Are You Suffering with an Ulcer?
Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., MS
Signs and SymptomsGastric and duodenal ulcers both present with symptoms of an annoying, burning, gnawing, and aching from your navel to your breastbone. The most common symptom is a dull ache in the upper abdomen that usually occurs two to three hours after a meal.
Duodenal ulcer pain most often occurs when the stomach is empty, such as during the night or between meals, and is relieved by food.
With gastric ulcers, the pain occurs at any time during the day, but frequently occurs immediately or within a couple of hours of eating a meal.
Other less common symptoms associated with the development of an ulcer include nausea, vomiting, belching, bloating, and Unexplained weight loss.
Vomiting of blood and dark blood in stools are other rare symptoms which should be watched for.
Clinical Lab Assessments
Helicobactor Pylori Antibody
Medical studies continue to show a strong link between H. pylori and ulcer disease. The presence of H. pylori can be detected three ways. Blood tests, stool sample and breath test. Each has there advantages and disadvantages, however, your physician may decide to do one or a combination of tests to accurately diagnose the presence of a H. Pylori pathogen.
Traditional Medical Testing
Upper GI X-ray
Your doctor may begin with an upper GI X-ray. This test involves swallowing a white, metallic liquid called barium which coats and helps outline your esophagus, stomach and duodenum. This test is used to make an ulcer more visible.
Endoscopy
Endoscopy is sensitive medical procedure which may follow an upper GI X-ray if the X-ray suggests a possible ulcer. An endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestines) to see abnormalities, like inflammation or bleeding, that don't show up well on x rays.
For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). With this instrument, your doctor can view your upper digestive tract and identify an ulcer. If an ulcer is found, your doctor may remove small tissue samples (biopsy) near the ulcer.
Conventional Treatment
The treatment goals of an uncomplicated acute peptic ulcer are to:
Relieve symptoms
promote ulcer healing
Prevent ulcer recurrence and complications. Ulcers associated with NSAIDs usually heal rapidly when the NSAID is withdrawn and the use of H2 receptor antagonists.
Peptic ulcers associated with H. pylori infection can be treated with antibiotics. The duration of therapy for healing of an acute gastric ulcer is 8-12 weeks, with duration of therapy for acute duodenal ulcer ranging from 6-8 weeks.
The most common medications for the treatment of gastric and duodenal ulcers include:
Cimetidine (Tagament) is considered a histamine blocker
Documented side effects:
Breast development in men, headache, agitation, anxiety, confusion, depression, disorientation, and hallucinations. Allergic reactions, anemia, blood disorders, diarrhea, dizziness, fever, hair loss, impotence, inability to urinate, joint pain, kidney disorders, liver disorders, mild rash, muscle pain, pancreas inflammation, rapid heartbeat, skin inflammation or peeling, sleepiness, slow heart beat.
Possible food and drug interactions when taking this medication
Micronase and Glucotrol
Diflucan and Nizoral
Aspirin
Augmentin
Valium, Librium, Ativan and Xanax
Inderal and Lopressor
Cardizem, Calan, and Procardia
Chlorpromazine (Thorazine)
Cisapride (Propulsid)
Cyclosporine (Sandimmune)
Digoxin (Lanoxin)
Cordarone, Tonocard, Quinidex, and Procan
Metoclopramide (Reglan)
Metronidazole (Flagyl)
Demerol and Morphine
Nicotine (Nicoderm, Nicorette)
Paroxetine (Paxil)
Pentoxifylline (Trental)
Phenytoin (Dilantin)
Quinine
Sucralfate (Carafate)
Theophylline (Theo-Dur, others)
Warfarin (Coumadin) Ranitidine (Zantac)
Documented side effects:
Headache, sometimes severe. Abdominal discomfort and pain, agitation, changes in blood count (anemia), changes in liver function, constipation, depression, diarrhea, difficulty sleeping, dizziness, hair loss, hallucinations, heart block, hepatitis, hypersensitivity reactions, inflamed blood vessels, inflammation of the pancreas, involuntary movements, irregular heartbeat, jaundice (yellowing of eyes and skin), joint pain, muscle pain, nausea and vomiting, rapid heartbeat, rash, reduced white blood cells, reversible mental confusion, severe allergic reactions, sleepiness, slow heartbeat, swollen face and throat, vague feeling of bodily discomfort, vertigo, yellow eyes and skin
Possible food and drug interactions when taking this medication
Alcohol
Coumadin
Diazepam (Valium)
Diltiazem (Cardizem)
Enoxacin (Penetrex)
Glipizide (Glucotrol)
Glyburide (DiaBeta, Micronase)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Metformin (Glucophage)
Nifedipine (Procardia)
Phenytoin (Dilantin)
Procainamide (Procan SR)
Sucralfate (Carafate)
Theophylline (Theo-Dur)
Triazolam (Halcion) Famotidine (Pepcid)
Documented side effects:
Headache, abdominal discomfort, acne, agitation, altered taste, anxiety, breast development in males, changes in behavior, confusion, constipation, decreased sex drive, depression, diarrhea, difficulty sleeping, dizziness, dry mouth, dry skin, facial swelling due to fluid retention, fatigue, fever, flushing, grand mal seizures, hair loss, hallucinations, hives, impotence, irregular heartbeat, itching, loss of appetite, muscle, bone, or joint pain, nausea, pounding heartbeat, prickling, tingling, or pins and needles, rash, ringing in ears, severe allergic reaction, sleepiness, vomiting, weakness, wheezing, yellow eyes and skinPossible food and drug interactions when taking this medication
Itraconazole (Sporanox)
Ketoconazole (Nizoral) Nizatidine (Axid)
Documented side effects:
Abdominal pain, diarrhea, dizziness, gas, headache, indigestion, inflammation of the nose, nausea, pain, sore throat, vomiting, weakness. Abnormal dreams, anxiety, back pain, chest pain, constipation, dimmed vision, dry mouth, fever, inability to sleep, increased cough, infection, itching, loss of appetite, muscle pain, nervousness, rash, sleepiness, stomach/intestinal problems, tooth problems
Antacids (Gaviscon, Maalox, Mylanta, Rolaids, Tums) play a role in the treatment of ulcers by relieving pain and healing the ulcer. They work by neutralizing gastric acid are primarily used for symptomatic relief.
Documented side effects:
Chalky taste, constipation, diarrhea, increased thirst, stomach cramps
Possible food and drug interactions when taking this medication
Cellulose sodium phosphate (Calcibind)
Isoniazid (Rifamate)
Ketoconazole (Nizoral)
Mecamylamine (Inversine)
Methenamine (Mandelamine)
Sodium polystyrene sulfonate resin (Kayexalate)
Tetracycline antibiotics (Achromycin, Minocin) Sucralfate (Carafate)
It is commonly used for the treatment of duodenal ulcers but not for the treatment of gastric ulcers.
Documented side effects:
Constipation, back pain, diarrhea, dizziness, dry mouth, gas, headache, indigestion, insomnia, itching, nausea, possible allergic reactions, including hives and breathing difficulty, rash, sleepiness, stomach upset, vertigo, vomiting.
Possible food and drug interactions when taking this medication
Antacids such as Mylanta and Maalox
Blood-thinning drugs such as Coumadin
Cimetidine (Tagamet)
Digoxin (Lanoxin)
Drugs for controlling spasms, such as Bentyl
Ketoconazole (Nizoral)
Levothyroxine (Synthroid)
Phenytoin (Dilantin)
Quinidine (Quinidex)
Quinolone antibiotics such as Cipro and Floxin
Ranitidine (Zantac)
Tetracycline (Sumycin)
Theophylline (Theo-Dur) Omeprazole (Prilosec), a proton pump inhibitor, is a specific inhibitor of gastric acid secretion. Omeprazole is effective in the treatment of both gastric and duodenal ulcers and is the drug of choice for the treatment of Zollinger-Ellison syndrome.
Documented side effects:
Abdominal pain, diarrhea, headache, nausea, vomiting. Abdominal swelling, abnormal dreams, aggression, anemia, anxiety, apathy, back pain, breast development in males, blood in urine, changes in liver function, chest pain, confusion, constipation, cough, depression, difficulty sleeping, discolored feces, dizziness, dry mouth, dry skin, fatigue, fever, fluid retention and swelling, fluttery heartbeat, frequent urination, gas, general feeling of illness, hair loss, hallucinations, hepatitis, high blood pressure, hives, irritable colon, itching, joint and leg pain, loss of appetite, low blood sugar, muscle cramps and pain, nervousness, nosebleeds, pain, pain in testicles, rapid heartbeat, rash, ringing in ears, skin inflammation, sleepiness, slow heartbeat, stomach tumors, taste distortion, tingling or pins and needles, throat pain, tremors, upper respiratory infection, urinary tract infection, vertigo, weakness, weight gain, yellow eyes and skin
Possible food and drug interactions when taking this medication
Ampicillin-containing drugs such as Unasyn
Cyclosporine (Sandimmune, Neoral)
Diazepam (Valium)
Disulfiram (Antabuse)
Iron
Ketoconazole (Nizoral)
Phenytoin (Dilantin)
Warfarin (Coumadin) Misoprostol (Cytotec)
Documented side effects:
Abdominal cramps, diarrhea, and/or nausea, especially during the first few weeks of treatment. Other side effects may include: constipation, gas, indigestion, headache, heavy menstrual bleeding, menstrual disorder, menstrual pain or cramps, paleness, spotting (light bleeding between menstrual periods), stomach or intestinal bleeding, vomiting.
Cytotec may cause uterine bleeding even if you have gone through menopause.
Treatment for H. Pylori
Treatment of H. pylori consists of one to two weeks of one or two effective antibiotics, such as amoxicillin, tetracycline, metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. Studies show that antibiotic treatment has been successful in eradicating H. Pylori approximately 70 to 90 percent.
Part 3: Alternative Nutritional and Herbal Treatments, Life Style Recommendations
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Reviewed and submitted on March 14, 2004
