June 01, 2017

Peptic Ulcers or something else?

Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.

Is that pain in your abdomen just a belly ache, or could it be reflux or a peptic ulcer? How do you know?

A short term ache in the upper abdomen is usually just that, an upset stomach that passes quickly.

Pain in the upper abdomen that burns up into the chest and throat is most likely a reflux condition, actually caused by too little stomach acid. (See my website for an article on reflux on June 28, 2012.)

Peptic ulcers are a whole different problem. About seven percent of Americans are diagnosed with ulcers, some 16 million in total, and 500,000 new cases each year.

Obviously the stomach is at the bottom end of the esophagus. After the stomach, the upper part of the small intestine is next, called the duodenum. It is about 12 inches long. Glands inside the stomach produce acid and pepsin. The stomach also produces mucus to protect the stomach lining from the acid.

If you have an ulcer on the stomach wall or duodenal lining, the mucosal protection is broken down. These ulcers can heal on their own, but approximately 35% of them cause serious issues such as bleeding or perforation of the stomach wall.

Inflammation of the stomach or duodenum can lead to infection and narrowing or blockage at the duodenal sphincter. This can lead to food leaving the stomach more slowly until it completely blocks. This is a worst case scenario where vomiting of food occurs due to the blockage. Symptoms of a peptic ulcer vary depending on where it is and the degree of inflammation. Most pain is located right below the sternum and include: gnawing or burning between meals or at night, burping, feeling full after small amounts of food, heart burn, nausea, loss of appetite and increased pain after eating fatty foods. Severe cases can have black stools from bleeding, vomiting blood and trouble breathing.

In 2005, the Nobel Prize was given to two doctors for their discovery of the link between the bacteria heliobacter pylori and peptic ulcer disease. It linked inflammation and ulceration of the stomach to an infection from bacteria.

Although the infections appear to heal by reducing gastric acid, they often come back quickly because the treatment did not reduce the level of bacteria or treat the inflammation.

Heliobacter pylori causes chronic infection and inflammation that may or may not produce symptoms. The stomachs ph of 4, highly acidic, usually protects the stomach from bad bacteria.

Unfortunately, treatment with proton pump inhibitors (PPI’s), antacids and H2 blockers only treat the symptoms by reducing stomach acid. Reducing acid simply allows bacteria to flourish. Then, when you stop taking these drugs, the acidity rises, resulting in more ulceration and more infections.

Treating the cause is not simple, but is effective in actually healing the problem. First, you must eliminate any known foods that trigger pain. This could be anything from alcohol, coffee, and nicotine to chocolates and mints. Many drugs impact the stomach lining including NSAIDS like ibuprofen, aspirin or naproxen.

Second, you need to replenish the good bacteria of the gut by using high quality probiotics and eating fermented foods like sauerkraut.

Another helpful recommendation would be to take a couple tablespoons of raw apple cider vinegar to maintain a healthy balance of gastric acid production and create an environment in the stomach that inhibits bacterial growth of heliobacter pylori. Try it, it works.