Ayurvedic medicine for stomach ulcers

Most stomach ulcers have a cause that can be found and removed, and one of the two common ones is an infection. That changes what a course of medicine is for: symptom relief and healing support, alongside the treatment that actually clears it.

What causes an ulcer

• Helicobacter pylori, a bacterium that lives in the stomach lining, is the leading cause. It is caught in childhood in many households and sits there for decades.
• Painkillers, the second great cause: ibuprofen, diclofenac, naproxen, high-dose aspirin. The risk climbs with dose, with age, with steroids alongside, and with a previous ulcer.
• Both together are responsible for the overwhelming majority. Everything else is a minority.
• Rarely: excess acid from a gastrin-secreting tumour, severe illness with stress ulceration, crohn's of the stomach, or cancer that has ulcerated.
• Spicy food does not cause ulcers. It makes an existing one hurt. That distinction matters, because people spend years blaming the chilli and never get tested for the bacterium.
• Stress, smoking and alcohol make ulcers more likely to happen and slower to heal, and none of them is a substitute for looking for the two real causes.

How it is diagnosed

• Burning or gnawing pain in the upper abdomen, better or worse with food, waking at night, with a sense of fullness and belching. Typical, but not reliable enough to diagnose on.
• Endoscopy is the test that settles it, and it also allows a biopsy, which is how H. pylori, atrophy and malignancy are found.
• A urea breath test or a stool antigen test finds the infection and is used to confirm it has gone. A blood antibody test says only that you met the bacterium at some point, which is not the same question.
• An ulcer in an older person, or one on the stomach rather than the duodenum, is biopsied. Cancer can look like a benign ulcer, and this is not a detail.

What we prescribe

• Mulethi, licorice, the best-known of the group. Deglycyrrhizinated licorice keeps the soothing effect and drops the blood pressure and potassium problem, and it is what we prefer for anything longer than a fortnight.
• Amla and nisha-amalaki, as gentle supportive preparations with some antioxidant and mucosal work behind them.
• Shankha bhasma and the classical antacid powders, in defined short courses, for the burning between meals. We avoid long-term use of metal-based preparations and we do not use the ones with questionable testing.
• Guduchi where inflammation is the dominant picture.
• Triphala guggulu where the bowel has been sluggish for years alongside, and a bitter preparation such as kutki or bhumyamalaki in small doses for the heavy, bloated feeling after meals.
• Ashwagandha for the sleep and the stress component, which is real and is not the cause.
• A cooling, non-spicy, non-acid diet for the first fortnight, small frequent meals, and no food late at night. This is not the treatment, but it is the difference between a tolerable two weeks and a miserable one.

What the treatment that actually works is

• If H. pylori is present, eradication: a proton-pump inhibitor with two or three antibiotics for a defined course. It is the cure, it works in most people, and it prevents the ulcer and the bleeding from coming back.
• If a painkiller is the cause, stopping it, or if it cannot be stopped, protecting the stomach with a proton-pump inhibitor and using the lowest effective dose, ideally a different class.
• An acid-suppressing course to let the ulcer heal, in the usual time frames: duodenal around four to six weeks, gastric six to eight, sometimes longer.
• A repeat test to confirm the bacterium has gone, and for a gastric ulcer a repeat endoscopy to confirm healing. An ulcer that has not healed is a biopsy question, not a stronger tablet question.
• We do not substitute for any of that, and we do not suggest that anyone decline it.

What herbal medicine will not do

• It will not eradicate H. pylori. Some preparations inhibit the bacterium in a laboratory, which is not the same as clearing an infection from a stomach, and the ulcer and the bleeding return.
• It will not heal an ulcer that is being kept alive by daily ibuprofen.
• It will not treat a cancer that has ulcerated, and this is the reason a persistent symptom must be scoped rather than soothed.
• It will not close a perforation or stop a bleed, and either of those is an emergency.
• Cabbage juice, banana, honey and milk are all soothing and none of them is treatment. Milk in particular was once prescribed for ulcers and is now known to make acid secretion worse.

When to be seen urgently

• Vomiting blood, or material that looks like coffee grounds.
• Black, tarry, sticky stools, or a sudden pale, watery, foul motion with a feeling of faintness. Bleeding does not always announce itself in red.
• Faintness, breathlessness, a racing pulse, or a blood count that has come back low.
• Sudden severe, board-like abdominal pain. That is a perforation and it is an emergency within the hour.
• Pain that goes straight through to the back, which can be a posterior ulcer eroding into the pancreas.
• Vomiting that will not stop, or food that will not pass, which can be an ulcer at the outlet of the stomach that has scarred it shut.
• Difficulty swallowing, loss of weight without trying, a hard lump in the abdomen, or a new change in an older person's symptoms.

The daily part

• No painkillers from the anti-inflammatory group without a doctor knowing, and none at all if there has been a bleed. Paracetamol, used properly, is the safer choice for most people with a history of ulcers.
• Smoking stopped, because it slows healing and raises the recurrence rate.
• Alcohol reduced hard during a healing course.
• Chilli, vinegar, very acidic food, strong tea and coffee in quantity, and late heavy meals kept down while the lining is raw.
• Not lying flat after eating, and giving the last meal a couple of hours before sleep, which helps the pain even where it does not help the ulcer.
• If the whole family has dyspepsia, H. pylori runs in households, and that is worth raising at the consultation rather than treating each person separately for years.

How we judge it

• Symptoms at two weeks and at six, and whether the night pain has gone.
• The test of cure for the infection, which is the number that decides whether this episode is finished.
• A repeat endoscopy for a gastric ulcer, on the schedule the gastroenterologist sets.
• Whether the painkiller has actually been stopped, because that is the part of the plan that is entirely in the patient's hands.