Ulcers in the stomach or duodenum were attributed for
years to excess stomach acid and treated with antihistamines which
reduce acid secretion and antacids. In the past, milk was
recommended, but dairy products can be the cause of the problem and
are often contra-indicated;
Milk allergy may be an original cause of gastritis which leads
to ulceration. A common cause of stomach ulcers is the regular use
of ASA or related anti-inflammatory drugs - NSAIDs. If ulcer
symptoms occur while taking these drugs, their use should be
discontinued. Food causes must be considered and diet revision is an
essential part of all gastrointestinal disease.
An acute duodenal ulcer will present with pain high and central
in the abdomen; the pain comes on as the stomach empties 3 or 4
hours after eating and during the night. Eating food, especially
bland foods, milk or antacid tends to relieve the pain.
Antihistamines ( H2 blockers - examples are tagamet, pepcid and
zantac) have been prescribed for years to treat ulcers and acid
reflux into the esophagus and are now available as over-the counter
Proton pump inhibitors (PPI) are more effective drugs for
treating ulcers but have negative effects if taken long term.
PPIs bind to ATPase (proton pump) in gastric
parietal cells, resulting in suppression stomach acid secretion. Several drugs
are marketed, some are over the counter and all are available on prescription.
Popular drugs are Nexium, Prevacid, Prilosec. They are used in the treatment of
Gastroesophageal Reflux Disease, Peptic Ulcers, Esophagitis and Helicobacter
Pylori Infection. PPIs can increase risk of Salmonella, Campylobacter,
Clostridia Difficile and other infections. Other negative effects, some serious,
limit their use long term.
In the past decade, evidence of bacterial infection in
ulcer disease has accumulated. It is reasonable to suspect
that recurrent or chronic duodenal ulcers are related to infection
with the bacteria, Helicobacter pylori; the bacteria may also play a
role in causing stomach ulcers and chronic gastritis. The puzzling
aspect of H Pylori (HP)is that 90% of the people who harbor the
bacteria in their stomachs do not have ulcer disease. The 10% of
people who develop ulcers in the presence of H. Pylori, however, may
have recurrent ulcers and benefit form treatment to eradicate the
If you look for H. pylori in the general population, you will
find that it is common. In Canada 20-40% of the population harbor
the bacteria (the incidence increases with age). In developing
countries 80% of the population may have the bacteria. The incidence
of infection increases with poor living conditions.
Benefits of H Pylori Infection ?
Anderson et al suggested that H pylori infection causes gastric
atrophy which turn reduces the complications of acid reflux into the esophagus
(Barrett's esophagus and esophageal adenocarcinoma). “This is one more reason to
screen for infection only when you are ready to eradicate and thereby ready to
treat -- and only as deemed appropriate by consensus standards.”
There may be other benefits from HP infection. It is likely that
the numerous and diverse microflora that populate the human
digestive tract are beneficial. Blaser et al suggested that
phylogeographic evidence from more than 58,000 years ago supports
that H pylori colonized the stomach of humans. Despite the antiquity
of this association, there is evidence that the prevalence of
H pylori is decreasing. In the United States and other
industrialized nations, the current prevalence of H pylori infection
in children younger than 10 years has decreased from 70%-90% to less
than 10%. There is substantial evidence now to support the inverse
association between H pylori and childhood asthma, allergic
rhinitis, and atopy.
The Canadian Helicobacter pylori Consensus Conference made
recommendations several years ago about the diagnosis and treatment
of HP. They offered a number of guidelines reviewed here:
Test for HP be done only when treatment is planned ( i.e. when
symptoms are convincing and prolonged or when an ulcer has been
demonstrated by X-ray examination.) The urea breath test or antibody
tests are recommend for people who have chronic dyspepsia - upper
abdominal pain and discomfort lasting more than three months.
No tests be done in asymptomatic people unless there is a strong
family history of stomach cancer.
Urea Breath tests have "excellent sensitivity and specificity".
(1) A carbon isotope (C13) can be used and is stable so that breath
samples can be collected in an MDs office and mailed to a lab for
analysis. A positive breath test indicates active infection and
treatment is indicated.
Test for antibodies to H pylori are available but the accuracy is
in doubt; these test are relatively inexpensive and easy to do and
may add further conviction to start treatment when the clinical
evidence is strong.
The question of who should have endoscopy - a look with a
fiberoptic scope with biopsy and culture is more difficult to
answer. This invasive procedure is expensive, has risk as associated
and (at least in Canada) may involve delay waiting for specialist
consultation and bookings in endoscopy suites. The consensus was
that treatment can proceed without endoscopy, although patients over
50 and patients with alarming associations such as anemia or weight
loss should be scoped to look for cancer. Testing for HP is
recommended in patients taking NSAIDs who develop an ulcer. In the
majority of cases, there is no need for follow-up tests after
appropriate eradication therapy. Antibody tests should not be used
to confirm eradication of HP.
HP Eradiation Therapy
Various schemes for treating heliobacter infection have emerged.
The use of antobiotic combinations and a proton pump inhibitor is
popular. For example: Clarithomycin 500 mg and metronidazole 500 mg
twice a day for 7 days plus omeprazole 20 mg twice a day for 7 days
followed by omeprazole 20 mg every morning for another 21 days.
Antibiotic resistance is emerging and complicates the choices of
Self Treatment of Symptoms
Self-therapy of milder symptoms - dyspepsia and early ulcer-like
symptoms consists of retreating to Alpha Nutrition Phase 1 foods,
using brown rice instead of white rice with the option of taking
tagamet or zantac as recommended by the manufacturer. Remember that
the bedtime dose is very important because your stomach will spend 8
hours or more in a near-empty condition vulnerable to the action of
accumulating acid. Phase 1 of the Alpha Nutrition should be sustained
for 2 to 3 weeks or until symptoms are gone and then food is
reintroduced using the medium track - foods from Phases 2 and 3 are
If adequate diet revision does not resolve symptoms promptly
and/or prevent recurrent gastritis or ulcers, you need medical
assessment and treatment.
References: Anderson LA, Murphy SJ, Johnston BT, et al
Relationship Between Helicobacter pylori Infection and Gastric
Atrophy and the Stages of the Oesophageal Inflammation, Metaplasia,
Adenocarcinoma Sequence: Results From the FINBAR Case-control Study.
Blaser MJ, Chen Y, Reibman J. Does Helicobacter pylori Protect
Against Asthma and Allergy? Gut. 2008;57:561-566