Introduction
A peptic ulcer is a sore that develops on the lining of stomach, small intestine or esophagus. A peptic ulcer in the stomach is called a gastric ulcer. A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum). An esophageal ulcer occurs in the lower part of your esophagus. Ulcers occur when stomach acid damages the lining of the digestive tract. Common causes include the bacteria H. Pylori and anti-inflammatory pain relievers including aspirin. Upper abdominal pain is a common symptom. Treatment usually includes medication to decrease stomach acid production. If it is caused by bacteria, antibiotics may be required.
Signs & symptoms
The most common symptom is a burning sensation or pain in the middle of the abdomen between your chest and belly button. Typically, the pain will be more intense when the stomach is empty, and it can last for a few minutes to several hours.
Other common signs and symptoms of ulcers include:
- dull pain in the stomach
- Trouble breathing.
- Feeling faint.
- Nausea or vomiting.
- Unexplained weight loss.
- Appetite changes.
- Vomiting or vomiting blood — which may appear red or black.
- Dark blood in stools, or stools that are black or tarry.
Causes
Stomach ulcers are almost always caused by one of the following:
H.pylori infection
long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
Zollinger-Ellison syndrome (a rare medical condition)
Pathophysiology
Peptic ulcer disease (PUD) is characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. It extends into the muscularis propria layer of the gastric epithelium. It usually occurs in the stomach and proximal duodenum. Peptic ulcers are defects in the gastric or duodenal mucosa that extend through the muscularis mucosa.
Under normal conditions, a physiologic balance exists between gastric acid secretion and gastroduodenal mucosal defence. Mucosal injury and, thus, peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted. Aggressive factors, such as nonsteroidal anti-inflammatory drugs (NSAIDs), H pylori infection, alcohol, bile salts, acid, and pepsin, can alter the mucosal defence by allowing back diffusion of hydrogen ions and subsequent epithelial cell injury. The defensive mechanisms include tight intercellular junctions, mucus, bicarbonate, mucosal blood flow, cellular restitution, and epithelial renewal.
H pylori can cause a major part of the pathology which includes acid and pepsin, that contributes to primary peptic ulcer disease. The unique microbiologic characteristics of H. pylori, such as urease production, allows it to alkalinize its microenvironment and survive for years in the hostile acidic environment of the stomach, where it causes mucosal inflammation and, in some individuals, worsens the severity of peptic ulcer disease.
When H pylori colonizes the gastric mucosa, inflammation usually results. In patients infected with H pylori, high levels of gastrin and pepsinogen and reduced levels of somatostatin have been measured. In infected patients, exposure of the duodenum to acid is increased. Virulence factors produced by H pylori, including urease, catalase, vacuolating cytotoxin, and lipopolysaccharide, are well described.
Most patients with duodenal ulcers have impaired duodenal bicarbonate secretion, which has also proven to be caused by H pylori because its eradication reverses the defect. The combination of increased gastric acid secretion and reduced duodenal bicarbonate secretion lowers the pH in the duodenum, which promotes the development of gastric metaplasia (i.e., the presence of gastric epithelium in the first portion of the duodenum). H pylori infection in areas of gastric metaplasia induces duodenitis and enhances the susceptibility to acid injury, thereby predisposing to duodenal ulcers.
Diagnosis
Medical history
Blood test, stool test, or a breath test to rule out H.pylori infection.
Other tests and procedures used to diagnose stomach ulcers include:
Barium swallow test
Endoscopy (EGD)
Endoscopic biopsy
Treatments
It’s important to promptly treat an ulcer. Treatment will vary depending on the cause of the ulcer. Most ulcers can be treated with medicines but in rare cases, surgery may be required. In an actively bleeding ulcer, hospitalisation and intensive treatment including endoscopy, IV ulcer medications or blood transfusion is needed.
- Nonsurgical treatment
Antibiotics and proton pump inhibitors (PPIs) are used to treat H. pylori infection. PPIs block the stomach cells that produce acid.
In addition to these following therapies are also advised in some cases:
- H2 receptor blockers
- stopping use of all NSAIDs
- follow-up endoscopy
- probiotics
- bismuth supplement
- Surgical treatment
In very rare cases, a non-healing or recurring and complicated stomach ulcer will require surgery.
Surgery may include:
- removal of the entire ulcer
- taking tissue from another part of the intestines and patching it over the ulcer site
- repairing a bleeding artery
- cutting off the nerve supply to the stomach to reduce the production of stomach acid
Prognosis
When the underlying cause of peptic ulcer disease is addressed, the prognosis is excellent. Most patients are treated successfully with the eradication of H pylori infection, avoidance of nonsteroidal anti-inflammatory agents (NSAIDs), and the appropriate use of antisecretory therapy.
Complications
If left untreated, peptic ulcers can result in:
- Internal bleeding
- A hole (perforation) in the stomach wall
- Obstruction in the digestive tract
- Gastric cancer
Disease & Ayurveda
In Ayurveda, abdominal pain and colic comes uder shola and peptic ulcer can be compared with parinama soola or annadravasoola in chronic stage. The word parinama means transformation and here it implies digestion. Abdominal pain which is related with the stages of digestion is called parinaama soola. Anna means solid foods and drava means liquids. Abdominal pain developing while the intake of solid or liquid diet (regardless of food intake) is called annadravasoolawhich is said to be incurable.
Nidana
Causative factors for the vitiation of Vaata dosha
Unwholesome diet
Untimely diet
Unhealthy eating habits
Sleeping disorders
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors, gets covered with the misplaced or aggravated Kapha or Pitta or both and produce pain in the abdomen. When the Kapha is moved from its normal site, along with Pitta blocks the Vaayu and causes pain during the digestion process.
Lakshana
Pain during the digestion of the food
Pain in the abdomen
Pain in the flanks and sides of abdomen
Pain in the navel region
Pain in the area of urinary bladder
Pain in between the breasts
Pain in the sacral area
Divisions
Parinaama soola
Annadrava soola
Prognosis
Kashtasaadhya/Asaadhya when 3 doshas are involved, with complications or when the strength, muscles and digestive power of individual is deteriorated.
Chikithsa
The Ayurveda treatment of this disease is primarily langhanam(weight reducing therapies like fasting). Also vamana(therapeutic emesis), virechana(therapeutic purgation)and vasti(therapeutic medicated enema) are recommended for a detoxified body and a well-balanced agni(metabolism)
Samana
Aamapaachanam
Agnideepanam
Pathya aaharam
Sodhana
Vamana
Virechana
Vasti
Commonly used medicines
Dadicmashtakachoornam
Hinguvachadi Churna
Pippalyadi Churna
Guduchyadi kashayam
Indukantham Kashayam
Chitrakadi Kashayam
Dadimadi ghrutam
Dhanwantaram gulika
Avipatti choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There is no proven home cure for peptic ulcer but as it is directly related with digestion, some changes in diet regimen are believed to be beneficial like including the following into daily diet:
Coconut
Virgin coconut oil
Turmeric
Tulsi leaves
Carrot juice
Raisins
Bananas
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Hot, spicy and pungent items like pickle
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, fresh vegetables and fruits, raisins, pome granate
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140150/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952291/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
Whatsapp – +91 9446918019, +91 8075810816
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