peptic Ulcer by: Joe Hing Kwok Chu Symptoms: a burning sensation in the upper abdomen or chest after meals or when the stomach is empty. Causes: Most peptic ulcers are caused by an infection by the bacteria Helicobacter pylori (H. pylori) in the stomach when the system is depressed by stress and/or the consumption of alcohol, tobacco, aspirin, ibuprofen, corticosteroids, coffee, and spicy food. Most people who have the infection are without symptoms, but long-term emotional stress and/or long-term consumption of aggravating substances can disrupt the protective mucus linings of the stomach and duodenum. This allows the strong digestive acid to directly contact the tissues of the stomach or duodenum and triggers ulcers. H. pylori diagnosis: 1. Tissue test: during endoscopy small bits of tissue are removed and tested for H. pylori. 2. Breathing test: patients are given urea orally, and an enzyme of the H. pylori breaks down the urea into carbon dioxide, which is exhaled and can be measured. 3. Antibody test: antibodies are formed when the patient is infected with H. pylori. If the antibody is present, it means the patient is either currently or previously infected. This test may not determine whether the patient’s infection is active. Western Treatments Include Use of antibiotics: H. pylori is difficult to eradicate because it burrows deep into the mucus layers. Usually several antibiotics are used in combination, such as metronidazole (Flagyl), tetracycline (Achromycin), clarithromycin (Biaxin), or amoxicillin (Amoxil). The side effects of antibiotic use include disruption of the balance of the beneficial bacteria (Escherichia coli,also known as E. coli) that can stimulate growth of yeast in the digestive tract, causing a yeast infection. Bismuth subsalicylate (an active ingredient of Pepto-Bismol) also possesses the effect of antibiotics. It may help to inhibit or erradict the bacteria but it may also create the side effects like antibiotics. Use of anti-acid medications: Alkalines include sodium bicarbonate (baking soda), aluminum hydroxide, or magnesium hydroxide. H2 antagonists include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid Pulvules), and ranitidine (Zantac). Proton pump inhibitors (PPIs) are a group of prescription medications that prevent the release of stomach acid by inhibiting the enzyme in the wall of the stomach that produces acid. PPIs include omeprazole sodium (Losec), esomeprazole sodium (Nexium), lansoprazole sodium (Zoton), pantoprazole sodium (Protium), and rabeprazole sodium (Pariet). Common side effects of PPIs include diarrhea, nausea, constipation, abdominal pain and headaches. In rare instances, side effects can also include allergic reactions, itchiness, dizziness, swollen ankles, muscle and joint pain, blurred vision, depression, and dry mouth, osteoporisis and hip fracture. Long-term inhibition of digestive acid using acid neutralizers or PPIs can promote bacteria growth in the stomach. Use proton pump inhibitors with care in case of pregnancy or with liver or kidney problems. Caved-S is manufactured by various pharmaceutical companies. One of its main active ingredients is the common Chinese herb gan cao (licorice), which is deglycyrrhizinated to eliminate the side effects of the glycyrrhizinic acid in the licorice, to eliminate the effect of mineralcortical hormone. (See a study of a two-year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence.) The side effects of Caved-S can include calcium depletion through excretion (both urine and stool) caused by aluminum hydroxide, one of the components of Caved-S. Aluminum hydroxide also depletes phosphorus in the normal body, and long-term use can bring phosphorus down to an unnaturally low level. One of the digestive juices secreted by the stomach is hydrochloride acid, which digests protein. The stomach and duodenum have linings that protect themselves from being digested. If ulcers are formed, the acid gets into contact with the stomach or duodenum tissues, causing injuries and pain. Note: H2 antagonists inhibit histamine action on the H2 receptor of the gastric parietal cell and slow down the secretion of hydrochloric acid. Caved-S main ingredients: Aluminum hydroxide 100 mg Sodium bicarbonate 100 mg Bismuth subnitrate 100 mg Magnesium carbonate 200 mg Deglycyrrhizinatedgan cao 300 mg mineralcortical hormone is a hormone secreted by the adrenocortex, the outer layers of the adreno glands, that sit on top of the kidneys. When this hormone is high, the body retains sodium and expels potassium. As early as 1946 gan cao (licorice) extract showed the characteristics of mineralcorticoid. Glycyrrhiza (gan cao) is metabolically converted to glycyrrhetic acid (GA). GA, when incubated in-vitro with adrenal gland cells increases production of DHEA (dehydroepiandrosterone), a precursor of androstenedione, testosterone and estrogen. Chinese Herb Therapies Include I. Ulcers of the duodenum with internal heat and fullness syndrome: burning sensation in the upper abdomen or inside chest area. Usually this symptom indicates an ulcer of the duodenum that usually occurs in younger persons 20 to 30 years old. The stomach acid secretion can be normal or increased and is usually accompanied by macerating gastritis (inflammation of the lining of the stomach). Prescription: Huang lian jie du tang combined with shao yao gan cao tang is commonly used. Huang lian jie du tang is also effective for ulcer bleeding and has been proven to inhibit H. pylori. II. Ulcers of the stomach with liver and spleen imbalance or with yang-deficient (yangxu) condition mostly occur in persons 40 to 50 years old. The stomach acid secretion can be normal or decreased and accompany atrophic gastritis. Symptoms include upper abdominal achiness after meals or when the stomach is empty. Sometimes there isn’t pain but only the sensation of fullness in the upper abdomen. An zhong san is commonly used; but during bleeding, huang lian jie du tang with adjustment can be used temporarily. For those who are yang deficient, warming formulas, like an zhong san, ren shen tang or liu jun zi tang, can be used. The rate of success using an zhong san has been about 75%. It has similar efficacy to the H2 antagonists. In the case of liver qi stagnation, formulas like dan zhi xiao yao san or chai hu shu gan tang can be used. The long-term maintenance use of the formula chai hu gui zhi tang has been proven effective for preventing the recurrence of peptic ulcers. It has been proven that chai hu gui zhi tang can inhibit pepsin and stomach acid secretion, thereby enhancing the secretion of mucus and promoting blood circulation in the stomach, enhancing stomach protection Liver qi stagnation can lead to inflammatory pathophysiological changes in gastric mucosa. The reduction of the concentrations of free mucus, PGE2 in gastric juice, and superoxide dismutase (SOD) and nitric oxide (NO) in the gastric mucosa are among the main pathophysiological changes caused by liver qi stagnation that lead to gastric mucosal inflammation. The herbs used to relieve depressed liver are effective in treating these pathophysiological changes, so they can also prevent and treat stomach ailments caused by liver-qi stagnation and reinforce the protective function of gastric mucosa. 【1】 Note: Pepsin is a digestive enzyme found in gastric juice that helps the breakdown of protein to peptides (digested protein). mineralcortical hormone is a hormone secreted by the adrenocortex. When this hormone is high, the body retains sodium and expels potassium. As early as 1946 gan cao extract showed the characteristics of mineralcorticoid. Glycyrrhiza is metabolically converted to glycyrrhetic acid (GA). GA, when incubated in-vitro with adrenal gland cells increases production of DHEA, a precursor of androstenedione, testosterone and estrogen.
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