Heartburn and ulcers are a common human problem.  Surgery used to be common in severe cases.  However, modern treatments with antibiotic treatment for H. pylori, the bacterium causing most ulcers, along with the availability of histamine-2 blockers like cimetidine (Tagamet) and Pepcid, and especially with proton pump inhibitors like omeprazole (Prilosec), Nexium, and Prevacid have markedly reduced this difficulty.  Herbal remedies in the U.S. are inferior to modern treatment, but melatonin, a natural treatment, is surprisingly effective.  

As prevention, I recommend eliminating salt, soy sauce, and cigarettes, and to start eating light or plain yogurt daily.  If symptoms of heartburn or stomach discomfort develop, the problem can be easily diagnosed by seeing if an antacid quickly relieves the pain.  If it does, try melatonin, probably the most successful, easiest and cheapest treatment for dyspepsia, acid reflux, and irritable bowel syndrome.  Take 3 mg each night for at least three months (over-the-counter for $1-2 per month).  If this fails, or while waiting for full benefit, try generic Tagemet (cimetidine) or generic Zantac (ranitidine), both histamine-2 blockers.  If that doesn't work, try Prilosec over-the-counter.  If the condition still persists or is severe, see your physician for possible antibiotic treatment for H. pylori infection.  Nexium and Prevacid are extremely expensive and usually no better than Prilosec.  Melatonin is usually better than any of them.  An herbal remedy, listed below, has also been found useful in one double-blind study, but I couldn't find a distributor.  The ingredients could be purchased individually.  I also like the animal research with taurine, but no human studies are yet available.  It's cheap over-the-counter.  Melatonin helps in many other ways and has also been shown helpful for irritable bowel syndrome in humans.  

For H. pylori infections, a major cause of peptic ulcers, a urea breath test is used to make the diagnosis.  Then a 7 to 10-day standard triple or quadruple therapy for elimination of H. pylori: 20 mg omeprazole b.i.d., 1000 mg amoxicillin b.i.d. (or doxycycline 100 mg b.i.d. or ciprofloxacin 500 mg b.i.d.), 500 mg metronidazole b.i.d. with or without 240 mg colloidal bismuth subcitrate b.i.d. (Peptobismol).  Retreatment with modifications is sometimes needed.

Salt, Soy Sauce, Cigarettes Cause Ulcers: A study of over 7000 Japanese-Americans in Hawaii for 20 years found 280 gastric and 150 duodenal ulcers. Both were increased with smoking and gastric ulcers were increased with salt or soy sauce. Alcohol had no impact. Fruit and milk were of no benefit. Am J Epidemiol 1992 Mar 1;135(5):521-30

Heliobacter Pylori May Cause Migraines: Italian researchers found 18% chronic migraine infected with H. pylori. In a DB study of 130 treated for 3 weeks with antibiotics or antibiotics for 3 weeks plus Lactobacillus probiotics (yogurt or lactobacillus tablets) for one year found no difference in headaches at one month with very low relapse in group on lactobacillus and 50% without lactobacillus vs. 20% with still getting headaches at one year. AP Milan, 4/27/02.

H. Pylori: One Day, Four Drug Treatment Effective: Arch Intern Med. 2003;163:2079-2084 = 95% success rate. Patients had dyspepsia and positive urea breath test. Lara LF, et al. Wake Forest University

Stool Antigen Test Best: National Institute for Clinical Excellence (NICE) recommends that patients with persistent or recurrent uncomplicated dyspepsia should have a non-invasive Helicobacter pylori test and, if the test is positive, receive triple therapy. The urea breath test detects products of the enzyme urease produced by live H pylori in the stomach and is 95% sensitive and specific. Unfortunately, it is cumbersome and more expensive. Serology has been the main non-invasive test but is less accurate. A positive serology result can mean: 1) that the patient is infected; 2) that the patient was once infected, but the infection has resolved; or 3) that the test is detecting non-specific cross reacting antibodies. The new stool antigen test detects H pylori antigens passed in the feces. A monoclonal antibody kit is now available with specificity 97.5%, and sensitivity 94.7%. It is easy and less expensive. Typically 25% of dyspeptic patients are H pylori positive. C. McNulty, BMJ  1/15/2005;330:105-106 

H Pylori From Hamburgers: Undercooked hamburger or beef can pass the bacteria which cows and pigs get from contaminated soil. Chicken is safer. Anticancer Research 7/02.

H Pylori From Well or Surface Water: A Penn State study found 75% of surface waters tested positive as did many private wells. It detected an increased rate of stomach ulcers in individuals drinking the well water. Amer Soc Microbiol 5/06

H Pylori Antibody titers: There is no need for a gastric biopsy to determine who is cured. Those cured have negative titers and those not cured had persistent antibodies. JAMA 7/22/98

H. Pylori Lowered by Wine: In a random national sample of 2,913 Danish adults, the seroprevalence of H. pylori infection reduced with 6+ alcohol drinks/week (odds ratio 0.7) due to a low rate of H. pylori infection among wine drinkers (odds ratio 0.6). No associations were found with smoking habits or serum lipids. People with upper quartile BMI (> or = 26.8 kg/m2) were more likely to be seropositive for H. pylori (odds ratio 1.6). Chronic bronchitis (odds ratio 1.6) and unspecified heart condition (odds ratio 2.0) was more often seen in seropositive women. The likelihood of being seropositive increased slightly with age at menarche (odds ratio per year 1.10). Association of Helicobacter pylori infection with lifestyle, chronic disease, body-indices, and age at menarche in Danish adults. Rosenstock SJ, Jorgensen T, Andersen LP, Bonnevie O. Denmark. Scand J Public Health. 2000 Mar;28(1):32-40

Triple Anti-Biotic: 7-Day Treatment Successful: In a DB PC study of 803 patients with H. pylori infections, researchers compared the efficacy of rabeprazole 20 mg b.d., amoxicillin 1000 mg b.d., and clarithromycin 500 mg b.d. for 3, 7, or 10 days, or 10 days of omeprazole 20 mg b.d. with the same antibiotic regimen (control). In intent-to-treat patients, the eradication percentages achieved for the rabeprazole-based treatments were: 3-day, 27%; 7-day, 77%; and 10-day, 78%. The eradication percentage with the 10-day omeprazole-based treatment was 73%. There was no statistically significant difference between the 7-day rabeprazole-based regimen and the 10-day rabeprazole- and omeprazole-based regimens. Seven-day therapy for Helicobacter pylori in the United States. Vakil N, Lanza F, Schwartz H, Barth J. University of Wisconsin Medical School, Milwaukee, WI, USA. Aliment Pharmacol Ther. 2004 Jul 1;20(1):99-107  

Ganoderma Helped NSAID Ulcers in Rats: The water-soluble PS fractions from Ganoderma lucidum (Reishi mushroom) have been shown to inhibit indomethacin-induced gastric mucosal lesions in rats. Oral administration of G. lucidum PS at 0.5 and 1.0 g/kg for 2 weeks caused a significant acceleration of acetic acid-induced ulcer healing by 40% and 56% in rats. J Med Food 2004 Winter;7(4):417-21.

Melatonin: Protects Against Alendronate Damage: Protective effect of melatonin and omeprazole against alendronate-induced gastric damage in rats. Each did equally well with pretreatment and attributed to anti-oxidant effect. Sener G, et al. Marmara University, Istanbul, Turkey. Dig Dis Sci. 2005 Aug;50(8):1506-12.

Melatonin: Melatonin Protects Against Piroxicam, Indomethacin-induced Ulcers: This study with piroxicam in rats. Authors says protection probably true for other NSAIDs. Bandyopadhyay D, et al. Indian Institute of Chemical Biology, Kolkata, India. J Pineal Res. 2004 Apr;36(3):195-203; Similar results against indomethacin ulcers. Singh, et al. Indian J Physiol Pharmacol. 2002 Apr;46(2):229-34.

Melatonin: Protects Against Stress-Induced Gastric Ulcers and Helps Ranitidine and Omeprazole: By self did better than ranitidine but not as well as omeprazole in study with rats. D Bandylpadhyay et al. Kolkata, India. J Pineal Res. 2002 Aug;33(1):1-7.

Melatonin: Protects Against Alcohol-Induced Ulcers: Bilici et al. Ataturk University. Turkey. Dig Dis Sci. 2002 Apr;47(4):856-61

Okra Might Help: An extra of sugar-coated proteins from okra prevents H. pylori from clinging to the stomach wall. Cooked okra might even have some benefit. Two European companies are working with Hensel testing the extracts in animals. Andreas Hensel, Univ Dusseldorf, J Agric Food Chem 52:1495, 4/2004.

Peppermint, with Caraway, Licorice, and Lemon Balm Helped Dyspepsia: In a staggered DB PC study of 120 patients with functional dyspepsia of a herbal preparation STW 5-II containing extracts from bitter candy tuft, matricaria flower, peppermint leaves, caraway, licorice root and lemon balm, after 8 weeks 43.3% on active treatment and 3.3% on placebo reported complete relief of symptoms. (p < 0.001). Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Madisch A, Holtmann G, Mayr G, Vinson B, Hotz J. University Hospital Dresden, Germany. Digestion. 2004;69(1):45-52. 

Yogurt Bacteria Lessens Harm: In a Swiss DB PC 16-week, 70-patient study, L. johnsoni fermented milk reduced the severity and activity of antral gastritis was reduced from an inflammatory cell score of 6.0 to 5.3; P=0.04). H. pylori density decreased in the antrum from 4.5 to 4.3 log10 colony forming units; P=0.04). Mucus thickness increased after 16 weeks in the antrum 0.6 vs. -0.2 in controls, P=0.01; and in the corpus: 0.3 vs. -0.6, P=0.03). Favourable effect of regular intake of fermented milk containing Lactobacillus johnsonii on Helicobacter pylori associated gastritis. Pantoflickova D, Corthesy-Theulaz I, Dorta G, Stolte M, Isler P, Rochat F, Enslen M, Blum AL. Aliment Pharmacol Ther. 2003 Oct 15;18(8):805-13

Yogurt Bacteria Helps Kill H. Pylori; Yogurt Better than Bacterial Capsules: In an MD Anderson study, the yeast and lactobacilli found in the yogurt studies formed a hardy symbiotic culture that secrete soluble factors capable of killing H. pylori. These yogurt-derived food preparations could become simple and inexpensive therapies to suppress H. pylori infections. Folk yogurt kills Helicobacter pylori. Oh Y, Osato MS, Han X, Bennett G, Hong WK J Appl Microbiol. 2002;93(6):1083-8; In a Taiwan study of 160 ulcer patients with H. pylori, those taking one week of triple therapy with live lactobacillus and bifidobacterium yogurt had a significantly higher intention-to-treat cure rate than those on triple therapy alone (91% vs. 78%). Impact of supplement with Lactobacillus- and Bifidobacterium-containing yogurt on triple therapy for Helicobacter pylori eradication. Sheu BS, Wu JJ, Lo CY, Wu HW, Chen JH, Lin YS, Lin MD. Aliment Pharmacol Ther. 2002 Sep;16(9):1669-75; However, a Canadian study of 27 asymptomatic women with H. Pylori found that live yogurt consumption alone failed to eradicate the H. pylori in 26 of the 27. Digestion. 2002;65(1):16-20; A literature review found 13 studies, six using just probiotics on 180 patients with two reporting some cures and five encouraging results. In the other seven with 682 patients, probiotics were combined with antibiotics with two aiding the cure rate and four reducing side-effects.  Int J Antimicrob Agents. 2003 Oct;22(4):360-. Yogurt or whole cultures did better than the bacteria alone. 

Zinc: Polaprezinc Protects Rat Stomach Against Indomethacin: Polaprezinc is a chelate compound consisting of zinc and L-carnosine. It has been shown to prevent gastric mucosal injury. In a rat study on indomethacin (IND)-induced apoptosis in a rat gastric mucosal cell line, pretreatment with PZ suppressed caspase-3 activation and subsequent apoptosis in the cells exposed to 500 microM IND in a dose-dependent manner, and 50 microM PZ exhibited the maximum inhibitory effect. Among PZ subcomponents, zinc but not L-carnosine played a pivotal role in this antiapoptotic function. Protection by polaprezinc, an anti-ulcer drug, against indomethacin-induced apoptosis in rat gastric mucosal cells. Fuji Y, et al. Tottori University, Yonago, Japan. Japan J Pharmacol 2000 Sep;84(1):63-70. Ed: It is apparently not possible to purchase this outside of Japan and in Japan only with a prescription despite the fact that it has been around for years. Taking the individual ingredients doesn't have the same benefit as when they are linked together.

Zinc: Polaprezinc and Its Components Speed Healing of Acid-Induced Stomach Ulcers in Rats: In a study with diabetic rats given ulcers with hydrochloric acid, polaprezinc (>10 mg/kg) significantly aided healing as did ZnSO4/7H2O or a mixture of ZnSO4/7H2O and L-carnosine, but not by L-carnosine alone. Polaprezinc exerts a salutary effect on impaired healing of acute gastric lesions in diabetic rats. Korolkiewicz RP, et al.Kyoto Pharmaceutical University, Yamashina, Japan. Dig Dis Sci 2000 Jun;45(6):1200-9.

Thomas E. Radecki, M.D., J.D.

 modern-psychiatry.com