DUODENAL ULCER

AYURVEDA PERSPECTIVE ON DUODENAL ULCER

An ulcer is an open wound or sore on the lining of the GI tract. If you have a stomach ulcer, you may experience a gnawing or scraping sensation in your upper abdomen, usually in the top center or slightly to the left.

This article will help you find out if you have an ulcer. It will provide you with an understanding of the causes of ulcers, outline the Ayurvedic perspective, and teach you how to recognize if you have a hidden ulcer. Most importantly, it will also share what you can do about it.

How Do I know if I Have An Ulcer?

The most basic symptom of an ulcer is pain, often described as a burning or gnawing sensation in the stomach area. The location of the pain will vary, depending on the type of ulcer. Gastric ulcers will be felt slightly more to the left of the upper abdomen and may be confused with heartburn. A duodenal ulcer will be felt closer to the belly button region, around the midline of the body, and can be misinterpreted as hunger or indigestion. Duodenal ulcers are more likely to be painful at night than gastric ulcers.

In a gastric ulcer, pain increases upon eating, but in a duodenal ulcer, pain is temporarily relieved by food. The pyloric valve, between the stomach and the duodenum, closes after a meal to concentrate the contents. After the stomach has a chance to digest the food, it starts to release the contents into the duodenum about 2-3 hours after the meal. This is when a duodenal ulcer feels most painful. Some other symptoms of an ulcer include bloating, belching, nausea, and vomiting.

There can also be a hunger like sensation, a sort of empty feeling in the stomach, but this is not true hunger. It can be compared to a "Clamoring Stomach" in Traditional Chinese Medicine (TCM) when the stomach is irritated and causes a false sense of hunger. Pain in the stomach does not always equate to hunger, and learning to distinguish between this irritation and true hunger is essential to heal an ulcer. Sometimes when I talk to clients and suspect an ulcer, they say, "But I don't feel any pain in my gut." Once I ask them to palpate their upper GI, they may feel some generalized tenderness if ulcers are present.

What Causes an Ulcer?

Peptic ulcers are sores that develop in the lining of the stomach (gastric ulcer) and the upper part of the small intestine (duodenal ulcer). Although the term stomach ulcer is most commonly used, duodenal ulcers are actually three to four times more prevalent. Peptic ulcers affect around 4.5 million Americans, with 500,000 - 850,000 new cases being diagnosed each year.

Fortunately, the understanding and treatment of peptic ulcers has improved dramatically in recent decades, particularly due to the discovery of the bacterium Helicobacter pylori (H. pylori). This bacteria is one of the most widespread infections in existence, with over 50% of the world's population infected. Before the discovery of this bacteria, nobody suspected a microorganism could have such a close relationship to the development of ulcers. It is now known that 90% of people with duodenal ulcers and 80% with gastric ulcers have H. pylori infections.

A lack of coordination between the pyloric valve and the intestines may also lead to ulcers. The pyloric valve is the sphincter which separates the stomach and the duodenum, the first part of the small intestine. When this valve is weak or uncoordinated, acidic contents of the stomach can enter the duodenum too quickly, or contents of the duodenum can reflux back into the stomach. This lack of coordination can occur when a person overeats, or when the muscles fail to perform normally.

Both smoking and alcohol play a significant role in the aggravation and growth of ulcers, but aren't always direct causative factors. Smoking accelerates gastric emptying and reduces the secretion of bicarbonate acid buffers by the duodenum. Smoking also causes the stomach to dump acidic food into the duodenum too quickly. Western medicine has shown that alcohol can increase the risk of ulcers when H. pylori is present, as it can further damage the gastric mucosa. Alcohol can also exacerbate the symptoms of an ulcer, and prevent it from healing.

While stress was once touted as the prime cause of ulcers, the discovery of H. pylori shows that the cause is multifactorial. Physical trauma to the body, in other words physical stress, has been shown to increase ulcers, but western medicine has not been able to prove that psychological stress can create ulcers. However, that is not to say that stress doesn't play an important role in aggravating ulcers depending on constitution.

Use of NSAIDS, such as aspirin, is also a cause of ulcers.

The Ayurvedic Approach

Ayurveda classifies ulcers into Vata and Pitta type ulcers. Vata ulcers occur due to the drying and thinning of the protective mucous membranes in the upper GI tract,. When this happens, the mucous membrane is not thick enough to protect the delicate lining of the GI tract from harmful digestive acids.

Individuals with a Vata constitution tend to be erratic and often skip meals, overriding sensations of hunger to go about their busy day uninterrupted. If the stomach is producing acid but there is no food to digest, the stomach is in a very vulnerable state to develop an ulcer, particularly if the mucous membrane is already thin and dry.

People with a Pitta predominance can develop ulcers when intense emotions, such as shame, anger, or rage, overstimulate the solar plexus area. Psychologically, these emotions give people that hot headed feeling, while physically, it can create a burning, tight, clenched sensation in the abdomen.

Ayurvedically, these emotions increase Pitta dosha and activate digestive juices from the stomach, liver, and pancreas, making the stomach and intestines excessively acidic. This occurs when stress causes bile reflux, hyperacidity, low digestive strength (agni), or when tension causes lack of blood flow to digestive organs.

Kapha is usually not a factor in ulcer development, unless it provokes either Pitta or Vata in the digestive tract.

What Can I do About It?

The first thing to do if you suspect an ulcer is to seek medical confirmation. Western medicine uses several techniques to diagnose gastric and duodenal ulcers, primarily discussing your medical history and current symptoms, such as pain. Doctors also use barium contrast x-rays, endoscopies, fecal tests, and blood tests to determine the presence of H. pylori. This hardy and resilient bacteria is thought to be able to survive a lifetime in the harsh environment of the stomach, unless fully eradicated through the use of antibiotics.

The first step to reduce Vata type ulcers is to establish a consistent routine, particularly eating meals at the same time each day. This ensures the digestive acids don't start eating into a thin, deficient mucus layer and erode the wall of the stomach. Proper hydration is also key for Vatas. Without adequate hydration, the mucous membrane is likely to become thin and dry. Sipping hot water throughout the day and having a cup of bone broth daily will protect and hydrate the stomach lining, as will herbs such as licorice root. Vata types also benefit from a diet rich in naturally sweet, gooey foods, like tapioca and oatmeal, that build the protective mucus layer in the stomach.

Pitta individuals, first and foremost, need to implement measures to manage their intense emotions that can contribute to ulcers. Daily time in nature, preferably by a body of water, can help ease tension. Pittas are logical thinkers and like being able to organize their thoughts rationally. Journaling can help them work through challenging emotions in a systematic, logical order. They will also benefit from practicing non-competitive exercise such as yoga.

Sweet, soothing, demulcent foods, like rice pudding, will reduce inflammation in the digestive tract and help restore the mucus lining. In Pitta type ulcers, bleeding is more likely, so hemostatic herbs such as raspberry leaf, amalaki, and manjistha can be helpful to reduce excess bleeding. Amalaki is a natural antacid, reducing excess acidity in the stomach. It is particularly useful in cases of Pitta ulcers, but also benefits Vata dosha.

In both types of ulcers, ensure to follow the top Ayurvedic tips for healthy digestion. This will lessen the strain on digestive organs, and reduce the resulting feelings of anxiety. Aromatic herbs and spices, like cardamom and mint, can dissolve mucus in the stomach and should be avoided when ulcers are present. Also, pungents like cayenne and black pepper can increase acid secretions and also erode the mucus layer. Certain substances, like caffeine, nicotine, chocolate, and alcohol irritate the lining of the GI tract and should be eliminated from the diet.

Summary

Ulcers are a major digestive disorder that affect millions of people in the US alone. The pain can often be misinterpreted as heartburn or strong hunger, so an ulcer may go undetected. If you have a hidden ulcer, you may be unknowingly experiencing digestive inflammation and irritation daily. The vagus nerve is the communicator between the digestive tract and the brain. It transmits signals of pain and inflammation from the digestive tract to the brain, which can lead to you feeling scattered and anxious.

If you are experiencing digestive discomfort and feeling anxious, but can't figure out why, consider the possibility that an ulcer is at play. Seek medical advice to confirm the presence of an ulcer, and follow the recommended treatment. The information in this article can help you learn how to build and protect the mucus lining of your stomach to reduce the likelihood of ulcers.