Peptic ulcers can cause significant pain, anxiety, and decreased quality of life. How are they diagnosed and treated, and what diet and supplement choices can you make to help speed treatment along? Read on to find out.
What are Peptic Ulcers?
Peptic ulcers are open sores in the lining of the upper digestive tract. They are most common in the lining of the stomach (gastric ulcers), though they can also emerge in the esophagus or small intestine [1, 2, 3, 4].
The most common causes of peptic ulcers are NSAIDs and H. pylori infection. They may also be caused by other medications (such as steroids and bisphosphonates) and rare diseases like Zollinger-Ellison syndrome, cystic fibrosis, and hyperparathyroidism [1, 2, 3, 4].
How are Ulcers Diagnosed?
If your doctor suspects that you might have ulcers, they will go through a series of tests to confirm or refute their suspicions. The first step is a physical exam, during which your doctor will check for bloating, unusual sounds in the digestive tract, and abdominal pain in response to pressure .
If a physical exam suggests that ulcers are possible, your doctor will order other tests to confirm the diagnosis.
If your doctor suspects an H. pylori infection, they will likely order blood tests, urea breath tests, or stool tests. A breath test with higher CO2 concentration than normal indicates H. pylori infection, while a stool sample is directly tested for the presence of the bacteria [5, 6].
Endoscopy & Biopsy
Endoscopic procedures use a tiny camera and light to visually inspect diseased tissues. To check for peptic ulcers, endoscopy is typically performed by feeding the camera down the esophagus and into the stomach [5, 6].
At this time, the doctor may use the endoscope to take a tiny tissue sample (a biopsy) for lab analysis [5, 6].
Upper GI Series
This procedure uses a chalky liquid containing barium to coat the upper digestive tract and make it more visible to an X-ray. The patient typically fasts and stops drinking water before the procedure (your doctor will tell you how long you must be fasted) and drinks the barium liquid while sitting or standing in front of the X-ray machine [5, 6].
How are Ulcers Treated?
Be sure to follow any and all prescriptions and recommendations from your doctor, which may or may not include therapies and strategies described here. Never use any of the following strategies in place of what your doctor recommends or prescribes.
There is disagreement about whether diet changes can significantly affect outcomes in the treatment of peptic ulcers. No research has yet found that diet had an effect on the development or prevention of ulcers; however, some researchers have argued that this research is simply lacking, and that robust studies on the relationship between diet and ulcers still need to be done [7, 8].
Your doctor may recommend that you avoid certain foods that may aggravate peptic ulcers. It is important to follow any dietary restrictions your doctor recommends; if you do not receive dietary guidance, you may want to ask them about the foods on this list:
- Coffee: because caffeine stimulates acid secretion in gastric cells, many doctors advise against drinking coffee while peptic ulcers are healing. Note that coffee is only considered detrimental to a person who already has ulcers; no correlation has been found between coffee drinking and the development of ulcers [9, 10, 11].
- Soft drinks: soft drinks and other carbonated beverages are also believed to stimulate acid secretion and are therefore often on the list of things to avoid if you have peptic ulcers [12, 8].
- Chocolate: all sweets, but especially chocolate, are considered potentially detrimental to peptic ulcers .
- Acidic fruits: most doctors will recommend that patients with peptic ulcers stay away from acidic fruits like oranges, pineapples, and especially lemons .
- Very fatty food: many doctors will advise against fatty meats and cheeses, and you may be advised to cut deep fried foods entirely .
Multiple studies have found that certain dietary flavonoids conferred protection in peptic ulcers. Quercetin, a common flavonoid found in many fruits and vegetables, appears to protect the lining of the digestive tract by suppressing acid secretion. Some of the foods richest in quercetin include leafy green vegetables, red grapes, and berries [13, 14].
Other flavonoids may protect the lining of the digestive tract by stimulating blood flow or preventing the release of histamine. Still others scavenge free radicals, inhibit oxidizing enzymes, and stimulate the body’s antioxidant defense mechanisms [14, 15, 16].
Most doctors and researchers agree that psychological stress and peptic ulcers are closely linked. In fact, a cohort study of 17,525 Danish adults found that people under high stress were more than twice as likely as people under low stress to develop ulcers. More specifically, people in the group with the highest stress developed ulcers at a rate of 1.2%, while people in the group with the lowest stress developed ulcers at a rate of 0.4% [17, 18].
Anxiety disorders, personality disorders, and panic disorders have also been directly linked to peptic ulcers. One study further found that alcohol or nicotine dependence exacerbated the connection between anxiety and ulcers; that is, people with anxiety disorders who were also dependent on alcohol or nicotine were even more likely to have ulcers [19, 20].
A large body of research suggests that managing stress is very important for healing peptic ulcers. Some researchers have recommended the inclusion of cognitive behavioral therapies and other psychological strategies to help manage family, job, economic, and workload problems .
Supplements for Ulcers
The FDA has not approved any natural substances for medical use in ulcers, and supplements generally lack solid clinical research. Speak with your doctor before using any of these substances, and never use them in place of something your doctor recommends or prescribes.
Bismuth salts have been a relatively common component of ulcer management for decades .
According to the American College of Gastroenterology, there is significant clinical evidence to support the use of bismuth as part of a “quadruple therapy” against H. pylori, along with tetracycline, a nitroimidazole, and a proton pump inhibitor (PPI) .
It is unclear, however, whether bismuth is helpful in ulcers that are not caused by H. pylori infection. Your doctor may or may not recommend bismuth as part of a treatment for ulcers. Talk to your doctor before attempting to use it, as the FDA has only approved bismuth to treat diarrhea, and large amounts may be toxic to the kidneys [24, 25].
According to one review, probiotics inhibited the development of acute gastric mucosal lesions and accelerated gastric ulcer healing in both humans and animals. Certain probiotics and probiotic blends also generally supported the health and integrity of the digestive mucosa (the lining of the digestive tract) .
Probiotics have been studied most often in ulcer patients with H. pylori infections. According to some researchers, probiotic bacteria compete with H. pylori in the digestive tract, possibly making this harmful infection more susceptible to antibiotics and other drugs. In rats, a probiotic blend called VSL#3 stimulated growth factors in the gut lining and more directly promoted healing of ulcers [27, 26, 28].
Probiotic bacteria can be introduced either in supplements or in fermented food and drinks like sauerkraut, miso, cheese, and kombucha [29, 30].
3) Mastic Gum
Mastic gum is a popular supplement for people who want to support H. pylori treatment with complementary approaches. There is some evidence in support of this approach; a study of 38 people with small intestine ulcers, for example, mastic gum improved ulcer healing and reduced ulcer symptoms [31, 32].
In a study of 52 people, pure mastic gum alone (350mg – 1g, 3x/day) was moderately effective at eradicating H. pylori (30% – 38% eradicated) after 14 days. However, it did not work when combined with the conventional anti-ulcer medication, pantoprazole .
But in another clinical trial of 8 people, 4 g/day of mastic gum had no effect on H. pylori infection status .
4) Chili Peppers/Capsaicin
Some documents and guidelines advise against eating chili peppers if you have ulcers, but a surprising amount of research has suggested that capsaicin, the active ingredient in chili, could actually be beneficial [35, 36, 37].
Capsaicin inhibits the growth of H. pylori bacteria, which may explain why people given chili powder healed more quickly than their peers in a study of 50 ulcer patients .
Capsaicin prevents stomach ulcers in animals, and may also help heal existing ones. Capsaicin inhibits gastric acid secretions, reduces acidity, promotes mucus secretion, and stimulates gastric blood flow .
We advise caution with capsaicin if you already have stomach ulcers, because it can also irritate the stomach.
Insufficient Evidence For
The following substances have shown promise against peptic ulcers in limited, low-quality clinical studies; there is currently insufficient evidence to support their use in this context, and they should never replace what your doctor prescribes. Remember to talk to your doctor before starting any new supplement or making significant changes to your diet.
Garlic is a hotly debated complementary approach for ulcers. In a recent meta-analysis of allicin (an active compound extracted from garlic) as an add-on therapy in H. pylori infection with ulcers, those who received allicin experienced a better healing rate and remission of symptoms .
However, the authors of this analysis noted that the evidence was still relatively weak and in need of further investigation .
Garlic can be irritating on the stomach, so caution is advised if you already have ulcers.
6) Licorice Root
Some clinical evidence exists to support the use of licorice root alongside conventional treatments for ulcers. However, much more research is required.
Licorice was a good adjunctive treatment to standard clarithromycin triple therapy in the treatment of Helicobacter pylori in a clinical trial on 120 people. It increased the eradication rate of H. pylori by about 20% .
Cranberry juice is a popular folk remedy for a variety of infections and digestive complaints. In two studies of a total of 389 patients with H. pylori, cranberry juices and extracts improved eradication rates, suggesting that cranberry could be useful in ulcers caused by H. pylori [42, 43].
However, there is no data on whether cranberry could help heal ulcers caused by NSAIDs or other factors.
Curcumin is a well-known anti-inflammatory compound extracted from turmeric. The evidence for its benefit in ulcers is thin, though some researchers are still optimistic. Adding curcumin to conventional therapies for H. pylori reduced digestive discomfort in a clinical trial of 60 patients; however, those who received curcumin did not experience faster or better eradication of the bacteria [44, 45].
Ginger increased protective prostaglandins in the stomach lining in 43 osteoarthritis patients who used NSAIDs long-term. NSAIDs cause stomach damage by reducing prostaglandins in the stomach, which otherwise help maintain healthy stomach mucus. Ginger could potentially be useful in people who developed ulcers from NSAIDs, but further clinical trials are needed .
In cellular studies, antioxidants in ginger blocked the growth of stomach-ulcer-causing H. pylori, mainly by fighting free radicals. Animal and human studies have yet to explore the effects of ginger on H. pylori .
Once your doctor diagnoses peptic ulcers and determines their cause (H. pylori, NSAIDs, or otherwise), they will likely prescribe medication and recommend strategies for healing. If your ulcers were caused by NSAIDs or other drugs, you may be advised to stop taking that medication. You should only stop taking medication if your doctor explicitly advises you to do so. By the same token, if you are told to stop a certain medication, do not start up again without getting the green light from your doctor.
The most common medications prescribed to treat ulcers include :
- Antibiotics, if you test positive for H. pylori
- Proton pump inhibitors, to reduce stomach acid production
- H2 histamine blockers, to reduce stomach acid production
- Antacids, to raise the pH of the stomach
- Cytoprotective agents, including prostaglandin analogues, to increase mucus production 
In rare, severe cases, surgery may be required. Surgery is most often recommended in emergencies (such as if the wall of the stomach is bleeding severely) or if ulcers persist for years without responding to pharmaceutical intervention [49, 50, 51].
Several specialized types of surgery exist to correct chronic ulcers:
In vagotomy, the surgeon carefully severs the link between the vagus nerve and the lining of the stomach. Because the vagus nerve stimulates gastric acid secretion, this should raise the pH of the stomach and reduce the recurrence rate of ulcers. Vagotomy is perhaps the simplest surgery for chronic ulcers, and it is often performed alongside one of the following two procedures to further reduce the rates of recurrence [49, 50, 51].
An antrectomy is a surgery to remove the lower part of the stomach (the antrum), which is the tissue that stimulates the production of gastric juices. After antrectomy, the stomach no longer produces as much acid [50, 51].
In pyloroplasty, the passage between the stomach and the small intestine is widened, allowing the contents of the stomach to pass more freely [50, 51].
Peptic ulcers are open sores in the lining of the upper digestive tract, anywhere in the esophagus, stomach, or upper small intestine. They are most often caused by H. pylori infections or by chronic use of NSAIDs.
If your doctor suspects that you may have ulcers, they will use a series of tests to confirm or refute their suspicions. They will typically begin with a physical exam, followed by lab tests, endoscopy, and occasionally even X-rays.
Your doctor will prescribe appropriate medication to treat ulcers and may even recommend surgery. In addition to these interventions, they may recommend that you avoid certain foods and drinks, such as coffee, soft drinks, and foods with high acid and fat content. Meanwhile, many doctors recommend increasing your intake of dietary flavonoids from fruits and vegetables.
Several supplements have been studied for their potential to protect the gut lining and prevent or help heal ulcers. Some of these have only been effective in studies on H. pylori ulcers, while others have improved healing regardless of the cause of ulcers. The best-studied of these have been bismuth, probiotics, mastic gum, and (surprisingly) capsaicin.
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