Muscle Spasm And Muscle Cramps 

What Is A Gastric Ulcer?

[dropcap]G astric ulcer is a painful stomach disorder characterized by an open sore involving the mucosa lining and deeper muscle layer of the stomach.

Gastric ulcer is associated with lymphocytic gastritis which is inflammation of the mucosal lining of the stomach. The thick mucosal lining normally protects the stomach from the erosive action of stomach acid.

Q: How do ulcers develop?

A: Ulcers develop if  hydrochloric acid secreted by the gastric glands of the stomach for the purpose of digesting food damages the normally resistant mucosal walls of the stomach. In the reverse, ulcers may be accompanied by achlorhydria (insufficient acid production).

Damage occurs when there is a predisposing factor that alters the health of the mucosal lining. The most common cause is infection with a bacteria called h. pylori bacter, stress and chronic use of the pain relievers aspirin and non-steroidal drugs like ibuprofen.

Smoking tocacco and consuming alcohol aggravate an ulcer but do not cause it to develop.

The most common location for ulcer formation is along the stomach antrum which is the area of the stomach before the pylorus, the lower region that empties liquid stomach contents into the small intestine.

What Is A Gastric Ulcer In Celiac Disease and/or Gluten Sensitivity?

• Relationship between  gastric ulcer and celiac disease. Gastric ulcer is a digestive complication of celiac disease. Changes in the stomach in 215 celiac disease patients with new-onset celiac disease were found to promote formation of ulcer. Subjects had high basal and stimulated acid-forming function, high gastrin concentration in the blood, and the morphological examination (biopsy) detected lymphocytic gastritis.¹

• Relationship between  gastric ulcer and helicobacter pylori (H. pylori) infection. Helicobacter pylori is an associated disorder in celiac disease that is largely due to impaired micronutrient homeostasis. Nontreated H. pylori infection of the stomach is a major pathogenic factor for the development of gastritis (inflammation of the stomach lining) leading to ulcer formation that may progress to gastric cancer.²

• Relationship between  gastric ulcer and inflammation. The pivotal role of antioxidants in the prevention and healing of peptic ulcer has been widely studied in numerous investigations. Tissue damage is always associated with intense generation of free radicals such as reactive oxygen species (ROS) that cause oxidative stress and subsequent mucosal injury. Likewise, oxidative mucosal damage contributes with DNA fragmentation, lowering cellular DNA content, and impairment of protein expression which is mediated by the intense generation of ROS.³

How Prevalent is Gastric Ulcer In Celiac Disease and/or Gluten Sensitivity?

Gastric ulcer has a 9.5% occurrence rate in celiac disease.

What Are The Symptoms Of A Gastric Ulcer?

Gastric ulcer is marked by these symptoms:

• Gnawing epigastric pain in most patients, but not all, felt after eating and usually relieved by more eating or antacids. A gnawing hunger may wake you up in the middle of the night and cause the need to eat something.
• Possible bleeding. Bleeding if it occurs, results in dark, tarry stool.
• Vomiting if it occurs, consists of food eaten a few hours before.
• Potential for hemorrhage.
• Potential for perforation of the stomach lining.

How Does Gastric A Ulcer In Celiac Disease and/or Gluten Sensitivity Develop?

• Gastric ulcer in celiac disease results from disruption in normal tissue repair and defense due to chronic inflammation from gluten exposure, deficiency of niacin and/or iron in celiac disease.
• If present, H. pylori infection gobbles up iron and causes ulcers.

Does Gastric Ulcer Respond To Gluten-Free Diet?

Yes. Celiac disease-related gastric ulcer responds to gluten free diet. However, this diet should be rich in fruit and vegetables to provide the necessary nutrients to heal the stomach and inhibit H. pylori activity if present.

It has been shown that eating a significant amount of foods containing dietary polyphenols or dietary supplementation  along with conventional treatment can result in perfect security and treatment of peptic ulcer.³

Polyphenols are widely distributed plant compounds called metabolites that actively promote health and prevent disease. They are found in whole, unrefined fruits and fruit drinks, vegetables and vegetable drinks, legumes (peas and beans), and grain. The deeper the color, such as blueberries and cranberries, the richer the polyphenol. Curcumin in tumeric is an excellent polyphenol with anti-ulcer properties.

6 Steps To Improve Gastric Ulcer In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

 [box type=”shadow” ]Treatment of gastric ulcer (peptic ulcer).

This condition responds to elimination of the cause and treatment of the ulcer. The initial medical management of a stable patient with dyspepsia differs from the management of an unstable patient with hemorrhage. In the latter situation, failure of medical management not uncommonly leads to surgical intervention.

Most patients with peptic ulcer  are treated successfully with cure of H. pylori infection and/or avoidance of NSAIDs like ibuprofen which are known to cause ulcer, bleeding, and perforation, along with use of antisecretory therapy to reduce stomach acid.

Endoscopy is required to document healing of gastric ulcers and to rule out gastric cancer. This usually is performed 6-8 weeks after the initial diagnosis. Documentation of H. pylori cure with a noninvasive test, such as the urea breath test or fecal antigen test, is appropriate in patients with complicated ulcers.⁴

Treatment of celiac disease. This condition responds to the complete elimination of gluten, which is the required treatment that improves both gastric ulcer and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery from gastric ulcer. You should begin to feel better as inflammation subsides and the damaged tissues return to normal, which depends on the severity of damage, of course. Surface cells lining the stomach are replaced every 3 days while the underlying layers require more time.

Recovery from gluten damage. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁵
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory). Licorice (gluten-free) works as well as ulcer treating drugs with fewer side effects. It strengthens the stomach’s normal protective mechanisms and induces healing.⁶

Avoid hot spices, particularly red and black pepper, alcohol, coffee and caffeine which can be in sodas and other drinks. Puree foods can ease digestion. Diet should include vegetables with fiber, particularly cabbage, and probiotics.

[box type=”shadow” ]Here Are Major Inflammatory Food Types:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷
• Bad Fats. Includes deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁸[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, phytochemicals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources include tuna, salmon, cod, and others. Plant sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 for examples such as ginger.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely: 

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Certain prescription drugs can promote gastric ulcer. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Iron.

ANTI-INFLAMMATORIES  disrupt intestinal permeability.

• Aspirin and Salicylates deplete Iron.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Niacin.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Iron.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Iron.[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Vitamin A. Recommended dose is 10,000 IU per day until ulcer is healed. Before starting, ask doctor for a baseline blood test and repeat again in 3 months to discover your vitamin status and how to proceed.⁶
• Vitamin E. Recommended dose is 400 to 800 IU per day.⁶This is a safe dose.
• B vitamin complex that contains 100 to 300% each. Do not buy bottles that have more than 300% each because the excess cannot be used. The body eliminates excess in the urine andin the process takes away needed minerals.
• Zinc. Recommended dose is 50 mg. This is a safe dose and needed to help heal the ulcer. Do not take with other supplements because of interactions.  Always check with your doctor when taking supplements to avoid interactions with medications.

Storage Note for Supplements: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet  – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies:

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives are plant sources that tone muscle and improve peristalsis, and thus aid in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort. Puree any foods that cannot be thoroughly chewed. Cook meats well or make them into soups and stews for ease of digestion.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets stimulate and improve digestion and are easily digested.
• Cabbage stimulates and improves digestion and is also a liver decongestant.
• Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
• Chamomile (as a tea) also promotes healing and help relieve nervous tension. Drink as a tea.
• Parsley relieves colic, gas and indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
• Plantain is a common garden weed that has soothing, wound healing properties for the stomach. Drink 3 cups of tea a day. Steep a tablespoon of fresh leaves in hot water for 10 minutes.⁶

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for abdominal bloating, indigestion and colic.
• Ginger also supresses inflammation.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Gastric Ulcer In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Functional condition of the stomach, pancreas, liver and gallbladder in celiac disease.” This study investigating the condition of the stomach, gall-bladder, pancreas, liver in celiac disease  and contribution of their dysfunction to clinical presentation of celiac disease symptoms found that changes in the stomach in 215 celiac disease patients with new-onset celiac disease promote formation of ulcer. Subjects had high basal and stimulated acid-forming function, high gastrin concentration in the blood, and the morphological examination detected lymphocytic gastritis. There were also an inert type of pancreatic enzyme secretion, gall-bladder hypokinesia or atony. Gall bladder contracted only after intravenous injection of cholecystokinin. Changes in the liver were characterized by hypertransaminasemia, steatohepatitis, resulting in dramatic disorder of digestion and absorption of food substances.¹

CASE REPORT SUMMARIES

“Helicobacter pylori-negative gastric ulcerations associated with celiac disease at first presentation.” This case report describes finding gastric ulcers at diagnosis of Celiac Disease in a 53-year-old woman presenting with diarrhea, epigastric pain and abdominal distensions for a period of few weeks. At upper GI endoscopy, biopsies were taken showing complete atrophy of the villi and colonization of the small bowel mucosa. Additionally, uncommon multilocular peptic ulcers were seen in the gastric antrum. These ulcers proved to be Helicobacter pylori-negative with no evidence of Zollinger-Ellison syndrome.

Biopsies of gastric ulcers showed signs of a lymphocytic gastritis with an extensive infiltration of the lamina propria by almost exclusively Celiac Disease3- and Celiac Disease45R0-positive T-lymphocytes. Intraepithelial T-lymphocytes were found to be increased in the antral as well as the corpus mucosa. Typing the patient for human leukocyte antigens showed a DQA1*0501 and DQB1*0201 phenotype. According to the present report, gastric peptic ulcers seem to be another phenomenon associated with celiac disease. In the case presented here, ulcers were diagnosed together with celiac disease already at first presentation of the patient.⁹

Sources:

1. Krums LM, Sabel’nikova EA, Parfenov AI. Functional condition of the stomach, pancreas, liver and gallbladder in celiac disease. Ter Arkh. 2011;83(2):20-4. [↩] [↩]
2. Steinbrenner H, Al-Quraishy S, Dkhil MA, Wunderlich F, Sies H. Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr. 2015 Jan 15;6(1):73-82. doi: 10.3945/an.114.007575. Print 2015 Jan. [↩]
3. Farzaei MH, Abdollahi M, Rahimi R. Role of dietary polyphenols in the management of peptic ulcer. World J Gastroenterol. 2015 Jun 7;21(21):6499-517. doi: 10.3748/wjg.v21.i21.6499. [↩] [↩]
4. http://emedicine.medscape.com/article/181753-treatment [↩]
5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
6. The Herbal Drugstore. Linda White, M.D and Steven Foster. 2000. Rodale Inc. USA. [↩] [↩] [↩] [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩]
8. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩]
9. Domagk D, Avenhaus W, Ullerich H, Henschke F, Menzel J, Domschke W. Helicobacter pylori-negative gastric ulcerations associated with celiac disease at first presentation. Z Gastroenterol. 2001 Jul;39(7):529-32. [↩]