By Dr. Mercola
Slightly less than 7 percent, or 15.9 million Americans, have been diagnosed with ulcers.1 Approximately 500,000 new cases are diagnosed each year.2 Although treatment has improved after physicians acknowledged the primary cause of ulcers, the number of new cases has not declined.
Unfortunately, while there are new drugs on the market to reduce the production of acid in an effort to reduce your symptoms, these drugs don't treat the underlying cause and come with their own set of side effects and problems.
The more common types of medications used to treat ulcers may also ultimately worsen the condition of your stomach lining and your overall health. The aim of these drugs are to significantly reduce stomach acid. However, this acid is a valuable chemical contributor to digestion and not the culprit behind your ulcer.
How do you know if you should see your physician about a potential ulcer? Before reading a list of symptoms, it's important to have an understanding of the basic anatomy of your digestive system, the different types of ulcers and your available treatment options.
What You Need to Know About the Anatomy of Your Digestive System
Your stomach is kidney shaped and located just below your ribs on the left side. Food passes through your esophagus and a muscular valve called the lower esophageal sphincter, before passing into your stomach.
The lower end of your stomach has another sphincter, called the pyloric sphincter, connecting your stomach with the beginning of your small intestines, called the duodenum.
The duodenum is about 12 inches long, and helps your body regulate the amount of food flowing out of your stomach. You have glands inside your stomach wall that produce acid and pepsin, an enzyme that helps digest food. Normally your stomach produces mucus to protect your mucosal lining from the acid.
If you have an ulcer in your digestive tract, this defense against the acid may break down. Often this is the result of an infection with helicobacter pylori (H. pylori) bacterium. The acid forms sores on the lining of either your duodenum (duodenal ulcer) or your stomach (gastric ulcer).
These ulcers are called peptic ulcers or peptic ulcer disease (PUD) and are named for their location in your digestive tract. Sometimes these ulcers can heal on their own. However, 35 percent of gastric ulcers will cause serious complications, such as bleeding or perforation (hole) of the stomach wall when not properly addressed.3
Other complications include bleeding, inflammation of the stomach or duodenum, infection, or narrowing or blockage where the duodenum leaves the stomach. In the last instance, food begins to leave your stomach more slowly until it is finally completely blocked or obstructed. This may cause vomiting.4
How to Tell If You Have an Ulcer
Symptoms of a peptic ulcer may vary slightly, depending upon the location, the degree of inflammation and whether or not you are suffering from a partial block to your duodenum.
The majority of symptoms are usually experienced in the epigastric area, in the upper abdomen just below the chest bone (sternum). Symptoms include:5,6,7,8
✓ A gnawing or burning pain in the middle or upper stomach between meals or at night
✓ Feeling full after eating a small amount of food or bloating
✓ Increased symptoms eating foods high in fat
✓ Losing weight without trying
✓ Loss of appetite
Severe cases may result in:
• Dark or black stool from bleeding
• Vomiting blood (looks like coffee grounds)
• Severe pain in the mid- to upper abdomen
• Trouble breathing
• Vomiting partially digested food from blockage
Common and Uncommon Causes of Peptic Ulcers
In some cases, symptoms of an ulcer may resolve when you remove the triggering agent. For instance, medications may impact the quality of your stomach lining, reducing protection against normal acid production.9
Medications known to have this effect include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen. Even enteric coated aspirin or other prescription medications may increase your potential for increased acid production and ulcer formation.
Excessive alcohol intake may trigger ulcer formation, as will smoking, chewing tobacco or radiation treatments to your abdomen.10 Excessive acid production may also occur from gastrinomas, or tumors formed in the cells producing acid in your stomach.
However, by far, the most common cause of ulcerations in the stomach or duodenum is the result of an overgrowth of the bacteria H. pylori. This bacteria damages the mucus protecting the lining of your stomach from your stomach acid.11
In 2005, the Nobel Assembly awarded the Nobel Prize in Physiology or Medicine jointly to Drs. Barry Marshall and J. Robin Warren for their discovery of the link between the bacteria helicobacter pylori and gastritis and peptic ulcer disease.12
Called an "unexpected discovery," Marshall and Warren linked inflammation and ulceration of the stomach to an infection from bacteria.
Although the ulcerations appear to heal by reducing the gastric acid in the stomach, they often quickly relapse because the treatment did not reduce the level of bacteria or treat the inflammatory response.
H. pylori causes a chronic infection and inflammation that may or may not be symptomatic. Normally your stomach's high acidity is a poor environment for bacterial growth.
Treatment with proton pump inhibitors (PPIs) reduces the acidity and allows bacteria to flourish. Other studies also support the theory that reflux diseases are triggered, in part, by an overgrowth of bacteria.13,14,15
The Value of Stomach Acid
Stomach acid is necessary for not only the digestion and breakdown of the food you eat, but also to protect your body against bacterial growth.
Your gastrointestinal tract is home to a large part of your immune system, protecting you from invaders by producing acids and accommodating colonies of beneficial bacteria that act as your defensive army.
The environment inside your stomach is normally highly acidic (pH 4). This acts as a defense against harmful pathogens that are unable to live in such an acidic setting. The majority of the acids are hydrochloric acid and pepsin. As you age, reaching your 30s and 40s, your stomach begins to produce less acid, giving you less protection.
Whether you experience low levels of stomach acid from aging or from the use of antacids, there are secondary effects that may negatively impact your health.
• Bacterial Overgrowth
Lack of stomach acid increases the growth of bacteria in your stomach, which may lead to malabsorption of nutrients and has been linked to inflammation of the stomach wall.16
• Poor Nutrient Absorption
One of the most common causes of impaired function of digestion and the absorption of nutrients is the reduction of stomach acid production. This occurs in both the elderly and individuals on long-term antacid treatments.17 Acid breaks down proteins, activates hormones and enzymes and protects your gut against overgrowth of bacteria.
Lack of acid results in iron and mineral deficiencies and incomplete digestion of proteins. This may also lead to a vitamin B12 deficiency.18
• Decreased Resistance to Infection
Your mouth, esophagus and intestines are home to a healthy growth of bacteria, but your stomach is relatively sterile. Stomach acid kills most of the bacteria coming from your food or liquids, protecting your stomach and your intestinal tract from abnormal bacterial growth.19 At the same time, your stomach acid prevents bacteria growing in your intestines from moving into your stomach.
Reducing stomach acid changes the pH of the stomach and allows external bacteria to grow. Some antacids may reduce stomach acid between 90 and 95 percent, increasing your risk of salmonella, c. difficile, giardia and listeria infections.20,21
Other studies have linked the use of acid-reducing drugs to the development of pneumonia, tuberculosis (TB) and typhoid.22,23,24 The distortion of the gut microbiome affects your immune system and may increase your overall risk of infection.
PPIs and H2 Blockers Treat the Symptoms, Not the Cause
When PPIs were first approved by the U.S. Food and Drug Administration (FDA), they were intended to be taken for no more than six weeks. However, today, it is not uncommon to find people who have been taking these drugs for more than 10 years.25 Both PPIs and H2 Blockers may initially reduce your symptoms as they reduce the amount of acid produced in your stomach, and thus reduce the acidity affecting the ulcerations. However, the reduction in acidity also encourages bacterial growth.
Also, when you stop taking these anti-acid drugs, your acidity will tend to rise, resulting in more ulcerations from the action of the acid on your stomach walls. This is why quitting cold turkey is not recommended. You need to gradually cut down on these drugs. Appropriate treatment will address the action that caused your stomach ulcer.
You may need to reduce or eliminate your use of NSAIDs and reduce your alcohol intake or frequency of tobacco use. There are several methods you and your physician may discuss to determine if H. pylori is the culprit behind your peptic ulcers.26
• Carbon Isotope Urea Breath Test
H. pylori convert urea into carbon dioxide. Ten minutes after consuming a special substance with urea, the carbon dioxide in your breath is measured. This test can accurately determine if you have an H. pylori infection and is used after treatment to determine if it was successful.
• Blood Test
A blood test can measure antibodies to H. pylori to determine if you have been exposed to the bacteria. This test can remain positive for years after an infection and so cannot be used to determine if any treatment was successful.
• Stool Test
H. pylori can be detected in your stool and so can be used to determine if you have an infection.
• Tissue Biopsy
This is the most accurate method to determine if you have an infection. A tissue sample from your stomach lining is taken during an outpatient endoscopy procedure.
Effective Treatment Choices
In this short video, I review why PPIs are a very poor choice to treat ulcers, and what options you have to reduce your pain and control the growth of H. pylori in your gut.
If your test for H. pylori is positive, you have two choices for treatment. Many people around the world have H. pylori in their gut,27 but not everyone is symptomatic. The bacteria is spread through mouth-to-mouth contact, and contaminated food and water.28 Food and lifestyle choices enable the bacteria to proliferate in your gut and create the symptoms of a peptic ulcer.
You may choose a combination of antibiotics to control the bacteria,29 but discover you must make other long-term choices to achieve lasting relief. Alternatively, you may choose to use the strategies listed below to both affect relief from the ulcers and continue to control the population of H. pylori in your gut, thus addressing the root cause of the problem.
Processed foods and sugars create an imbalance in your digestive microbiome and promote the growth of pathogenic microbes. Eating real, ideally organic foods is the first step toward re-establishing a healthy gut. Reduce or completely eliminate the foods you've found that trigger your pain. Many people find it necessary to eliminate mints, caffeinated drinks, coffee, alcohol, nicotine and chocolates as their gut is healing.
One of the most important things you can do to reduce these pathogenic bacteria is to reseed your gut with beneficial bacteria. You can use either traditionally fermented foods or a high-quality probiotic supplement. These can naturally help to reduce the bacterial growth of H. pylori in your gut.
Other Nutritional Recommendations
Drink a lot of clean water from a good source, up to a gallon a day divided equally throughout the day. This will help to dilute the acid in your stomach and help relieve discomfort. Include a high quality source of omega-3 fats, to improve your immune system and give your body the raw materials needed to attack the infection. My personal preference is krill oil.
Bone broth can help rebuild the tissue in your stomach lining. Bone broth naturally contains gelatin and cartilage, essential building blocks for tissue growth. It also increases gastric acid secretion, normally inhibited by PPIs and H. pylori bacteria.30 The broth contains glutamine, which plays a small but important role in cell metabolism and cell growth in your small intestines.31
Vitamin D is also important to address any bacterial overgrowth in your body. Optimized vitamin D levels can be obtained through sensible sun exposure, ideally daily, or through the use of an oral vitamin D3 supplement. It's important to remember to take vitamin K2 (MK-7 form) if you are using oral vitamin D3 to reduce your risk of hardening your arterial walls.
A tablespoon of raw, unfiltered apple cider vinegar in 6 ounces of water daily can help to balance your gastric acid production and create an inhospitable environment for H. pylori growth. Ginger root also has a protective effect on your gastrointestinal tract. Put two slices of fresh ginger root in 16-ounces of hot water and allow it to steep for about 30 minutes.
Drink it about 20 minutes before a meal. In one study the use of ginger root proved six to eight times more potent in the treatment of heartburn than Prevacid.32