PUD. And a Glimpse into my Journey.

Peptic ulcer disease (PUD) affects around 10% of people worldwide, although some research is suggesting those rates are getting lower. PUD starts when a small section of the lining of the stomach or upper small intestine (the duodenum) becomes weak and eventually deteriorates causing a shallow open wound (called an ulcer). This happens when something has caused the protective coating on the lining of the stomach or intestine to erode. Once eroded, stomach acid and enzymes irritate the lining to the point of an ulcer forming.

The main symptoms associated with PUD are epigastric pain and dyspepsia which are essentially recurring pain in your abdomen, either all over (epigastric) or in the upper portion (dyspepsia). I am personally familiar with these symptoms and they suck. The two main risk factors of PUD are Helicobacter pylori infection and the use of NSAIDS (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil and Motrin) and naproxen (Aleve). Of course only a small percentage of people who have H. pylori hanging out in their gut (around 50% of the world) and who use NSAIDs regularly end up with PUD. But there are people who get PUD despite not having H. pylori and no history of regular NSAID use.

So what else causes PUD?

There was a study that came out in 2013 (listed below) that found the rates of PUD increased in people who lived close to the Great East Japan earthquake in 2011. The study looked at the rates of PUD diagnosed up to 3 months after the earthquake in several hospitals near the site of the disaster. The researchers found an 11% increase in non H. pylori and non NSAID cases of PUD compared to the same time frame the previous year. The researchers concluded that it was the stress of the natural disaster that caused the disease.

Another study published in 2015 looked at a population in Denmark who had participated in a large epidemiological study in the late 80’s and early 90’s that showed participants who indicated they had high levels of stress in their life were at a higher risk for PUD. Based on statistical analysis, the researchers found that stress was an independent risk factor for PUD meaning, regardless of the presence of H. pylori or NSAID use, stress increased the risk for developing PUD. Another interesting finding was that low socioeconomic status was also an independent risk factor for PUD. There are other studies out there with similar findings and there are of course, other well known risk factors for PUD, including certain medications, especially when used together, tobacco use, and alcohol intake.

I talk about stress a lot and I’m using it as an umbrella term that can include anxiety stemming from a variety of mental illnesses, trauma, mental or emotional exhaustion, internalized discrimination, or any other definition of stress. Why I like to talk about stress specifically as a risk factor is because it often seems to be forgotten despite how systemically damaging it can be. Also, stress, in all of its forms, can be a risk factor or symptom trigger for pretty much any gastrointestinal condition.

Now, if the stars have aligned and we discover that we do have PUD, how do we treat it (assuming there are no complications)?

There are medications of course that can be effective, I talk from experience. But, like with any medications, they do have side effects and may not be effective for everyone. There are also many medicinal plants that have shown some efficacy in the fight against gastric ulcers and H. pylori especially. But as I am not a pharmacist, physician, nor homeopath, let’s look at diet.

Diet is not a major risk factor for PUD, so changes to your diet are not going to make lasting improvement alone, but they can help. Some ways diet is effective or affected by PUD:

Including plant foods in your diet can aid with prevention and treatment.
fruit, veggies, nuts, seeds, beans, lentils, soy, legumes, and whole grains provide antioxidants which help reduce the damage caused by some of the risk factors for PUD.
Identifying triggers for your symptoms may be part of treatment. Sometimes these triggers are diet related, sometimes they are stress related, and sometimes they are related to things we would never have guessed.
To treat the symptoms you need to avoid the triggers as best you can until your ulcers are healed which may mean removing them from your diet temporarily.
Because PUD can cause a lot of pain it may affect how much you are able to eat.
If this is the case and you notice you are losing weight, feeling dizzy, exhausted, or having a hard time concentrating, you need to go see your doctor or dietitian.

For most people, PUD can be cured as long as the root cause can be dealt with, like eradicating H. pylori infection, stopping the use of NSAIDs, and reducing or eliminating alcohol.

But what if stress is the main cause?

In this case, that treatment plan is a lot more complicated and not so straightforward and will need to be individual. Because stress is different for everyone, where your stress is originating from, mental illness, poor relationships with others, food, your body, past trauma, low socioeconomic status, etc. is likely going to affect how it can be best managed.

For me, acute anxiety, not eating regularly, eating deep fried foods, and wearing pants that were too tight triggered my symptoms. Thankfully, I went on medication for a month or so, long enough to let my stomach lining heal, and felt soooo much better. But, even 10 years later I still get symptoms from time to time. Some of my triggers have stopped, like fried foods (thank god); some I manage better, like anxiety and eating regularly; and some I try my best to avoid, like wearing pants that I soon regret.

Sources:

Kanno, T., Iijima, K., Abe, Y. et al. Peptic ulcers after the Great East Japan earthquake and tsunami: possible existence of psychosocial stress ulcers in humans. J Gastroenterol 48, 483–490 (2013). https://doi.org/10.1007/s00535-012-0681-1

Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic Ulcer Disease: A Brief Review of Conventional Therapy and Herbal Treatment Options. Journal of Clinical Medicine, 8(2), 179. https://doi.org/10.3390/jcm8020179

Levenstein, S., Rosenstock, S., Jacobsen, R. K., & Jorgensen, T. (2015). Psychological Stress Increases Risk for Peptic Ulcer, Regardless of Helicobacter pylori Infection or Use of Nonsteroidal Anti-inflammatory Drugs. Clinical Gastroenterology and Hepatology, 13(3). https://doi.org/10.1016/j.cgh.2014.07.052

Tovey, F. I., Bardhan, K. D., & Hobsley, M. (2012). Dietary Phosphilipids and Sterols Protective against Peptic Ulceration. Phytotherapy Research, 27(9), 1265–1269. https://doi.org/10.1002/ptr.4865

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