trigger foods / drinks and any foods associated with a food sensitivity or allergy, e.g., wheat.
• A Mediterranean diet has been shown to be protective.
• Slow down, chew thoroughly, eat mindfully, don’t overeat (or too late within 3 hours of bed), do not drink with meals.
• Avoid lying down post meals; when sleeping
  elevate the head of the bed (by up to 20 cm).
• Address stress and anxiety. Lose weight if applicable.
• Visceral manipulation of hiatus hernia. Also ↑ fibre to ↓ straining.