Peptic+Ulcer

//Western Diagnosis// ulceration of the mucous membrane of areas exposed to gastric acid and pepsin

Types
b. 5x more than gastric c. 5x more in males d. 1/2 - 2/3 secrete more acid than N e. males aged 20-30 f. females aged 40-50 a. lesser curvature of stomach b. 80% have decreased acid c. aged 50-60
 * duodenal** - most common
 * gastric**

Etiology
1. Helicobacter pylori 2. drugs ---NSAID’s ---corticosteroids ---aspirin ---caffeine ---alcohol ---cigarettes 3. dec mucous production 4. food allergens: egg 5. stress

Signs & Symptoms
1. burning, gnawing, aching pain - often radiates through to back 2. empty feeling, hunger 3. steady, well-circumscribed 4. epigastric pain

---consistent pain pattern ---absent on waking but appears mid-morning ---**better with food** ---recurs 2-3 hours after eating ---nocturnal pain
 * duodenal**

---rarely follow a pattern ---**worse with food**
 * gastric**

Complications
1. hemorrhage 2. perforation 3. obstruction

Diagnosis
1. endoscopy 2. upper GI series 3. anti-H. pylori antibodies 4. H. pylori breath test

Treatment
1. antibiotics 2. proton pump inhibitors a. omeprazole (Prilosec); lansoprazole (Prevacid) ---completely inhibit HCl secretion 1. H2 antagonist meds a. cimetidine (Tagamet); ranitidine (Zantac) ---block gastric acid secretion ---slightly block pepsin secretion ---slightly block IF secretion 2. avoid food allergens: dairy, egg, gluten 3. inc fiber to dec gastric emptying time 4. avoid aspirin, NSAID’s, alcohol, caffeine, cigarettes 5. decrease stress 6. increase protective substance production a. EFA’s - inc mucosal resistance to injury ---black currant oil - 2 caps tid b. **zinc** 30 mg up to 5x/day ---inc mucin production ---heals ulcers ---need 2-4 mg Cu daily c. deglycyrrhizinated licorice root 250 mg tid d. raw cabbage juice 1 liter/day: glutamine 500-1000 mg tid [high levels of glutamine] e. ulmus fulva (slippery elm): 1/2 tsp after meals f. unripe plantain 7. catechin 1 gm 3-5x/d (green tea, Gou Teng): [decreases histamine levels] 8. bismuth -H. pylori 9. **vit. A**: 100,000 IU/day