The highly concentrated acid produced by the stomach is quite capable of burning a hole through the tissue of the stomach and duodenum (part of the small intestine). That it usually does not do so is a tribute to the effectiveness of the methods that the body uses to protect itself. However, sometimes these protective mechanisms fail, and the ever-present acid begins to produce an ulcer.
Ulcer pain is caused by stomach acid coming into contact with unprotected tissue. Eating generally decreases ulcer pain temporarily because food neutralizes the acid. As soon as the food begins to be digested, the pain returns.
Conventional medical treatment for ulcers has gone through a slow revolution. A few decades ago, the prescribed response to ulcers was a bland diet—one low in spices and high in dairy products, which were believed to coat the stomach. However, eventually it was discovered that spicy foods are innocent and that milk itself is somewhat ulcer forming! The only other option at that time was surgery.
Next came antacids containing magnesium and aluminum. However, these were seldom strong enough to allow the ulcer to heal fully. Ulcer treatment took a big step forward with the development of Tagamet (cimetidine), followed by Zantac (ranitidine), Pepcid (famotidine), and others. These H2-blocking drugs dramatically lower the stomach's production of acid. Later, a new class of even more potent acid suppressors appeared, the proton-pump inhibitors , led by Prilosec (omeprazole).
When stomach acid is suppressed, ulcer pain rapidly diminishes and the ulcer heals. For a time, these drugs were regarded as the definitive answer to ulcers. This early enthusiasm began to fade when it became clear that ulcers frequently returned after the drugs were stopped. In the late 1980s, a new explanation for this problem began to surface. First regarded as a wacky theory, it has now become the accepted explanation.
We now believe that ulcers are caused by the bacteria Helicobacter pylori . Apparently, this previously ignored organism has the capacity to infect the stomach and, by so doing, weaken the stomach lining. When antibiotics to kill H. pylori are combined with stomach acid suppressants ulcers are far more likely to go away and stay away. However, it isn’t easy to kill H. pylori ; antibiotic treatment is not always successful, and it has side effects. Friendly bacteria ( probiotics ) may help this treatment work better.
Probiotics are bacteria that are healthy for you. The most famous probiotic is Lactobacillus acidophilus , found in yogurt. There are many other probiotics, as well.
Evidence suggests that various probiotics in the Lactobacillus family can inhibit the growth of H. pylori . 24-27,51 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary studies, including several small, double-blind trials, suggest that probiotics may help standard antibiotic therapy work better, reducing side effects, and improving the rate of eradication. 24-25,28-32,41-42,44,48,49,50,52,53
For more information, including dosage and safety issues, see the full Probiotic article.
The herb cranberry is thought to help prevent bladder infections by preventing adhesion of bacteria to the bladder. Preliminary evidence suggests that it might also help prevent the adhesion of H. pylori to the stomach wall. 33,51
A 90-day, double-blind, placebo-controlled study performed in China tested the effects of daily consumption of cranberry juice in individuals who were chronically infected with helicobacter (but who did not necessarily have ulcers). 43 The results indicated that use of cranberry significantly decreased levels of helicobacter in the stomach, presumably by causing some of the detached bacteria to be “washed away.”
However, while this was a promising finding on a theoretical level, it did not directly address treatment or prevention of ulcers.
A more practical study evaluated the use of cranberry as a support to standard therapy. 46 This double-blind trial enrolled 177 people with ulcers who were undergoing treatment with a common triple-drug therapy known as OAC (omeprazole, amoxicillin, and clarithromycin) used to eradicate H. pylori . All participants received standard therapy for one week. During this week and for two weeks after, they were additionally given either placebo or cranberry juice. Researchers also looked at a third group attending the same clinic, and who received only OAC.
The results were somewhat promising. In the study group at large, OAC plus cranberry was no more effective than OAC plus placebo or OAC alone. However, among female participants in the study, use of cranberry was associated with a significantly increased rate of helicobacter eradication as compared to placebo or no treatment.
Does this mean that women undergoing ulcer treatment may benefit from cranberry? Perhaps, but not necessarily. When a treatment fails to produce benefit in the entire group studied, researchers may, after the fact, go on a hunt for a subgroup who did benefit. The laws of chance alone ensure that they can almost always find one. Therefore, it is not clear whether cranberry actually did provide benefit, or whether this finding was merely a statistical fluke.
For more information, including dosage and safety issues, see the full Cranberry article.
The most famous supplement used for ulcer disease is a special form of licorice known as deglycyrrhizinated licorice (DGL) . However, the studies that supposedly showed it effective were not double-blind, and they involved a combination product that also contained antacids. 2,3 Very preliminary evidence does suggest that DGL might help protect the stomach from damage caused by nonsteroidal anti-inflammatory drugs . 4
One study found that use of vitamin C supplements at a dose of 500 mg daily can improve the effectiveness of antibiotic therapy for H. pylori . 45 (Specifically, use of vitamin C allowed a reduction in the dosage of clarithromycin, one of the most important antibiotics used to eradicate H. pylori . However, vitamin C did not help in cases where the species of H. pylori involved was resistant to clarithromycin.) Another study involving 200 people infected with H. pylori were randomized to receive 14 days of standard antibiotic therapy (lansoprazole, amoxicillin, clarithromycin) alone or with the addition of vitamin C (500 mg) and vitamin E (200 IU) for 30 days. 54 The researchers found that the eradication rates were higher in the group receiving the vitamins. Similar results were found in another study. 55 It's important to bear in bind that although these anitoxidant vitamins appeared to be effective against H. pylori infection, which is a good thing, these studies did not measure the direct impact on the symptoms or prognosis of peptic ulcers.
Highly preliminary studies suggest that various bioflavonoids including citrus bioflavonoids can inhibit the growth of H. pylori . 9 All fruits and vegetables provide bioflavonoids, but these substances can also be taken as supplements. One study failed to find that the carotenoid astaxanthin is helpful for treating H. pylori infection. 47
Bacopa monniera , betaine hydrochloride , cat's claw , glutamine , marshmallow , methyl sulfonyl methane (MSM) , reishi , sea buckthorn oil , selenium , suma , vitamin A , and zinc have also been suggested as aids to ulcer healing, but there is as yet no meaningful scientific evidence that they are effective.
Acupuncture has been part of the medical mainstream in countries such as China and Japan for centuries. It is also one of the most widely utilized forms of alternative therapy in the United States. Simply defined, acupuncture is a treatment method aimed at eliciting a response (such as pain relief) through insertion of very fine needles in the body surface at sites called acupuncture points.
Functional dyspepsia includes a wide range of symptoms that cause epigastric pain or discomfort. A randomized trial of 72 patients suffering from functional dyspepsia show significant symptom relief with real as opposed to sham acupuncture. Those who had real acupuncture experienced less bloating and early saiety, though the differences were minor and may not have been clinically meaningful. 56
Various herbs and supplements may interact adversely with drugs used to treat ulcers. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.
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3. Morgan AG, Pacsoo C, McAdam WAF. Maintenance therapy: a two-year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence. Gut. 1985;26:599-602.
9. Beil W, Birkholz C, Sewing K-F. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung. 1995;45:697-700.
23. Meier R, Wettstein A, Drewe J, et al. Fish oil (Eicosapen) is less effective than metronidazole, in combination with pantoprazole and clarithromycin, for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2001;15:851-855.
24. Aiba Y, Suzuki N, Kabir AM, et al. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol. 1998;93:2097-2101.
28. Armuzzi A, Cremonini F, Ojetti V, et al. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion. 2001;63:1-7.
29. Canducci F, Armuzzi A, Cremonini F, et al. A lyophilized and inactivated culture of Lactobacillus acidophilus increases Helicobacter pylori eradication rates. Aliment Pharmacol Ther. 2000;14:1625-1629.
30. De Francesco V, Stoppino V, Sgarro C, et al. Lactobacillus acidophilus administration added to omeprazole/amoxycillin-based double therapy in Helicobacter pylori eradication. Dig Liver Dis. 2000;32:746-747.
32. Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol. 2002;97:2744-2749.
41. Myllyluoma E, Veijola L, Ahlroos T, et al. Probiotic supplementation improves tolerance to Helicobacter pylori eradication therapy—a placebo-controlled, double-blind randomized pilot study. Aliment Pharmacol Ther. 2005;21:1263-72.
42. Duman DG, Bor S, Ozutemiz O, et al. Efficacy and safety of Saccharomyces boulardii in prevention of antibiotic-associated diarrhoea due to Helicobacterpylori eradication. Eur J Gastroenterol Hepatol. 2005;17:1357-1361.
44. Tong JL, Ran ZH, Shen J, et al. Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2007;25:155-168.
45. Chuang CH, Sheu BS, Kao AW, et al. Adjuvant effect of vitamin C on omeprazole-amoxicillin-clarithromycin triple therapy for Helicobacter pylori eradication. Hepatogastroenterology. 2007;54:320-324.
46. Shmuely H, Yahav J, Samra Z, et al. Effect of cranberry juice on eradication of Helicobacter pylori in patients treated with antibiotics and a proton pump inhibitor. Mol Nutr Food Res. 2007 May 9. [Epub ahead of print]
47. Andersen LP, Holck S, Kupcinskas L, et al. Gastric inflammatory markers and interleukins in patients with functional dyspepsia treated with astaxanthin. FEMS Immunol Med Microbiol. 2007 May 23. [Epub ahead of print]
48. Cindoruk M, Erkan G, Karakan T, et al. Efficacy and safety of saccharomyces boulardii in the 14-day triple anti-helicobacter pylori therapy: A prospective randomized placebo-controlled double-blind study. Helicobacter. 2007;12:309-316.
49. Imase K, Tanaka A, Tokunaga K, et al. Lactobacillus reuteri tablets suppress Helicobacter pylori infection—a double-blind randomised placebo-controlled cross-over clinical study. Kansenshogaku Zasshi. 2007;81:387-393.
54. Sezikli M, Cetinkaya ZA, Güzelbulut F, Yeşil A, Coşgun S, Kurdaş OO. Supplementing Vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori. J Clin Pharm Ther. 2011 Jul 11.
55. Sezikli M, Cetinkaya ZA, Güzelbulut F, et al. Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity. Clin Res Hepatol Gastroenterol. 2011;35(11):745-749.
56. Zeng F, Qin W, Ma T, et al. Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am J Gastroenterol . 2012;107(8):1236-1247.
Last reviewed September 2014 by EBSCO CAM Review Board
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