Peptic  Ulcer 胃十二指腸潰  (in English and Chinese 中英文)

   Edited by: Joe Hing Kwok Chu      按此看中文

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Symptoms:

a burning sensation in the upper abdomen or chest after meals or when the stomach is empty.

 For more information see under the item: Chinese herb therapy

These symptoms of peptic ulcers can also exist in:

• GERD ( gastro-esophageal reflux disease),

• Non-ulcer dyspepsia (chronic dyspepsia without the presence of ulcers or functional dyspepsia),

• gallbladder disease,

• liver disease

• other disorders.

Causes:

Most peptic ulcers are caused by:

1.  Primary cause:  Helicobacter pylori, a bacteria

2.  Inducing causes:  system suppressed by stress, and/or consumption of alcohol, tobacco, aspirin,  corticosteroids, coffee and spicy food, non-steroidal anti-inflammatory drugs (NSAIDS)

3. Secondary causes: tumors on the pancreas and duodenum.

Most people who have the infection are without symptoms, but long-term emotional stress and/or long-term consumption of aggravating substances can disrupt the protective mucus linings of the stomach and duodenum. This allows the strong digestive acid to directly contact the tissues of the stomach or duodenum and triggers ulcers.

H. pylori diagnosis:

1.      Tissue test: during Endoscopy small bits of tissue are removed and tested for H. pylori.

2.      Breathing test: patients are given urea orally, and an enzyme of the H. pylori breaks down the urea into carbon dioxide, which is exhaled and can be measured.

3.      Antibody test: antibodies are formed when the patient is infected with H. pylori. If in the antibody is present, it means the patient is either currently or previously infected. This test may not determine whether the patient’s infection is active.

Western Treatments include :

(1) using antibiotics:

H. pylori is difficult to eradicate because it burrows deep into the mucus layers. Usually several antibiotics are used in combination, such as metronidazole (Flagyl), tetracycline (Achromycin), clarithromycin (Biaxin), or amoxicillin (Amoxil).

The side effects of antibiotic use include disruption of the balance of the beneficial bacteria (Escherichia coli, also known as E. coli). Low level of E. coli can promote  the  growth of yeast in the digestive tract, causing a yeast infection.

Bismuth subsalicylate (an active ingredient of Pepto-Bismol) also provides the effect of antibiotics  It may help to inhibit or eradicate the bacteria but it may also create the side effects like antibiotics.

(2) using anti-acid:

alkaline include sodium bicarbonate (baking soda), aluminum hydroxide, magnesium hydroxide

H2 antagonists  include Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid Pulvules), and ranitidine (Zantac)

proton pump inhibitors (PPIs) are a group of prescription medications that prevent the release of stomach acid by inhibiting the enzyme in the wall of the stomach that produces acid. PPIs include omeprazole sodium (Losec), esomeprazole sodium (Nexium), lansoprazole sodium (Zoton), pantoprazole sodium (Protium), and rabeprazole sodium (Pariet).

Common side effects of PPIs include diarrhea, nausea, constipation, abdominal pain and headache. In rare instances, side effects can also include allergic reactions, itchiness, dizziness, swollen ankles, muscle and joint pain, blurred vision, depression, dry mouth, osteoporosis and hip fracture. Long-term inhibition of digestive acid using acid neutralizers or PPIs can promote bacteria growth in the stomach and also can may interfere with calcium absorption because of insufficiency of hydrochloride acid but they also may reduce bone resorption ^[2] through inhibition of osteoclastic vacuolar proton pumps. See here

See this study  that shows that long-term  proton pump inhibitors (PPI) therapy, particularly at high doses, is associated with an increased risk of hip fracture.^[2]

Use proton pump inhibitors with care in case of pregnancy or with liver or kidney problems.

(3) Using De-Glycerrhizinated Licorice (DGL) (Caved-S) Therapy:

Caved-S is manufactured by various pharmaceutical companies. One of its  main ingredients is the common Chinese herb gan cao (licorice,  Glycyrrhiza glabra L)  but has been deglycerrhinated, to eliminate the side effects of the glycyrrhizinic acid in the licorice which possess the effect of mineralcortical hormone.  See a study of : a two year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence.

Side effects of Caved-S:  can include calcium depletion through excretion (both urine and stool) caused by aluminum hydroxide, one of the components of Caved-S. Aluminum hydroxide also depletes phosphorus in the normal body, and long-term use can bring phosphorus down to an unnaturally low level which may cause adverse effect on memory..