Ulcers, Digestive Health Article

Herbals

Botanical medicine offers the following remedies that may help treat ulcers:

• Bilberry (Vaccinium myrtillus): heals ulcers.
• Cabbage: heals ulcers.
• Calendula (Calendula officinalis): heals duodenal ulcers.
• Chamomile tea: speeds healing, reduces mucosal reaction, reduces stress, and lessens gas.
• Comfrey (Symphytum officinale) root: soothes the stomach, lessens bleeding, and speeds healing, however, the patient must take caution, in that prolonged or excessive use can be harmful to the liver.
• Geranium (Pelargonium odoratissimum): lessens bleeding.
• Licorice (Glycyrrhiza glabra): heals ulcers.
• Marsh mallow (Althaea officinalis) root: soothes the stomach.
• Meadowsweet: soothes the stomach.
• Plantain (Plantago major): soothes the stomach.
• Slippery elm (Ulmus fulva): lessens bleeding and heals mucous membrane.
• Wheat grass (Triticum aestivum): heals ulcers.

Chinese medicines

Chinese herbal treatment principles are based upon specific groups of symptoms. Chinese patent medicines are also based upon specific symptoms and include:

• Wu Bei San (cuttlefish bone and fritillaria): acid reflux and bleeding
• Wu Shao San (cuttlefish bone and paeonia): acid reflux and bleeding
• Liang Fu Wan (galangal and cyperus pill): pain
• 204 Wei Tong Pian (204 epigastric pain tablet): pain, acid reflux, and bleeding
• Xi Lei San (tin-like powder): ulcer with tarry stool

Other treatments

Other treatments for ulcers are:

• Essence therapy. Dandelion essence can help reduce tension, and pink yarrow essence can help the patient distinguish between his or her problems and those of others.
• Reflexology. For ulcers, the practitioner work the solar plexus and stomach points on the feet and the solar plexus, stomach, and top of shoulder points on the hands.
• Biofeedback. Thermal biofeedback can help protect and heal the stomach.
• Sound therapy. Music with a slow, steady beat can promote relaxation and reduce stress.
• Ayurveda. Ayurvedic treatment is individualized to each patient but common ulcer remedies include: aloe vera natural gel, arrowroot powder with hot milk, and tea prepared from cumin, coriander, and fennel seeds.
• Acupuncture. Ulcers can be treated using target points for stress, anxiety, and stomach problems.
• Relaxation techniques. Stress reduction and involvement in stress management programs may help relieve ulcer symptoms.

Medications

Most drugs that are used to treat ulcers work by either lowering the rate of stomach acid secretion or protecting the mucous tissues that line the digestive tract.

Medications that lower the rate of stomach acid secretions fall into two major categories: proton pump inhibitors and H₂ receptor antagonists. The proton pump inhibitors, which have been in use since the early 1990s, include omeprazole (Prilosec) and lansoprazole (Prevacid). The H₂ receptor antagonists include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid).

Drugs that protect the stomach tissues are sucralfate (Carafate), bismuth preparations, and misoprostol (Cytotec).

Most doctors presently recommend treatment to eliminate H. pylori to prevent ulcer recurrences. Without such treatment, ulcers recur at the rate of 80% per year. The drug combination used to eliminate the bacterium is tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol). Eradication is not always successful, however, for reasons that are unclear.

Surgery

Surgical treatment of ulcers is generally used only for complications and suspected cancer. The introduction of a newer technique for repairing perforated ulcers using a laparoscope rather than opening the patient's abdomen may reduce some of the risks associated with surgical treatment of ulcers. The most common surgical procedures are vagotomies, in which the connections of the vagus nerve to the stomach are cut to reduce acid secretion; and antrectomies, which involve the removal of part of the stomach.

Expected results

The prognosis for recovery from ulcers is good for most patients. Very few ulcers fail to respond to the medications that are currently used to treat them. Recurrences can be cut to 5% by eradication of H. pylori. Most patients who develop complications recover without problems even when emergency surgery is necessary.

Prevention

Strategies for the prevention of ulcers or their recurrence include the following:

• giving misoprostol to patients who must take NSAIDs
• participating in integrated stress management programs
• avoiding unnecessary use of aspirin and NSAIDs
• improving the nutritional status of critically ill patients
• quitting smoking
• cutting down on alcohol, tea, coffee, and sodas containing caffeine
• eating high-fiber foods

BOOKS

Miller, David K. "Chronic Abdominal Pain." In Current Diagnosis 9. Edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.

Viggiano, Thomas R. "Peptic Ulcer Disease." In Current Diagnosis 9. Edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.

Way, Lawrence W. "Stomach and Duodenum." In Current Surgical Diagnosis & Treatment. Edited by Lawrence W. Way. Stamford, CT: Appleton & Lange, 1994.

Ying, Zhou Zhong, and Jin Hui De. "Gastrointestinal Diseases." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.