Goblet cells in the mucosa of the stomach are important to the mucosal defence. The production of mucus is stimulated by mechanical and chemical actions and through the vagus nerve (cholinergic stimulation). There is mucus in the gastric juice and in a 0.2 mm. thick layer on the entire surface of the gastric mucosa. The layer is constantly re-formed and functions as a barrier to pepsin and acid. The thickness of the mucus layer is reduced by acetylsalicylic acid (e.g. Aspirin) and by rheumatic medicine of the NSAID type (e.g. ibuprofen).
Other cells in the gastric mucosa produce the acid neutralizing bicarbonate which is sent into the stomach. The production of bicarbonate is stimulated by calcium, the "good" prostaglandins of the E- and F-type, medication with cholinergic effects, etc. The production is on the other hand reduced by acetylsalicylic acid, NSAIDs, and alcohol.
Under normal conditions, the gastric acid will not be able to penetrate the mucus layer, but the barrier can be broken down by bile acids, acetylsalicylic acid, alcohol, and mild organic acids which can all make it possible for the acid to penetrate the mucosa and damage it. If the cells are damaged, histamine is liberated and this increases the production of acid which will then further damage the mucosa with the formation of wounds and bleeding from damaged blood vessels. A poor circulation of blood in the wall of the stomach can also be contributing to damages.
Smoking cigarettes does not increase the production of gastric acid but is said to lead to an increased emtying of acid into the duodenum in which the mucosa is not as resistant to acid.
This is the most common form of ulcers. The wounds in the duodenum are usually deep and sharply defined contrary to the wounds in the stomach which are usually more superficial and only located to the mucosa.
Wounds in the duodenum are present in 6 - 15% of people in the Western population. In many cases, it is a case of a chronic or re-occuring disease, but the prevalence is diminishing - the reason for this is not known.
There are many indications that the Helicobacter pylori bacterium is significant to the development of duodenal ulcers. The bacterium can be found in almost everyone suffering from this type of ulcer, but it can also be found in many people who do not suffer from ulcers. Only an estimated maximum of 20% of the people who carry the Helicobacter pylori in their duodenum actually develop an ulcer during the spand of their lifetime. Too little gastric acid and too few antioxidants - especially vitamin C - in the gastro-intestinal wall increase the risk of ulcers caused by Helicobacter pylori.
Smokers have an increased prevalence of duodenal ulcers. This can partly be explained by an increased emptying of gastric acid into the duodenum, and partly by the fact that nicotine or the smoke can result in a reduced secretion of the acid neutralizing bicarbonate from the pancreas which empties into the duodenum. Smoking also reduces the resistance towards bacteria - and thereby also weakens the immune system.
The frequency of duodenal ulcers is increased if suffering from renal failure, cirrhosis of the liver caused by alcohol, smoker's lungs, or if the production of parathyroid hormone is too high. It has not yet been established whether stress and other mental factors, such as anger, have any significance in the development of duodenal ulcers, but it cannot be excluded that these factors can also lead to reduced resistance to the formation of wounds.
Burning and gnawing pains in the upper side of the abdomen, possibly also under the right costal angle, are common but the pains might also be uncharacteristic. They most often come when the stomach has almost been emptied which is between 1½ and 3 hours after a meal.
The food neutralizes the gastric acid, but afterwards an increased secretion of gastrin occurs which again stimulates the production of gastric acid. The symptoms typically come in attacks which last from days to months. The upper part of the abdomen is very often sore. Food or acid neutralizing remedies often quickly relieve the pains. Many people suffering from duodenal ulcers, however, have no symptoms.
If food does not reduce the pains in case of duodenal ulcers, it might be a sign that the wound is penetrating the intestinal wall into the pancreas. If there is vomiting, it is an indication that there are problems with emptying the stomach. If violent pains quickly occur, it might be a sign that the intestine has been perforated into the abdominal cavity. Bleeding from the wound can occur, sometimes with vomiting with material that has the appearance of coffee grounds, and, if the blood moves the other way, the stools will be black and tar-like.
The diagnose is made after an X-ray examination which is most often combined with a telescope examination of the stomach and duodenum. Samples will also be taken in order to check for the bacterium Helicobacter pylori.
These wounds often penetrate the mucosa and are surrounded by gastric catarrh. They are almost always located in the bottom of the stomach. If they are located at the top, there is a significant risk of cancer. As is the case with duodenal ulcers, there is a clear connection with the bacterium Helicobacter pylori.
Gastric acid and pepsin are also involved in gastric ulcers just like in duodenal ulcers, but the production of gastric acid is also often normal or reduced.
The emptying of the gastric contents is often reduced and then pains will then be located at the top of the stomach but can be uncharacteristic and be provoked by food. Weight loss on account of nausea and uneasiness after meals as well as on account of vomiting in case of wounds in the area of the stomach outlet can occur.
Bleeding is a common complication to wounds in the stomach, but holes in the stomach is not that common.
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Many wounds in the duodenum heal by themselves, so at first it is a good idea to concentrate on removing possible causes and treat and relieve the symptoms.
Smoking as well as the use of analgesics with acetylsalicylic acid and NSAIDs should be avoided.
Be careful with drinking too much coffee (also decaffeinated coffee) as it stimulates the production of acid. Never drink alcohol between meals. Choose red wine which has a bactericidal effect on the Helicobacter pylori. Avoid beer and white wine which has a quite powerful effect on the production of acid.
In quite a few cases, people suffering from gastric ulcers have also suffered from food allergy. It might be relevant, therefore, to be examined for food allergy. Some people try to relieve ulcer symptoms with milk - however milk increases the production of gastric acid.
Eat several times a day - at least six times as food binds acid. Be careful with milk which can stimulate the production of gastric acid. Do not eat too much at a time - rather eat small meals low in fat.
Many people benefit from consuming the juice or gel of Aloe vera which both has a soothing effect on wounds and can make them heal more quickly. Drinking potato juice for weeks or months is also a quite cheap, easy, and effective remedy in case of ulcers: The juice of 1 potato (if you can tolerate potatoes) is to be drunk 3 times a day before meals. Cabbage also has some bactericidal effect, and cabbage juice effectively strengthens the gastric mucosal resistance to acid. Cabbage and broccoli also contain the substance sulforaphane which has an inhibiting effect on the "ulcer bacterium" Helicobacter pylori.
Feel free to eat bananas as frequently as you wish - they strengthen the gastric mucosa. Also eat a couple of almonds a day - with the brown shell. They should be thoroughly chewed.
Use extra virgin olive oil for cooking. It contains active polyphenols which are extracted from the oil by stomach acid where it helps kill the Helicobacter bacteria.
Many spices strengthen the gastric mucosa - especially red chilli and turmeric. If you experience burning pains after eating spices, it is most often a case of reflux - the food re-enters the oesophagus from the stomach because the sphincter between the stomach and the oesophagus is failing (see "Heartburn" ).
- Aloe vera - juice and gel - has a healing and soothing effect if used internally. In case of acute, bleeding ulcer, drink 1 litre a day.
- Blueberry, Vaccinium, has a protective effect on an irritated gastric mucosa.
- Broccoli sprouts: Regular consumption seems to be able to reduce the amount of Helicobacter pylori bacteria.
- Centaury, Centaurii minoris/Eruthrea centaurium, to be taken as both tea and extract - has a beneficial influence on gastric acid.
- Chamomile, Chamomilla recutita/Chamaemelum nobile, normalizes digestion. Drink chamomile tea several times a day. It reduces the gastric acid production and at the same time has a bactericidal effect.
- Chilli/Cayenne, Capsicum, protects the gastric mucosa.
- Cone flower, Echinacea purpurea, has a strenghtening effect on the immune system.
- Garlic, Allium sativum, has a bactericidal effect andincreases resistance, but may be too strong for some people.
- Gentian, Gentiana officinalis, stimulates the transport of gastric acid and thereby leads the stream of this and other digestive juices more quickly through the gastro-intestinal system.
- Ginger, Zingiber officinale, promotes digestion.
- Liquorice root, Glycyrrhiza glabra, is beneficial in case of ulcers and stomach catarrh - it should not be used, however, if you suffer from elevated blood pressure.
- Marigold, Calendula officinalis, has a healing effect on the gastric mucosa - use it either as a tea or a tincture with a little lemon or lemon balm added to taste.
- Rhubarb, Rheum. The juice is beneficial in case of acute bleeding.
- Turmeric, Curcuma longa, is a very widespread remedy for treating ulcers. It has a bacteriostatic effect and a soothing effect on stomach ache.
- Witch hazel, Hamamelis virginica, is beneficial in case of gastric- and intestinal ulcers - to be used as tincture and exctract.
- Yarrow, Achillea millefolium, has a beneficial effect on internal bleedings and wounds - to be used as tincture or extract.
Bismuth has been used for centuries. It has a protective effect on the gastric mucosa and counteracts Helicobacter bacteria. It is mostly used in the form of subsalicylate.
The use of acid-binding tablets is very common, especially mixtures of aluminium hydroxide and magnesium hydroxide which neutralize hydrochloric acid. If used regularly, constipation and a lack of phosphorus can occur which will lead to general weakening, uneasiness, and loss of appetite. Magnesium hydroxide can cause thin stools. Magnesium can also cause a subsequent increase in the production of gastric acid.
However, studies have shown good results with a combination of an antacid and lactic acid bacteria supplements of the type Lactobacillus reuteri.
Sucralfate is a substance which can both protect the mucosa and stimulate its growth. It binds to wounds in particular and prevents acid and pepsin from affecting the wounds.
A reduction in the production of gastric acid can be obtained with substances that counteract histamine (H2-receptor antagonists, cimetidine, ranitidine, famotidine, nizatidine). These substances can affect the decomposition of other kinds of medication. Particularly strong acid-reducing remedies are proton pump inhibitors like omeprazole and lansoprazol.
The recommended medical treatment for the Helicobacter pylori is 2 - 3 antibiotics together with an acid inhibitor.
The need for surgical measures after the introduction of a treatment for Helicobacter pylori has been significantly reduced. One of the most common procedures consists of cutting the branches from the vagus nerve which lead to the stomach. At the same time, the lower part of the stomach can be removed.