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MoonDragon's Health & Wellness
Disorders

PEPTIC ULCER
(Gastric Ulcer, Duodenal Ulcer)




BASIC INFORMATION


DESCRIPTION

A peptic ulcer, also known as ulcus pepticum, PUD or peptic ulcer disease, is an ulcer (defined as mucosal erosion equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and extremely painful. In simple terms, it is a spot where the lining of the stomach and the tissues beneath, sometimes including part of the stomach muscle itself, have been eroded, leaving an open wound inside the stomach. The surrounding tissue is usually swollen and irritated. Ulcers can occur anywhere along the gastrointestinal tract, but are most common in the stomach (gastric ulcers) and duodenum (duodenal ulcers), the portion of the small intestine closest to the stomach. Contrary to general belief, more peptic ulcers arise in the duodenum than in the stomach.

Peptic ulcers affect approximately 5 million Americans each year, and it is estimated that they will affect approximately 10 percent of the U.S. population at some point in their lives.

PEPTIC ULCER LOCATIONS

A peptic ulcer may arise at various locations:
  • Stomach (called gastric ulcer).
  • Duodenum (called duodenal ulcer).
  • Esophagus (called esophageal ulcer).
  • Meckel's Diverticulum (called Meckel's Diverticulum ulcer).

TYPES OF PEPTIC ULCERS

Type I: Ulcer along the lesser curve of stomach.
Type II: Two ulcers present - one gastric, one duodenal.
Type III: Prepyloric ulcer.
Type IV: Proximal gastresophageal ulcer.





SIGNS & SYMPTOMS

PAIN

Burning pain is the most common peptic ulcer symptom. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area.
  • Chronic burning or gnawing stomach pain is the most common peptic ulcer symptoms. The pain is caused by the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area. It usually begins 45 to 60 minutes after eating or at night and can last for a few minutes to many hours. Gastric ulcer pain is made worse by eating.


  • Pain that is worse when the stomach is empty that is relieved by eating, taking antacids, vomiting, or drinking a large glass of water. Pain becomes worse after around 3 hours after a meal. Duodenal ulcers are classically relieved by food.


  • Pain can often be temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication.


  • Pain may range from mild to severe.


  • Pain may come and go for a few days or weeks.

  • Lower back or chest pain. Pain can be felt anywhere from the navel to the breastbone.


  • Pain may flare up at night causing the individual to waken in the middle of the night.

MoonDragon's Health & Wellness: Abdominal Pain

OTHER POSSIBLE PEPTIC ULCER SYMPTOMS
  • Bloating and abdominal fullness.


  • Itching.


  • Headaches.


  • A choking sensation.


  • Waterbrash (the rush of saliva after an episode of regurgitation to dilute the acid in the esophagus).


  • Nausea and lots of vomiting.


  • Loss of appetite and unexplained weight loss.


  • Vomiting of blood (hematemesis). This can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe and/or continuing vomiting. Blood may appear red or black.


  • Melena (tarry, foul-smelling feces due to oxidized iron from hemoglobin). Dark blood in stools appear black and tarry.


  • Rarely, an ulcer can lead to gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

OTHER RELATED GASTRIC PROBLEMS - HEARTBURN (GERD)

Heartburn can also includes a burning sensation after eating. Heartburn is a burning pain caused by reflux (regurgitation) of the stomach's contents back up the esophagus. The medical term for the condition is gastroesophageal reflux (GERD). The pain is normally felt in the center of the chest or behind the sternum (breastbone). If severe, it can be hard to distinguish from a heart attack.

MoonDragon's Health & Wellness: Heartburn

OTHER RELATED GASTRIC PROBLEMS - INDIGESTION

Indigestion has several causes. Depending on the cause, the symptoms may occur for a short time only, they may return intermittently, or they may be regular and prolonged.

MoonDragon's Health & Wellness: Indigestion

CONTACTING YOUR HEALTH CARE PROVIDER

There are certain symptoms that could be associated with a serious underlying condition such as an ulcer or occasionally cancer. Anyone experiencing any of the following symptoms in addition to indigestion should consult their health care provider.
  • Symptoms continue after 2 weeks, or get worse, even after home treatment and change of diet.
  • Unintended weight loss.
  • Severe pain.
  • New symptoms in anyone over 45 years old who has not previously suffered any indigestion problems.

Urgent medical treatment is needed for anyone who experiences the following symptoms:
  • Vomiting with specks of blood or blood that looks like coffee-grounds.
  • Vomiting fresh, red blood.





CAUSES

Too much stress, too much spicy food, and you may be headed for an ulcer - that was the way the thinking used to go. Peptic ulcers are open sores that develop on the inside lining of your stomach, upper small intestine or esophagus. Not long ago, the common belief was that peptic ulcers were a result of lifestyle. Health care providers now know that a bacterial infection or some medications, not stress or diet, cause most ulcers of the stomach and upper part of the small intestine (duodenum). Esophageal ulcers also may occur and are typically associated with the reflux of stomach acid. Peptic ulcers are common, and oftentimes successful treatment of peptic ulcers takes just a few weeks.

Depending on their location, the most common peptic ulcers have different names:
  • The Gastric Ulcer: This is a peptic ulcer that occurs in your stomach.


  • The Duodenal Ulcer: This type of peptic ulcer develops in the first part of the small intestine (duodenum).


  • The Esophageal Ulcer: An esophageal ulcer is usually located in the lower section of your esophagus. It's often associated with chronic gastroesophageal reflux disease (GERD).

peptic ulcer types


The stomach produces a strong acid (hydrochloric [HCl] acid ) that helps digest food and protects against infection. A layer of mucus lines the stomach, esophagus and intestines to act as a barrier against this acid. If the mucus layer is damaged, acid can irritate the underlying tissues.

An ulcer results when the lining of the stomach fails to provide adequate protection against the effect of digestive acids and enzymes, which, in effect, start to digest the stomach itself. This may be caused by an excess of stomach acid, insufficient production of protective mucus, or both.

Many factors affect the secretion of stomach acid and contribute or are risk factors for developing a peptic ulcer.
    H. PYLORI INFECTION

    It was once believed that stress, anxiety and spicy foods were the main causes of peptic ulcers. However, evidence has shown ulcers to be the result of infection with a common type of bacteria combined with the presence of stomach acid. Helicobacter pylori (H. pylori) is a spiral-shaped bacterium, which lives in the acidic environment of the stomach and on the mucus layer of the stomach and small intestine, where it can cause damage to the lining and also to the mucous layer that protects the lining from digestive acids resulting in irritation (gastritis).

    H. pylori lives and multiplies within the mucous layer that covers and protects tissues that line the stomach and small intestine. Often, H. pylori causes no problems. But sometimes it can disrupt the mucous layer and inflame the lining of the stomach or duodenum, producing an ulcer. One reason may be that people who develop peptic ulcers already have damage to the lining of the stomach or small intestine, making it easier for bacteria to invade and inflame tissues.

    H. pylori is present in about half the population, often without causing any symptoms. H. pylori is a common gastrointestinal infection around the world. In the United States, 1 in 5 people younger than 30 and half the people older than 60 are infected. Although it is not clear exactly how H. pylori spreads, many health care professionals believe that the bacteria are transmitted from person to person through close contact, such as kissing. People may also contract H. pylori through food and water.

    This organism is almost always found in people who suffer from a stomach ulcer and is seldom found in persons who do not. As much as 80 percent of ulcers are associated with H. pylori infection. However, only 20 percent of those cases go to a health care provider.

    About 15 percent of people who carry the H. pylori organism will go on to develop an ulcer. Eradication of these bacteria often results in healing of the ulcers.

    H. Pylori may also be a risk factor for stomach cancer. About 4 percent of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to make sure. Duodenal ulcers are generally benign.

    The presence of H. pylori can be documented by direct biopsy of the stomach lining, by a blood test, or by a breath test.

    H. pylori is the most common, but not the only, cause of peptic ulcers.

    STRESS & ANXIETY

    Despite the finding that a bacterial infection is the cause of ulcers in 80 percent of cases, bacterial infection does not appear to explain all ulcers and researchers continue to look at stress as a possible cause, or at least a complication in the development of ulcers.

    Many health care providers still consider stress and anxiety to be a risk factor for ulcers as it causes an increase in stomach acid production. Although stress is not a cause of peptic ulcers, it is a contributing factor. Stress may aggravate symptoms of peptic ulcers and, in some cases, delay healing.

    An expert panel convened by the Academy of Behavioral Medicine research concluded that ulcers are not purely an infectious disease and that psychological factors do play a significant role. Researchers are examining how stress might promote H. pylori infection. For example, Helicobacter pylori thrives in an acidic environment, and stress has been demonstrated to cause the production of excess stomach acid.

    A study of peptic ulcer patients in a Thai hospital showed that chronic stress was strongly associated with an increased risk of peptic ulcer, and a combination of chronic stress and irregular mealtimes was a significant risk factor.

    A study on mice showed that both long-term water-immersion-restraint stress and H. pylori infection were independently associated with the development of peptic ulcers.

    A person may undergo stress for a number of reasons such as an emotionally disturbing circumstance or event, surgery, or a physical trauma, such as a burn or other severe injury. Burns and head trauma, can lead to "stress ulcers", and it is reported in many patients who are on mechanical ventilation. There is ongoing debate as to whether Stress in the psychological sense can influence the development of peptic ulcers.

    NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

    Taking aspirin or non-steroidal anti-inflammatory drugs that inhibit cyclooxygenase, especially if taken over a long period of time, can increase stomach acid and lead to ulcers. Regular use of pain relievers. Non-steroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine. The medications are available both by prescription and over-the-counter. Non-prescription NSAIDs include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) and ketoprofen (Orudis KT). To help avoid digestive upset, take NSAIDs with meals.

    The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block (inhibit) the production and function of cyclooxygenase-1 (cox-1), which is essential for the production of these prostaglandins. These hormone-like substances help protect your stomach lining from chemical and physical injury. Without this protection, stomach acid can erode the lining, causing bleeding and ulcers.

    Newer NSAIDs (celecoxib, rofecoxib) only inhibit cox-2, which is less essential in the gastric mucosa, and roughly halve the risk of NSAID-related gastric ulceration. As the prevalence of H. pylori-caused ulceration declines in the Western world due to increased medical treatment, a greater proportion of ulcers will be due to increasing NSAID use among individuals with pain syndromes as well as the growth of aging populations that develop arthritis.

    ANTIBIOTIC OVERUSE

    Overzealous use of antibiotics is not recommended. Antibiotic therapy is often used to treat bacterial infections including H. pylori bacterial infections (major cause of peptic ulcers). Antibiotics should only be used when absolutely necessary and only for the amount of time it takes to eliminate the infection. Antibiotics are notorious for killing off not only invasive organisms, but also friendly bacteria required for the proper function of the digestive tract. If you must use an antibiotic, be sure to replace friendly bacteria in the gut by using a quality acidophilus/bifidus supplement and/or eat yogurt with live cultures.

    STEROID MEDICATIONS

  • Steroids, such as those taken for arthritis can contribute to stomach ulcers. Most glucocorticoids (e.g. dexamethsone and prednisolone) can raise suspicion for peptic ulcer. Glucocorticoids lead to atrophy of all epithelial tissues. Their role in ulcerogenesis is relatively small.

    DIET & NUTRITIONAL SUPPLEMENTS

  • Vitamin C (ascorbic acid) supplements may contribute to or aggravate existing stomach ulcers, especially if taken in megadoses over a long period of time. If you are prone to peptic ulcers, take your vitamin C in a buffered form do not take it on an empty stomach. If you have problems with any nutritional supplement, even those taken with food, discontinue using them and discuss your options with your health care provider or nutritionist.


  • Alcohol consumption. Alcohol is irritating to the digestive tract. Excessive alcohol consumption can irritate and erode the mucous lining of your stomach and increases the amount of stomach acid that is produced. It is uncertain, however, whether this alone can progress into an ulcer or whether other contributing factors must be present, such as H. pylori bacteria or ulcer-causing medications, such as NSAIDs.


  • Coffee, rich foods, fatty foods, spicy foods can irritate a sensitive stomach or an existing peptic ulcer. If you have problems with peptic ulcers, avoid these foods in your diet.


  • OTHER CONTRIBUTING RISK FACTORS

  • Heavy smokers are more prone to developing ulcers, and have greater trouble getting ulcers to heal. Smoking leads to atherosclerosis and vascular spasms, causing vascular insufficiency and promoting the development of ulcers through ischemia. Nicotine in tobacco increases the volume and concentration of stomach acid, increasing your risk of an ulcer.


  • Genetic predisposition to excessive acid secretion. Having a family history of peptic ulcer disease also increases your risk. A family history is often present in duodenal ulcers, especially when blood group Type O is also present. Type O blood group people are more prone to duodenal ulcers. Type A blood group people are more prone to develop cancerous gastric ulcers. Inheritance appears to be unimportant in gastric ulcers.


  • A history of chronic heartburn, gastroesophageal reflux (GERD) can raise the suspicion for peptic ulcer.


  • African-Americans and Latinos are twice as likely as Caucasians to have ulcers.

  • Elderly people are more affected. Duodenal ulcers are more common in males and usually occurs between 40 and 50 years of age. Gastric ulcers are common between 60 and 70 years of age. People over 45 with more than 2 weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation.

    RARE CAUSES OR CONDITIONS

    Rare causes of peptic ulcers or unusual cases or conditions other than H. pylori infection or medications, include:

  • Gastrinomas (Zollinger Ellison syndrome), a condition of rare gastrin-secreting tumors in the pancreas that cause multiple and difficult-to-heal ulcers. Zollinger-Ellison syndrome is a tumor in the pancreas (a gastrinoma) that secretes excessive levels of a hormone called gastrin, which stimulates gastric acid production, leading to severe and usually recurrent peptic ulcer disease.


  • Peptic ulcers of the stomach or duodenum may also be associated with certain viral infections (e.g. cytomegalovirus, herpes simplex virus type I), radiation therapy to the abdominal region, treatment with certain anti-cancer drugs (chemotherapy), or other factors.

If left untreated, ulcers can cause internal bleeding or perforation of the stomach or small intestine. See Complications (below) for more information.





peptic ulcer emergencies


PEPTIC ULCER COMPLICATIONS

  • Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life threatening. It occurs when the ulcer erodes one of the blood vessels. Anemia may result from loss of blood.


  • Perforation (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation at the anterior surface of stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis; pain in this situation often radiates to back.


  • Penetration is when the ulcer continues into adjacent organs such as liver and pancreas.


  • Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. Scar tissue can obstruct passage of food through the digestive tract, causing the person to become full easily, to vomit and to lose weight. Patient often presents with severe vomiting.


  • Pyloric stenosis. This is involuntary constriction of the pyloric valve leading from the stomach to the small intestine.


  • Peptic ulcers can also result in pancreatic problems or stomach cancer.





  • PREVENTION

    There is no proven way to prevent peptic ulcer disease. But several lifestyle changes may reduce the risk of ulcers.

  • Curb NSAID Use: NSAIDs (non-steroidal anti-inflammatory drugs) appear to cause ulcers by inhibiting the body's production of prostaglandins, hormones that protect the stomach lining. If possible, avoid these drugs or use the lowest possible dose for the shortest possible time. Package labeling on most NSAIDs recommends using the drugs for no longer than 10 days in a row. If you feel you need to control pain longer, discuss the treatment with your health care provider.


  • Get Tested For H. Pylori: If you are over 60 years old, have previously had an ulcer, or have a family history of ulcers, you should ask your health care provider about being tested for infection with the bacterium, a major cause of ulcers. It is estimated that half of the United States population older than 60 has been infected. There are several tests for H. pylori, and you and your health care provider can decide which is best for you.


  • Stop Smoking: Smokers are about two times as likely to develop ulcers as non-smokers. Cigarette smoking may increase susceptibility to H. pylori, provide a more favorable milieu for the bacteria to thrive, or diminish gastric mucosal defenses.


  • MoonDragon's Health Therapy: Smoking Cessation

  • Reduce Stress: There is conflicting evidence about the role of psychological stress in peptic ulcer disease; it may exacerbate ulcers rather than cause them. Acute stress increases pulse rate, blood pressure, and anxiety, yet only in patients with duodenal ulcers has stress been shown to increase acid secretion. Relaxation exercises, meditation, and other stress-reducing strategies have been shown to reduce blood pressure and slow heart rate. While they may not prevent ulcer formation, they remain sound wellness practices.


  • MoonDragon's Health Therapy: Relaxation Techniques & Therapy

  • Watch Alcohol Intake: Alcohol, like smoking, is known to worsen ulcers and aggravate pain because alcohol can irritate the stomach lining.


  • RELATED DIGESTIVE DISORDER LINKS

    MoonDragon's Health & Wellness: Abdominal Pain

    MoonDragon's Health & Wellness: Alcoholism

    MoonDragon's Health & Wellness: Allergies

    MoonDragon's Health & Wellness: Anxiety Disorder

    MoonDragon's Health & Wellness: Appetite, Poor

    MoonDragon's Health & Wellness: Celiac Disease

    MoonDragon's Health & Wellness: Crohn's Disease

    MoonDragon's Health & Wellness: Diarrhea

    MoonDragon's Health & Wellness: Diverticulitis

    MoonDragon's Health & Wellness: Flatulence (Gas)

    MoonDragon's Health & Wellness: Food Poisoning

    MoonDragon's Health & Wellness: Gall Bladder Disease

    MoonDragon's Health & Wellness: Heartburn

    MoonDragon's Health & Wellness: Hiatal Hernia

    MoonDragon's Health & Wellness: Indigestion

    MoonDragon's Health & Wellness: Irritable Bowel

    MoonDragon's Health & Wellness: Lactose Intolerance

    MoonDragon's Health & Wellness: Malabsorption Disorders

    MoonDragon's Health & Wellness: Ulcerative Colitis




    TREATMENT


    STOMACH ACID SELF-TEST

    Hydrochloric acid (HCl), which is produced by glands in the stomach, is necessary for the breakdown and digestion of many foods. Insufficient amounts of HCl can lead to indigestion. HCl levels often decline with age.

    You can determine if you need more hydrochloric acid with this simple test. Take a tablespoon of apple cider vinegar or lemon juice. If this makes your indigestion go away, then you need more stomach acid. If it makes your symptoms worse, then you have too much acid, and you should take care not to take any supplements that contain HCl.





    h. pylori at work


    DIAGNOSIS

    Digestion is a highly complicated process dependent upon many factors. Hydrochloric acid (HCl), enzymes and bile are crucial. If any of these are lacking, digestion will be incomplete and result in bloating, nausea, and digestive upset. If there is a deficiency of healthy intestinal bacteria, as a result of antibiotic use for instance, digestion will also be poor. This deficiency must be re-balanced for proper digestion.

    It is helpful to provide your health care provider with a precise description of the discomfort you are experiencing. In describing the symptoms, try to define where in the abdomen the discomfort usually occurs. Simply reporting indigestion as pain in the stomach is not detailed enough for your health care provider to help identify and treat your problem.

    MEDICAL HISTORY

    The medical history will be obtained and a physical examination performed. Medical history questions documenting digestive symptoms in detail may include:
    • Aggravating factors.
    • Does it begin (or is it worse) after eating particular foods?
    • Does it begin (or is it worse) after drinking wine or other alcoholic drinks or carbonated drinks?
    • Eating habits.
    • Do you eat fast?
    • Have you been overeating?
    • Have you changed your diet? Particularly, have you had any spicy foods, high-fiber foods, or fatty foods? Have you increased your intake of caffeine or alcohol?
    • Medications: What medications are you taking? Have you changed medications recently?
    • Other symptoms: What other symptoms are occurring at the same time? Is there abdominal pain? Is there vomiting?

    The physical examination will probably include emphasis on the abdominal region and digestive system.

    The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid is secreted, or after the meal, as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal - when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice.

    MINIMALLY INVASIVE DIAGNOSTIC TESTS

    To diagnose digestive problems, your health care provider must first rule out any underlying conditions such as ulcers. The laboratory diagnosis of peptic ulcers caused by H. pylori can be performed using a variety of different methods and specimen types. Diagnostic tests that may be performed include:

  • Blood Tests: The most common laboratory test for diagnosing peptic ulcers is a blood test for the presence of antibodies to H. pylori. Measurement of antibody levels in blood does not require EGD. The presence of H. pylori antibodies means you have been infected at some time with this organism. It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy. A disadvantage of this test is that it sometimes can not differentiate between past exposure and current infection. After H. pylori bacteria have been eradicated, you may still have a positive result for many months.


  • Urea Breath Test: A breath test is also available that detects the enzyme activity of H. pylori. This procedure uses a radioactive carbon atom to detect H. pylori. First, you blow into a small plastic bag, which is then sealed. Then, you drink a small glass of clear, tasteless liquid. The liquid contains radioactive carbon as part of a substance (urea) that will be broken down by H. pylori. Thirty minutes later, you blow into a second bag, which also is sealed. If you are infected with H. pylori, your second breath sample will contain the radioactive carbon in the form of carbon dioxide. The urea breath test is non-invasive and does not require EGD. The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori, detecting when the bacteria have been killed or eradicated. With the blood test, H. pylori antibodies may sometimes still be present a year or more after the infection is gone.


  • Stool Antigen Test: This test checks for H. pylori in stool samples. It is useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment. A stool sample may be collected to look for the H. pylori antigen; however, this test is not appropriate for individuals who have blood in their stool.


  • INVASIVE DIAGNOSTIC TESTS

  • Upper GI & Small Bowel X-ray: An upper gastrointestinal (upper GI) X-ray may be performed to check for a peptic ulcer. Your health care provider may begin with this test, which outlines your esophagus, stomach and duodenum. During the X-ray, you swallow a white, metallic liquid (containing barium) that coats your digestive tract and makes an ulcer more visible. An upper GI X-ray can detect some ulcers, but not all. Barium x-ray is done to spot the ulcer.


  • If a peptic ulcer perforates, air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to "free gas" within the peritoneal cavity. If the patient stands erect, as when having a chest X-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.

  • Endoscopy (EGD): An esophagogastroduodenoscopy (EGD), is a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. This procedure may follow an upper GI X-ray if the X-ray suggests a possible ulcer, or you health care provider may perform the endoscopy first.

    Your health care provider may also use an instrument to look closely at the inside of the stomach, referred to as an endoscope. An endoscope is a flexible tube that contains a light and a camera to produce images of the stomach and intestines in a procedure called endoscopy. A gastroscopy is a similar procedure used to evaluate just the inside of the stomach.

    In this more sensitive procedure, a long, narrow tube with an attached camera is fed through your mouth, threaded down your throat and esophagus into your stomach and duodenum. With this instrument, your health care provider can view your upper digestive tract and identify an ulcer.

    If tissue is removed from the stomach during the endoscopy (a biopsy), it may be examined in the lab for the presence of active H. pylori infection and associated stomach damage (gastritis).
      Macroscopical Appearance: Gastric ulcers are most often localized on the lesser curvature of the stomach. The ulcer is a round to oval parietal defect ("hole"), 2 to 4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular in the acute form of peptic ulcer, regular but with elevated borders and inflammatory surrounding in the chronic form. In the ulcerative form of gastric cancer the borders are irregular. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.

      Microscopical Appearance: A gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria, produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis.

    EGD TISSUE BIOPSY

    If your health care provider detects an ulcer, he or she may remove small tissue samples (biopsy) near the ulcer. These samples are examined under a microscope to rule out cancer. A biopsy can also identify the presence of H. pylori in your stomach lining. Depending on where the ulcer is found, your health care provider may recommend a repeat endoscopy after two to three months to confirm that the ulcer is healing.

    Histological examination and staining of an EGD biopsy is done microscopically. The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. This is especially true in ulcers of the greater (large) curvature of the stomach; most are also a consequence of chronic H. pylori infection.

  • Direct Culture From Biopsy: The diagnosis of H. pylori can be made by Direct culture from an EGD biopsy specimen; this is difficult to do, and can be expensive. Many labs are not set up to perform H. pylori cultures.


  • Rapid Urease Test: Direct detection of urease activity in a biopsy specimen by rapid urease test.


  • If these tests cannot diagnose the digestive problem, ultrasound, a CT or MRI scan or heart tests may be used to look at the other organs such as the liver, heart, gallbladder, pancreas, bowels or kidneys.

    Peptic ulcers are rarely fatal, but if they penetrate the stomach or duodenal wall (perforation), break a blood vessel (hemorrhage), or block food leaving the stomach (obstruction), they can be very serious. Treatment usually involves a combination of antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced.

    Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery or injection.





    CONVENTIONAL MEDICAL TREATMENT

    DRUG TREATMENT

    Non-Prescription Medicines: A range of indigestion treatments can be bought from the pharmacy without a prescription. These include:
    • Antacids: These can be taken in either in liquid or tablet form. They often contain chalky compounds that work by neutralizing the stomach acid. Some antacids contain an ingredient called an alginate which forms a barrier that floats on the top of the stomach contents to prevent them splashing back up into the gullet, thus preventing heartburn and reflux symptoms. Others contain magnesium or aluminum. Side-effects of antacids can include looseness of the bowels and constipation. Many of the popular antacids brands contain a mixture of more than one active ingredient. Examples of antacids brands include Rennies and Gaviscon. See Aluminum Toxicity regarding antacids.


    • H2 Antagonists: If antacids do not work, or if large quantities of antacid are needed, a pharmacist may recommend a more powerful medication. One group of more powerful drugs that can be bought at a pharmacy is known as H2 blockers. They work by reducing the amount of acid produced by the stomach. Examples are famotidine (contained in Pepcidtwo) and ranitidine (Zantac).

    Prescription-Only Medicines: If symptoms continue, your health care provider can prescribe another type of drug called proton pump inhibitors, which also work by reducing acid production. Examples are omeprazole (Losec) and lansoprazole (Zoton).

    Other Medications work by coating the stomach lining, to protect it against the acid-attack. These include bismuth, sucralfate or carbenoxolone.

  • Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. Bismuth compounds may actually reduce or even clear organisms.


  • Patients who are taking non-steroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs.

    helicobacter pylori bacteria


    H. PYLORI TREATMENT

    H. pylori can be treated with "triple therapy" which aims to kill off the bacterial infection. This is usually a one-week course of a proton pump inhibitor combined with two different antibiotics.

    When H. pylori infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. Clarithromycin, Amoxicillin, Tetracycline, Metronidazole) and 1 proton pump inhibitor (PPI), sometimes together with a bismuth compound. In complicated, treatment-resistant cases, 3 antibiotics (e.g. amoxicillin plus clarithromycin plus metronidazole) may be used together with a PPI and sometimes with bismuth compound. An effective first-line therapy for uncomplicated cases would be Amoxicillin plus Metronidazole plus Rabeprazole (a PPI). In the absence of H. pylori, long-term higher dose PPIs are often used.

    Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete.

    TYPES OF MEDICATIONS

    Accomplishing treatment goals requires the use of at least two, and sometimes three or four, of the following medications:
      Antibiotic Medications: Health care providers use combinations of antibiotics to treat H. pylori because one antibiotic alone is not sufficient to kill the organism. For the treatment to work, it's essential that you follow your health care providers instructions precisely. Antibiotics commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil), clarithromycin (Biaxin) and metronidazole (Flagyl). Some companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent specifically for treatment of H. pylori infection. These combination treatments are sold under the names Prevpac and Helidac. You will likely need to take antibiotics for two weeks, depending on their type and number. Other medications prescribed in conjunction with antibiotics generally are taken for a longer period.

      Acid Blockers: Acid blockers - also called histamine (H-2) blockers - reduce the amount of hydrochloric acid released into your digestive tract, which relieves ulcer pain and encourages healing. Acid blockers work by keeping histamine from reaching histamine receptors. Histamine is a substance normally present in your body. When it reacts with histamine receptors, the receptors signal acid-secreting cells in your stomach to release hydrochloric acid. Available by prescription or over-the-counter (OTC), acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid).

      Antacids: Your health care provider may include an antacid in your drug regimen. An antacid may be taken in addition to an acid blocker or in place of one. Instead of reducing acid secretion, antacids neutralize existing stomach acid and can provide rapid pain relief.

      Proton Pump Inhibitors: Another way to reduce stomach acid is to shut down the "pumps" within acid-secreting cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. These drugs include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). The drug pantoprozole (Protonix) can be taken orally or administered intravenously in the hospital. Proton pump inhibitors are frequently prescribed to promote the healing of peptic ulcers. If you are admitted to the hospital with a bleeding ulcer, taking intravenous proton pump inhibitors decreases the chance that bleeding will recur. Proton pump inhibitors also appear to inhibit H. pylori. However, long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip fracture.

      Cytoprotective Agents: In some cases, your health care provider may prescribe these medications that help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). Another non-prescription cytoprotective agent is bismuth subsalicylate (Pepto-Bismol). In addition to protecting the lining of your stomach and intestines, bismuth preparations appear to inhibit H. pylori activity.

    If H. pylori is not identified in your system, then it is likely that your ulcer is due to NSAIDs - which you should quit using, if possible - or acid reflux, which can cause esophageal ulcers. In both cases, your health care provider will try to reduce acid levels - through use of acid blockers, antacids or proton pump inhibitors - and may also have you use cytoprotective drugs.

    ULCERS THAT FAIL TO HEAL

    Peptic ulcers that do not heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal. Not taking medications according to directions is one reason. Another is that some types of H. pylori are resistant to antibiotics. Other factors that can interfere with the healing process include regular use of tobacco, alcohol or non-steroidal anti-inflammatory drugs (NSAIDs). Sometimes the problem is accidental: People are unaware that a medication they are taking contains an NSAID.

    In rare cases, refractory ulcers may be a result of:
    • Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome.
    • An infection other than H. pylori.
    • Stomach cancer.
    • Other digestive diseases, including Crohn's disease or cancer.

    Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with stronger doses of ulcer medications. Sometimes, additional medications may be included. Surgery to help heal an ulcer is necessary only when the ulcer does not respond to aggressive drug treatment.


    MEDICINES USED TO TREAT STOMACH ACID

    ANTACIDS
    Medications Manufacturer Main use
    Actonorm gel Wallace Manufacturing Indigestion (dyspepsia)
    Algicon Rhone-Poulenc Rorer Heartburn
    Alka-Seltzer original Bayer Headache and upset stomach
    Alka-Seltzer XS Bayer Headache and upset stomach
    Altacite Peckforton Indigestion
    Altacite Plus Peckforton Indigestion
    Alu Cap 3M Indigestion
    Aludrox Tablets Pfizer Consumer Healthcare Indigestion (dyspepsia)
    Aluminium hydroxide Non-proprietary Indigestion
    Aluminium hydroxide 3M Indigestion
    Aluminium hydroxide, magnesium hydroxide, simethicone Rhone-Poulenc Rorer Heartburn
    Aluminium hydroxide-magnesium carbonate co-dried gel, magnesium hydroxide Pfizer Consumer Healthcare Indigestion (dyspepsia)
    Andrews Antacid Fruit Flavor GlaxoSmithKline Consumer Healthcare Heartburn
    Asilone Antacid Liquid Seton Scholl Healthcare Indigestion (dyspepsia)
    Asilone Heartburn Liquid Seton Scholl Healthcare Heartburn
    Asilone Heartburn Tablets Seton Scholl Healthcare Heartburn
    Bismag Tablets Wyeth Consumer Healthcare Heartburn
    Bisodol extra strong mint tablets Forest Laboratories Heartburn
    Bisodol heartburn relief tablets Forest Laboratories Heartburn
    Bisodol indigestion relief powder Forest Laboratories Heartburn
    Bisodol indigestion relief tablets Forest Laboratories Heartburn
    Bisodol wind relief tablets Forest Laboratories Heartburn
    Calcium carbonate antacids Roche Consumer Health
    GlaxoSmithKline Consumer Healthcare
    SSL International
    Indigestion
    Carbenoxolone Sodium Sanofi-Synthelabo Reflux esophagitis
    Gaviscon Advance Reckitt & Colman Heartburn
    Gaviscon Infant Reckitt & Colman Gastro-esophageal reflux disease
    Gaviscon Liquid Reckitt & Colman Heartburn
    Gaviscon Tablets Reckitt & Colman Heartburn
    Hydrotalcite Peckforton Indigestion
    Infacol Pharmax Abdominal pain
    Jaaps Health Salts Roche Consumer Health Heartburn
    Maalox plus suspension Aventis Pharmaceuticals Heartburn
    Maalox suspension Aventis Pharmaceuticals Indigestion
    Magnesium carbonate co-dried gel, magnesium hydroxide, aluminum hydroxide Pfizer Consumer Healthcare Indigestion (dyspepsia)
    Magnesium hydroxide, aluminum hydroxide, simethicone Rhone-Poulenc Rorer Heartburn
    Magnesium hydroxide, aluminum hydroxide-magnesium carbonate co-dried gel Pfizer Consumer Healthcare Indigestion (dyspepsia)
    Magnesium Trisilicate Mixture BP Adams Indigestion
    Magnesium Trisilicate Tablets BP Regent-GM Laboratories Ltd Indigestion
    Mucaine (discontinued in the UK - May 2002) Wyeth Pharmaceuticals Inflammation of the esophagus
    Nulacin Goldshield Heartburn
    Opas Co-Pharma Heartburn
    Pepcidtwo Johnson & Johnson, MSD Indigestion
    Heartburn
    Peptac Liquid IVAX Heartburn
    Pepto-Bismol Procter & Gamble Indigestion (dyspepsia)
    Pyrogastrone Liquid (discontinued in the UK - July 2002) Sanofi-Synthelabo Reflux esophagitis
    Pyrogastrone Tablets Sanofi-Synthelabo Reflux esophagitis
    Remegel SSL International Indigestion
    Remegel Wind Relief SSL International Indigestion
    Wind
    Rennie deflatine Roche Consumer Health Heartburn
    Rennie digestif Roche Consumer Health Heartburn
    Rennie duo Roche Consumer Health Heartburn
    Rennie rap-eze Roche Consumer Health Indigestion
    Rennie soft chews Roche Consumer Health Indigestion
    Resolve Extra SSL International Headache and upset stomach
    Setlers antacid GlaxoSmithKline Consumer Healthcare Indigestion
    Simethicone, aluminum hydroxide, magnesium hydroxide Rhone-Poulenc Rorer Heartburn
    Sodium Bicarbonate Tablets IVAX Indigestion (dyspepsia)
    Topal Ceuta Healthcare Heartburn
    Tums GlaxoSmithKline Consumer Healthcare Indigestion


    H2 ANTAGONISTS
    Medications Manufacturer Main use
    Axid Lilly Stomach and duodenal ulcers
    Cimetidine Tablets Non-proprietary Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Dumoran Dumex Stomach and duodenal ulcers
    Dyspamet Chewtab Tablets GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Dyspamet Suspension GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Famotidine Non-proprietary Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Histac Ranbaxy Stomach and duodenal ulcers
    Nizatidine Non-proprietary Stomach and duodenal ulcers
    Pepcid Merck Sharp & Dohme Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Pepcidtwo Johnson & Johnson, MSD Indigestion
    Heartburn
    Pylorid GlaxoSmithKline Stomach and duodenal ulcers
    Raciran Opus Stomach and duodenal ulcers
    Ranitic Tillomed Stomach and duodenal ulcers
    Ranitidine bismuth citrate GlaxoSmithKline Stomach and duodenal ulcers
    Ranitidine hydrochloride (150mg or 300mg tablets) Non-proprietary Stomach and duodenal ulcers
    Ranitidine hydrochloride (75mg tablets) Eastern
    GlaxoSmithKline Consumer Healthcare
    Indigestion
    Heartburn
    Ranitidine oral solution Rosemont Stomach and duodenal ulcers
    Ranitil Tillomed Stomach and duodenal ulcers
    Rantec Berk Stomach and duodenal ulcers
    Ranzac Eastern Indigestion
    Heartburn
    Tagamet Effervescent Tablets GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Tagamet Injection GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Tagamet Syrup GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Tagamet Tablets GlaxoSmithKline Stomach and duodenal ulcers
    Gastro-esophageal reflux disease
    Zaedoc Ashbourne Stomach and duodenal ulcers
    Zantac 150mg or 300mg tablets GlaxoSmithKline Stomach and duodenal ulcers
    Zantac 75 GlaxoSmithKline Consumer Healthcare Indigestion
    Heartburn
    Zantac 75 dissolve GlaxoSmithKline Consumer Healthcare Indigestion
    Heartburn
    Zantac 75 relief GlaxoSmithKline Consumer Healthcare Indigestion
    Heartburn
    Zantac 75 relief dissolve GlaxoSmithKline Consumer Healthcare Indigestion
    Heartburn
    Zantac syrup GlaxoSmithKline Stomach and duodenal ulcers
    Zinga (discontinued in the UK - August 2003) Ashbourne Stomach and duodenal ulcers


    PROTON PUMP INHIBITORS
    Medications Manufacturer Main use
    Exomeprazole AstraZeneca Stomach and duodenal ulcers
    Acid Reflux
    HeliClear Wyeth Pharmaceuticals Duodenal ulcers
    HeliMet Wyeth Pharmaceuticals Duodenal ulcers
    Lansoprazole Wyeth Pharmaceuticals Stomach and duodenal ulcers
    Losec AstraZeneca Stomach and duodenal ulcers
    Nexium AstraZeneca Stomach and duodenal ulcers
    Acid reflux
    Omeprazole Non-proprietary Stomach and duodenal ulcers
    Omeprazole (non-prescription) GlazoSmithKline Consumer Healthcare Heartburn
    Pantoprazole Injection Knoll Stomach and duodenal ulcers
    Pantoprazole Tablets Knoll Stomach and duodenal ulcers
    Pariet Eisai, Janssen-Cilag Stomach and duodenal ulcers
    Protium Injection Knoll Stomach and duodenal ulcers
    Protium Tablets Knoll Stomach and duodenal ulcers
    Rabeprazole sodium Eisai, Janssen-Cilag Stomach and duodenal ulcers
    Zanprol GlaxoSmithKline Consumer Healthcare Heartburn
    Zoton capsules Wyeth Pharmaceuticals Stomach and duodenal ulcers
    Zoton FasTab Wyeth Pharmaceuticals Stomach and duodenal ulcers
    Zoton suspension Wyeth Pharmaceuticals Stomach and duodenal ulcers


    OTHER MEDICINES FOR EXCESS STOMACH ACIDS
    Medications Manufacturer Main use
    Carbenoxolone Sanofi-Synthelabo Reflux esophagitis
    Pyrogastrone Liquid (discontinued in the UK - July 2002) Sanofi-Synthelabo Reflux esophagitis
    Pyrogastrone Tablets Sanofi-Synthelabo Reflux esophagitis
    Remegel Wind Relief SSL International Indigestion
    Wind (Gas)
    Woodward's Colic Drops Seton Scholl Abdominal Pain


    People experiencing digestive problems gobble up antacid tablets by the ton every day in the United States. An occasional antacid tablet to relieve stomach upset is harmless, but to take antacid tablets constantly, week after week, is asking for trouble. Health care providers have found that phosphorus depletion can result from frequent antacids not of a dietary nature. These cannot be absorbed. Bones are the "storehouse" for phosphorus, but when this mineral is inadequately supplied, the bones are in danger of becoming soft or brittle. Many over-the-counter antacids, liquid or tablet, contain either or both, magnesium hydroxide and aluminum hydroxide. Neither can be digested by human stomachs. The fully absorbable magnesium mineral which occurs naturally in various foods and plants is so valuable to human nutrition. These 2 hydroxides can bind gastrointestinal absorption of phosphorus resulting in a state of debility characterized by weakness, anorexia or loss of appetite, and a feeling of being ill (malaise). Mother Nature, the true alchemist, can provide the treasures of her plant kingdom to neutralize acidity gently, safely, and effectively.




    DIETARY & HOLISTIC RECOMMENDATIONS


    LIFESTYLE RECOMMENDATIONS

  • Before the discovery of H. pylori, health care providers often advised people with ulcers to eat a restricted diet and reduce the amount of stress in their lives. Now that food and stress have been eliminated as direct causes of ulcers, these factors are no longer of as much importance. However, while an ulcer is healing, it is still advisable to watch what you eat and to control stress. Acidic or spicy foods may increase ulcer pain. The same is true for stress. Stress may increase acid and slow digestion, allowing food and digestive acid to remain in your stomach and intestines for a longer period. If stress is severe, it may delay the healing of an ulcer.

  • Control acid reflux. If you have an esophageal ulcer - usually associated with acid reflux - you can take several steps to help manage acid reflux. These include avoiding spicy and fatty foods, avoiding reclining after meals for at least three hours, raising the head of your bed and reducing your weight. Avoiding smoking, alcohol and NSAIDs also may help to control acid reflux.

  • Do not smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer. Smoking also increases stomach acid. Smoking can delay or even prevent healing, and makes relapse more likely.


  • Avoid painkillers such as aspirin. Aspirin is present in many over-the-counter remedies. Read labels carefully. Also avoid ibuprofen (in Advil, Nuprin, and other products). Avoiding non-steroidal anti-inflammatory drugs (NSAIDs) is necessary. If you use pain relievers regularly, use acetaminophen (Tylenol, others). Discuss with your health care provider your options in pain relieving medications.


  • Try to avoid stressful situations. Learn stress management techniques.


  • MoonDragon's ObGyn Information: Stress

    MoonDragon's Health Therapy: Meditation

    MoonDragon's Health Therapy: Pain Control

    MoonDragon's Health Therapy: Music & Sound Therapy





    CONSIDERATIONS

  • While prescription and over-the-counter (OTC) drugs may temporarily relieve the symptoms of ulcers, they do not get to the root of the problem, which is damaged tissue. They offer short-term relief by temporarily decreasing stomach acid. In the long run, they may make the problem worse because they create the illusion that the ulcer has been cured. They also disrupt the normal digestive processes and alter the structure and functioning of the tissues that line the digestive tract.


  • With treatment, most peptic ulcers heal, but they may take 8 weeks or long for healing to be complete.


  • Antacids are often recommended for people with ulcers. if you must take antacids, avoid products containing aluminum, which has been linked to Alzheimer's disease. Maalox has been known to cause a gray film on the tongue in rare instances. Discontinue use if this occurs.


  • MoonDragon's Health & Wellness: Alzheimer's Disease

    MoonDragon's Health & Wellness: Alzheimer's Disease Nutrition Recommendations

    MoonDragon's Health & Wellness: Alzheimer's & Aluminum

  • People who take cimetidine (Tagamet) or ranitidine (Zantac) for ulcers should be cautious about ingesting alcohol. These drugs can magnify the effects of alcohol on the brain.


  • A simple procedure using Kool-Aid to test for the presence of stomach ulcers has been developed by the Cabrini Medical Center in New York City. The person being tested is given two glasses of Kool-Aid made with extra sugar. After a short period, he or she takes a urine test. In people with ulcers, the sugar leaks across the stomach wall and shows up in the urine as undigested sugar. If there is no ulcer, the sugar is broken down normally by the body.


  • Peptic ulcers were once thought to be a chronic illness that one "just has to live with". However, it is now known that 90 percent of peptic ulcers can be cured with appropriate treatment.


  • If an ulcer does not heal, your health care provider may perform a biopsy to rule out cancer.


  • The combination of 2 prescription medications, omeprazole (Prilosec, an ulcer medication) and clarithromycin (Biaxin, an antibiotic), may be prescribed for people with H. pylori infection and duodenal ulcer. These drugs should not be used for an extended period of time, as they have known side effects.


  • GERD (Gastroesophageal reflux disease) and peptic ulcers cause very similar symptoms. However, GERD is both more common and, usually, less serious than a peptic ulcer.


  • MoonDragon's Health & Wellness: Heartburn & GERD

  • Many experts believe that food allergies may be a cause of ulcers. Follow the allergy self-test program to identify possible problem foods. Consider consulting with an allergist for testing.


  • MoonDragon's Health & Wellness: Allergies

  • People with a deficiency of healthy intestinal bacteria, such as those on antibiotic therapy, need to re-establish the intestinal flora with acidophilus supplements. These acidophilus supplements will aid digestion. Lactobacillus Acidophilus, 3 capsules or 1 teaspoon daily.


  • Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose-Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.

    Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps

    Acidophilus / Lactobacillus Acidophilus Supplements & Products

  • Avoid antacids as they inhibit digestion causing cycles of indigestion, gas, bloating, and constipation. Neutralization or suppression of gastric acid has no therapeutic benefit. Most antacids sold in the United States contain aluminum compounds, calcium carbonate, magnesium compounds, or sodium bicarbonate. Aluminum-based antacids can cause constipation. Calcium carbonate can cause a rebound effect in which the stomach produces more acid than before once the antacid's effects wear off. Magnesium compounds can cause diarrhea. Sodium bicarbonate can cause gas and bloating. Stomach bitters and herbal remedies that support the liver and gallbladder are a much better alternative and most effective when taken 15 to 30 minutes before meals.


  • Digestion Supplement With Enzymes, Nature's Way, 530 mg, 100 Caps
    Nature's Way Digestion Supplement has concentrated enzymes help in efficient breakdown of carbohydrates, proteins and fats, while the herbal bitters support gastric activity and soothe digestion.



  • Beano from GlaxoSmithKline and BeSure from Wakunaga of America Company are good for preventing gas. These products must be taken with the first bite of food to be effective.




  • See these other pages for more information about digestive-related problems:





    NUTRITIONAL RECOMMENDATIONS

  • Eat plenty of dark green leafy vegetables. These contain vitamin K, which is needed for healing and is likely to be deficient in people with digestive problems.


  • Do not consume coffee (even decaffeinated) or alcoholic beverages. Limit or avoid alcohol is necessary since excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding.


  • Drink freshly made cabbage juice daily. Drink it immediately after juicing.


  • MoonDragon's Health Therapy: Juicing

  • If symptoms are severe, eat soft foods such as avocados, bananas, potatoes, squash, and yams. Put vegetables through a blender or food mill. Eat vegetables like broccoli and carrots occasionally - well steamed.


  • Eat frequent small meals. Include well-cooked millet, well-cooked rice, raw goat's milk, and soured milk products such as yogurt, cottage cheese, and kefir. Drink barleygrass, wheatgrass, and alfalfa juice. They contain chlorophyll, making them potent and anti-ulcer treatments.


  • If you have a bleeding ulcer, consume organic baby foods or steamed vegetables blended in a blender or mashed. Add non-irritating fiber such as guar gum and/or psyllium seed. These foods are easy to digest and nutritious, and the contain no chemicals.


  • For rapid relief of pain, drink a large glass of water. This dilutes the stomach acids and flushes them out through the stomach and duodenum.


  • Avoid fried foods, tea, caffeine, chocolate, animal fats of any kind, and carbonated drinks. Instead of drinking soda, sip distilled water with a bit of lemon juice added.


  • Avoid salt and sugar. They have been linked to increased stomach acid production.


  • Reduce your intake of refined carbohydrates, as they have been linked to peptic ulcers.


  • Do not drink cow's milk. Even though it neutralizes existing stomach acid, the calcium and protein it contains actually stimulate the production of more acid, and it is known to be associated with the occurrence of ulcers. Almond, rice, or soy milk are good substitutes.


  • Chew your food thoroughly. This improves digestion. Taking bitters also improves digestion. Place 10 to 15 drops under your tongue before meals.


  • Allow teas and other hot beverages to cool before drinking them. Otherwise, they may trigger gastric discomfort.


  • Keep the colon clean. Make sure the bowels move daily, and take cleansing enemas periodically.


  • MoonDragon's Health Therapy: Colon Cleansing

    MoonDragon's Health Therapy: Enemas





    HERBAL RECOMMENDATIONS

  • Alfalfa supplies needed vitamin K and trace minerals. It can be taken in liquid or tablet form.


  • Herbal Remedies: Alfalfa Supplements & Products

  • Aloe Vera is good for pain relief and speeds healing. Take 4 ounces of aloe vera juice or gel daily. be sure to buy a food-quality-grade product. symptoms.


  • Herbal Remedies: Aloe Vera Supplements & Products

    George's Aloe Vera Juice from Warren Laboratories tastes like spring water.



  • Anise seeds can help relieve a sour stomach. Chew the whole seeds or grind them and sprinkle on food. For flatulence (gas), crush seeds (1-2 teaspoons), pour a cup of boiling water over the seeds, let stand 5 to 10 minutes, twice a day before meals (anti-flatulence teas work best if take before the meal).


  • Bupleurum is used in combination with Angelica and Licorice Root, is good for treating ulcers.


  • Herbal Remedies: Stomach Peace, TCM Formula, Ganweishu, 100% Natural, 400 mg, 60 Caps
    In China this product is extensively used for gastritis, peptic ulcer, abdominal pain, hepatitis, cholecystitis, costal neuralgia, kidney stone, cystitis, epilepsy, neurasthenia, anti-shock, anti-arrhythmia, mastitis, otitis media, costal chondritis, obstruction of Fallopian tube, chronic annexitis, hyperthyroidism and impotence.

  • Cat's Claw is used for cleansing and healing to the digestive tract. Cat's Claw Defense Complex is a combination of Cat's Claw and other herbs, plus antioxidant nutrients such as beta-carotene, N-Acetylcysteine, Vitamin C and Zinc. Caution: Do not use Cat's Claw during pregnancy.


  • Herbal Remedies: Cat's Claw Supplements & Products



  • Comfrey is beneficial for treating ulcers. Caution: Do not take this herb internally for more than 1 month, and use it only under the close supervision of a health care provider.


  • Herbal Remedies: Comfrey Supplements & Products

  • Garlic is an antimicrobial and may aid in eradicating ulcers.


  • Herbal Remedies: Garlic Supplements & Products

  • Hops, Passionflower, Skullcap, and Valerian Root are good for promoting a restful sleep. These supplements can be found singly or in a combined complex.


  • Herbal Remedies: Silent Night Formula With Hops & Valerian Supplement, 100 Caps
    Silent Night is an herbal sleep aid combining herbal relaxants which have a calming effect upon the nervous system and promote restful sleep. Recommended Daily Dosage: 380 mg per capsule. Take four to six capsules with water 30-60 minutes prior to bedtime. Provides 500-750mg of Valerian per dose. The following list is for serving size of 4 capsules (proprietary formula): Hops Flower, Scullcap Herb, and Valerian Root.

    Herbal Remedies: Get Some ZZZZ's Herb Tea For Rest, No. 5, Republic of Tea, 36 Tea Bags
    Say goodnight to tossing and turning. Brew a pot of this caffeine-free herbal blend and breathe a sigh of sweet relief as the bouquet of organic rooibos, soothing chamomile, passionflower and the mellowing properties of valerian gently lulls you toward blissful effects. Valerian will not interfere with REM sleep, so you will not have to contend with the morning "hangover" that often results from sleep-aids. Heat fresh water to a rolling boil. Place one tea bag in the cup and pour boiling water over it. Infuse tea bag for five to seven minutes. Remove tea bag and enjoy Sip by Sip. For iced tea, double the amount of tea used. Cool and serve over ice. Ingredients: Rooibos (leaf), Orange (peel), Spearmint (leaf), Chamomile (flower), Passionflower (herb), Stevia (leaf) Valerian Root Extract.

    Herbal Remedies: Hops Supplements & Products

    Herbal Remedies: Passionflower Supplements & Products

    Herbal Remedies: Skullcap Supplements & Products

    Herbal Remedies: Valerian Root Supplements & Products

  • Kava Kava and St. John's Wort have calming effects and reduce stress.


  • Herbal Remedies: Kava Kava Supplements & Products

    Herbal Remedies: St. John's Wort Supplements & Products

  • Licorice promotes healing of gastric and duodendal ulcers. Take 750 to 1,500 mg of deglycyrrhizinated Licorice (DGL) 2 to 3 times daily, between meals, for 8 to 16 weeks. Studies have shown that DGL may be as effective as the pharmaceutical drug cimetidine (Tagamet) or ranitidine (Zantac) in treating peptic ulcers. Caution: Do not substitute ordinary Licorice Root for the deglycyrrhizinated variety. Ordinary licorice can elevate blood pressure if used on a daily basis for more than 7 days in a row, and should be avoided completely by persons with high blood pressure. Deglycyrrhizinated Licorice has had a component known as glycyrrhizinic acid removed, which should eliminate this side effect.


  • Herbal Remedies: DGL, NOW Foods, 400 mg, 100 Lozenges
    De-Glycyrrhizinated Licorice (DGL) Extract from NOW is a tasty chewable lozenge that delivers 400mg of Licorice per lozenge. Licorice has a long history of use and is one of the most widely known medicinal herbs today. It has been extensively researched for its ability to support healthy digestive function. De-Glycyrrhizinated Licorice is a milder form of Licorice necessary for a chewable lozenge. As a dietary supplement, chew 1 to 2 lozenges slowly between, or 20 minutes before meals, or as advised by a health practitioner.

    Herbal Remedies: Licorice Supplements & Products

  • Malva (Mallow) tea calms the stomach and reduces intestinal irritation.


  • Marshmallow Root and Slippery Elm soothes irritated mucous membranes.

    Herbal Remedies: Marshmallow Supplements & Products

    Herbal Remedies: Slippery Elm Supplements & Products

  • Rhubarb, taken in juice or tablet form, is good for treating intestinal bleeding, which sometimes accompanies peptic ulcers.


  • Herbal Remedies: Wild Rhubarb Supplements & Products

    Herbal Remedies: Rhubarb Supplements & Products

  • Other beneficial herbs include Bayberry, Catnip, Chamomile, Goldenseal, Myrrh, and Sage. All of these can be taken in tea form. Caution: Do not use Chamomile on an ongoing basis, as ragweed allergy may result. Avoid it completely if you are allergic to ragweed. Do not take Goldenseal on a daily basis for more than 1 week at a time, as it may disturb normal intestinal flora. Do not use it during pregnancy, and use it with caution if you are allergic to ragweed. Do not use Sage if you suffer from any type of seizure disorder or during pregnancy.


  • Herbal Remedies: Bayberry Supplements & Products

    Herbal Remedies: Catnip Supplements & Products

    Herbal Remedies: Chamomile Supplements & Products

    Herbal Remedies: Goldenseal Supplements & Products

    Herbal Remedies: Myrrh Supplements & Products

    Herbal Remedies: Sage Supplements & Products





    TCM HERBAL FORMULAS FOR DIGESTION


    Chinese Formula #18

    1. INSUFFICIENCY-COLD TYPE

    Main Symptoms and Signs: Latent pain in the upper abdomen with predilection for heat, and intolerance of cold which aggravates the pain, sallow complexion, lassitude and weakness, or loose stool, pale tongue with thin whitish fur, deep, slow and weak pulse.

    Therapeutic Principle: Warming and invigorating middle-warmer.

    Recipe: Modified Decoction of Astragalus for Tonifying Middle-Warmer.
    • Astragalus root.
    • Cinnamon twig.
    • White peony root.
    • Cuttle-fish bone.
    • Dahurian Angelica root.
    • Prepared Licorice root.

    All the above herbs are to be decocted in water for oral administration.

    2. QI-STAGNATION TYPE

    Main Symptoms and Signs: Epigastric distension and pain, distension and fullness in the hypochondria, belching, acid regurgitation, poor appetite, thin and whitish coating of the tongue, and taut pulse.

    Therapeutic Principle: Soothing the liver, regulating the circulation of qi and regulating the function of stomach to relieve pain.

    Recipe: Modified Powder for Treating Cold Limbs in combination with Sichuan Chinaberry Powder.
    • Bupleurum root.
    • Cyperus tuber.
    • White peony root.
    • Bitter orange.
    • Tangerine peel.
    • Sichuan chinaberry.
    • Corydalis tuber.
    • Aucklandia root.
    • Perilla stem.
    • Ark shell.
    • Finger citron.
    • Prepared licorice root.

    All the above herbs are to be decocted in water for oral administration.

    3. STAGNATED-HEAT TYPE

    Main Symptoms and Signs: Epigastric pain which is aggravated after food intake, burning sensation in the stomach, dry mouth with bitter taste, fondness of cold drink, constipation, deep-colored urine, red tongue with yellow fur ,taut and rapid pulse.

    Therapeutic Principle: Clearing away pathogenic heat and regulating the function of stomach.

    Recipe: Modified Two Old herbs Decoction in combination with decoction for Eliminating Pathogenic Heat from the Liver.
    • Coptis rhizome.
    • Capejasmine fruit.
    • Scutellaria root.
    • Anemarrhena rhizome.
    • White peony root.
    • Tangerine peel.
    • Pinellia tuber.
    • Poria.
    • Finger citron.
    • Dendrobium.
    • Prepared licorice root.

    All the above herbs are to be decocted in water for oral administration.

    If the case is complicated with insufficiency of the stomach-yin marked by latent pain in the epigastric region, dry mouth with reduced saliva, hot sensation in the palms and soles, red tongue with little fur or absence of fur and taut weak pulse, it is preferable to administer the Modified decoction of Glehnia and Ophiopogon instead. Its compositions are: Glehnia root 10 g, Ophiopogon root 10 g, Fragrant Solomon Seal rhizome 10 g, White Hyaciath Bean 10 g, Finger Citron 10 g, Dendrobium 10 g, prepared Licorice root 6 g. All the drugs in the above recipe are to be decocted in water for oral administration.

    If the case is manifested as severe symptom of blood stasis such as epigastric stabbing pain, or fixed pain just like knife-cutting ,dark purple tongue or with ecchymoses, taut or unsmooth pulse, the modified Red Sage Drink in combination with Wonderful Powder for Relieving Blood Stagnation is preferable: 20 g, Amomum Fruit Dung 10 g, Sichuan chinaberry 12 g, Corydalis tuber 12 g, Chinese Angelica root 12 g, Red Peony root 10 g, prepared Licorice root 6 g. All the above drugs are to be decocted in water for oral administration.

    For the case with hematemesis and tarry stools, 6 grams of powder of Notoginseng should be added (administered orally after being mixed with the finished decoction). The above drugs except powder of notoginseng are to be decocted in water for oral administration.





    ACUPRESSURE & ACUPUNCTURE

    Generally this therapy offers effective relief from anxiety, nervousness, stress and gastrointestinal disorders when administered by a trained practitioner.




    YOGA & DUODENAL OR GASTRIC ULCERS

    Daily yoga practice helps alleviate stress and anxiety which are the major cause of increase acid secretion in the stomach and thereby irritating ulcers.






    HOMEOPATHIC RECOMMENDATIONS

    Practitioners start thinking of duodenal or gastric ulcers whenever a patient constantly starts complaining of pain in the stomach after eating. This pain may get better on eating liquid food and inducing vomiting. The area of the stomach may become tender and even slight pressure or touch is unbearable. The vomit may contain blood in later stages.

    According to homeopathic philosophy duodenal or gastric ulcers is a lifestyle disease whose main causes are food with too many spices and oil, having meal at irregular timings, lack of exercise and sedentary habits. Some patients may complain of bloating and belching of gas. Many may say that the food is lodged in the chest and the digestion process has painfully slowed down. Some patients may complain of chest burn and feeling of uneasiness. It is advised that the patient should try to figure out the food which makes him worse and then he should avoid them.

    One must not drink too much tea, coffee or aerated drinks. Lots of water should be taken all through the day. Consumption of alcohol should be minimal.

    The patient who gets angry easily or is highly emotional should start doing yoga which really helps soothe the nerves.

    There are 19 homeopathic medicines which give great relief in duodenal or gastric ulcers. However, the correct choice and the resulting relief is a matter of experience and right judgment on the part of the homeopath. The treatment is decided after thorough case taking of the patient. Thus homeopathic remedies of duodenal or gastric ulcers are tailor made unlike allopathy in which all patients receive the same drugs although trade name may be different. Some of the homeopathic remedies which may be used under an expert homeopath are Arsenic album, Phosphoros, Sulphur, Iris versicolor, Kali bichromicum, Bismuthum, Argentums nitricum and Graphitis. Whenever cancer (malignancy) is suspected along with duodenal or gastric ulcers then Pepsinum, Kreosotum and Nitric acid have given great relief to patients.

    As soon as the right homeopathic remedies are started the patient starts experiencing great relief in symptoms and his or her dependence on allopathic drugs starts decreasing. For total cure the homeopathic treatment must be taken seriously for about 8 to 12 months. In allopathy the treatment is suppressive with antacids which do not deal with the cause of peptic or duodenal ulcers, thus further aggravating the problem. Homeopathy cure for duodenal or gastric ulcers aims at dealing with the cause and thus curing peptic ulcers from its root. For online homeopathic treatment of duodenal or gastric ulcers, you may fill in the consultation form at HomeopathicTreatment4U.com.

    Use the Amazon.com search box further down on this page to search for individual homeopathic remedies.





    NUTRITIONAL SUPPLEMENT RECOMMENDATIONS

    The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.

    NUTRIENTS
    Supplement Suggested Dosage Comments
    Important
    Acid-Ease As directed on label Balances acidity in the body, reducing symptoms. For some people, may be able to replace ulcer medications such as ranitidine (Zantac).
    Digestive Enzyme Combination 1 capsule with each meal. A digestive aid that helps promote better digestion. Avoid any complex that contains hydrochloric acid (HCl).
    Digestion Supplement w/ Enzymes, Nature's Way, 530 mg, 100 Caps
    L-Glutamine 500 mg daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Important in the healing of peptic ulcers. See Amino Acids for more information.
    L-Glutamine Powder, 100% Pure Free Form Amino Acid & GH Releaser, Vegetarian, NOW Foods, 1 lb.,
    L-Glutamine, Amino Acid Supplement, NOW Foods, 1000 mg, 120 Caps,
    L-Glutamine, Amino Acid Supplement, NOW Foods, 500 mg, 120 Caps
    Pectin As directed on label. Helps relieve duodenal ulcers by creating a soothing protective coating in the intestines.
    Aloe Vera 4 ounces daily. Aloe vera aids in pain relief and speeds healing.
    Aloe Vera Concentrate, NOW Foods, 100% Organic, 4 oz.,
    Aloe Vera Gel & Juice, Wild Berry Flavor, Premium Quality, Nature's Way, 1 Liter,
    Aloe Vera Gel & Juice, 99.7% Pure, Certified Organic, Nature's way, 1 Liter,
    Aloe Vera Juice, Herbal Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.,
    Aloe Vera Gel, NOW Foods, 32 oz.
    Vitamin E 200 IU daily or 400 IU every other day. A potent antioxidant that aids in reducing stomach acid and in relieving pain. Helps promote healing. Use alpha-d-tocopherol form.
    Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
    Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
    Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
    Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
    Helpful
    Acidophilus
    Or
    Kyo-Dophilus
    2-3 capsules, 1 to 3 times daily. Acidophilus is necessary to provide flora for the small intestine that improves assimilation of nutrients and aid in digestion. Use a non-dairy formula.

    Kyo-Dophilus contains both garlic and acidophilus. Milk-free and heat-resistant.
    Acidophilus Supplement Powder, Non-Dairy, 3 oz. Bulk,
    Acidophilus, 3 Billion, NOW Foods, 90 Tabs,
    Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps,
    Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.,
    Alfalfa As directed on label. It can be taken in liquid or tablet form. Needed for vitamin K and trace minerals.
    Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps,
    Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps,
    Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.,
    Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps,
    Alfalfa, NOW Foods, 650 mg, 500 Tabs,
    Alfalfa Tincture, 2 fl. oz.,
    Bromelain 250 mg 3 times daily. An enzyme from pineapple that improves digestion and relieves symptoms. Chewable papaya tablets are also good.
    Bromelain 2000 GDU Supplement, NOW Foods, 500 mg, 90 Tabs,
    Papaya Juice, Natural Kosher, Dynamic Health, 16 fl. oz.,
    Papaya Dried Spears, Low Sugar, NOW Foods, 12 oz.,
    Papaya Enzyme With Mint & Chlorophyll, Chewable, NOW Foods, 23 mg, 360 Lozenges,
    Super Digestive Enzymes, NOW Foods, 90 Caps
    Curcumin
    (Turmeric)
    250-500 mg 2 to 3 times daily, between meals. Promotes healing.
    Curcumin, NOW Foods, 665 mg, 60 VCaps,
    Turmeric Root Powder, Certified Organic, Banyan Botanicals, 1/2 lb.,
    Turmeric Extract (Curcuma Longa), Standardized to 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs
    Essential Fatty Acids As directed on label. Protects the stomach and intestinal tract from ulcers.
    Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels,
    Essential Fatty Acids For Baby & Children, Organic, 8 fl oz.,
    Salmon Oil Capsule, NOW Foods, 120 EPA/80 DHA, 2000 mg, 250 Softgels,
    Evening Primrose Oil With Gamma-Linolenic Acid (GLA), Barlean's, 1300 mg, 120 Softgels,
    Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.,
    Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps
    Iron As directed by a health care provider. Take with 100 mg buffered or esterified Vitamin C for better absorption. Helps to prevent anemia, which may occur with bleeding ulcers. Use ferrous chelate or ferrous fumarate forms. Caution: Do not take iron unless anemia is diagnosed.
    Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.,
    Ionic Iron Supplement With ConcenTrace, Trace Minerals, 2 oz.,
    Iron Complex With Vitamins & Herbs, Vegetarian, NOW Foods, 250 Tabs,
    Iron Gluconate, Nature's Way, 18 mg, 100 Caps,
    Multi-Vitamin & Mineral Complex As directed on label. To provide a balance of essential nutrients.
    Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption),
    Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)
    Floradix Iron Plus Herbs As directed on label. A non-toxic form of iron from food sources.
    Proteolytic Enzymes
    Or
    Infla-Zyme Forte
    As directed on label, take between meals. Works on undigested food remaining in the colon, and helps to reduce inflammation. Caution: Do not use a formula containing HCl.
    MetabolicZyme (Hypoallergenic), Allergy Research Group / Nutricology, 900 Tabs,
    Plant Enzymes, NOW Foods, Vegetarian, 120 VCaps,
    Enzymes, All Complete, 250 mg, 90 Caps
    Wobenzym N As directed on label. Works on undigested food remaining in the colon, and helps to reduce inflammation.
    Grape Seed Extract
    Or
    Pycnogenol
    As directed on label. Powerful free radical scavengers that also act as anti-inflammatories and strengthen tissues.
    Grape Seed (Grapeseed) (Vitus vinifera), 100% Pure, NOW Foods, 16 fl. oz.,
    Pycnogenol With Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs
    SAM-e (S-Adenosylmethionine) 200 mg twice daily, in the morning and in the evening. Aids in relief of stress and depression, eases pain, and produces antioxidant effects. Caution: Do not use if you have manic depressive disorder or take prescription antidepressants. A very small number of people taking high doses have reported gastrointestinal disturbances. if this happens, discontinue the supplement.
    SAM-e, Enteric Coated, NOW Foods, 100 mg, 30 Tabs,
    SAM-e, S-Adenosyl-L-Methionine, 400 mg, 30 Tabs
    Garlic (Kyolic) 2 capsules 3 times daily. Aids in digestion and destroys unwanted bacteria in the bowel.
    Kyolic Aged Garlic Liquid Extract, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
    Kyolic Aged Garlic One-Per-Day, Vegetarian, Wakunaga Kyolic, 1000 mg, 30 Caps
    Vitamin A Emulsion Emulsion: 50,000 IU daily for 1 month; then 25,000 IU daily for 1 month; then reduce to 10,000 IU daily. Capsules: 25,000 IU daily. If you are pregnant do not exceed 10,000 IU daily. Needed for healing. Protects the mucous membranes of the stomach and intestines. Emulsion form is recommended for easier assimilation and greater safety at high doses.
    Vitamin A, Nature's Way, 100% Natural, 10,000 IU, 100 Softgels,
    Vitamin A, Fish Liver Oil, NOW Foods, 25,000 IU, 250 Softgels,
    Dry Vitamin A & D, Nature's Way, 15,000 IU / 400 IU, 100 Caps
    Vitamin B Complex 100 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary). Essential for normal digestion. A sublingual type is best.
    Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
    Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
    Plus Extra
    Vitamin B-6 (Pyridoxine)
    50 mg 3 times daily. Needed for enzyme production and wound healing
    Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps
    Vitamin C With Bioflavonoids 3,000 mg daily. Promotes wound healing and protects against infection. Use a buffered or esterified form.
    Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
    Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
    Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
    Meta Vitamin C Supplement, 1000 mg, 100 Tabs,
    The Right C Powder, Nature's Way, 120 g,
    The Right C, Nature's Way, 1000 mg, 120 Tabs
    AbsorbAid As directed on label. To prevent acid reflux.
    Activated Charcoal Take as directed on label. Take separately from other supplements and medications. To absorb intestinal gas.
    Activated Charcoal Supplement, Nature's Way, 260 mg, 100 Caps
    Or
    Vitamin K
    100 mcg daily. Needed for healing and to prevent bleeding; promotes nutrient absorption and has a neutralizing effect on the intestinal tract. Deficiency is common in those with digestive disorders.
    Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps,
    Chlorofresh Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels,
    Chlorofresh Liquid Chlorophyll, Mint Flavor, Nature's Way, 16 fl. oz.,
    Chlorella Powder, NOW Foods, 100% Pure, 4 oz.,
    Vital Greens, Vital Earth, 180 Caps,
    Gastro-Calm
    (Olympian Labs)
    As directed on label. A combination of herbs and digestive enzymes to help relieve indigestion and reduce gastrointestinal inflammation.
    Lecithin Granules
    Or
    Capsules

    Or

    Phosphatidyl Choline
    1 tablespoon 3 times daily, before meals.

    1,200 mg 3 times daily, before meals. Take with vitamin E (below).

    Phosphatidyl Choline: As directed on label.
    Aids in cellular protection.
    Lecithin Vegetarian Granules, NOW Foods, 97% Phosphatides, Identity Preserved Non-GE, 1 lb,
    Lecithin Liquid, NOW Foods, Vegetarian, 16 fl. oz.,
    Lecithin Concentrate, Nature's Way, 400 mg, 100 SoftGels

    Phosphatidyl Choline: Restores gastrointestinal mucosa by strengthening the mucosa lining.
    Phosphatidyl Choline, Derived From Soy, Allergy Research Group / Nutricology, 100 Softgels
    N-Acetylcysteine (NAC) 500-1,000 mg daily, on an empty stomach with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Essential for repair of the large, and especially the small, intestines. Also detoxifies harmful substances. See Amino Acids for more information.
    NAC (N-Acetyl Cysteine), NOW Foods, Selenium, Molybdenum, 600 mg, 100 Caps
    Pro-Flora Probiotic As directed on label. Essential for maintaining the proper pH of the colon flora. Helps prevent constipation and prevents infection.
    Ultimate Probiotic Supplement, 4 Billion, 45 Tabs,
    Probiotic Defense, NOW Foods, 90 Caps,
    Pro-Flora Concentrate Probiotic Pearls, Integrative Therapeutics, 30 Caps
    Zinc 50-80 mg daily. Do not exceed a total of 100 mg daily from all supplements. Promotes healing. Use zinc gluconate lozenges or optizinc for best absorption.
    Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
    Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
    Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
    Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps





    PEPTIC ULCER SUPPLEMENTS & PRODUCTS

    Information, supplements and products for ulcers, gastric ulcers and peptic ulcers, crater-like lesions in the lining of the stomach or small intestine.

    Activated Charcoal Supplement, Nature's Way, 260 mg, 100 Caps

    Nature's Way Activated charcoal supplement captures unwanted material of gas and carries it safely through the digestive system.
    Acidophilus, 3 Billion, NOW Foods, 90 Tabs

    NOW Foods is pleased to introduce Stabilized Acidophilus, a real-time lab-tested acidophilus. Because some strains of acidophilus are more stable then others, scientists have developed a proprietary method that optimizes growth medium during fermentation.
    Acid Redux, NOW Foods, 90 Lozenges

    Acid Redux is a unique proprietary formulation of acid buffering agents that can be helpful in the alleviation of occasional acid indigestion. Acid Redux is an all-natural dietary supplement, containing no artificial flavors or colors.
    AlkaMax, Natural Antacid & Alkaline Booster, 200 grams Powder

    Natural antacid for digestion and entire body.
    Alfa-Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps

    Nature's Way Alfa-Max Alfalfa Extract capsules is a 10X extract of fresh green alfalfa leaves.
    Aloe Vera Juice, Herbal Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.

    Herbal Aloe Force, Aloe Vera Juice, Re-Natures the cells, tissues, glands, organs and all systems of the body to function as originally designed.
    Aloe Vera Juice, Pure Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.

    The magnificent Aloe plant, that is designed to be self-sufficient & thrive in the desert, feeds us in unique ways with its 250+ naturally occurring constituents including: enzymes, amino acids, essential fatty acids, vitamins, minerals, glycoproteins, sterols, growth factors, & all sizes of uniquely complex Aloe polysaccharides and mannans.
    Aloe Vera Latex & Leaf, All Natural Laxative, Nature's Way, 550 mg, 100 VCaps

    Aloe Vera Latex & Leaf from Nature's Way is an all natural laxative that offers healing benefits to the digestive system.
    Bio Defender, Antibacterial, Antiviral and Antifungal Formula, Balanceuticals, 56 Caps

    This unique antibacterial, antiviral and antifungal formula is a clinical nutritionist response to bio-terrorism such as anthrax.
    Black Seed Theramune Ultimate With Garlic, 100 Caps

    Promotes healthy circulation, useful for arthritis and cardiovascular & respiratory support. It also supports digestion and is a natural remedy for ulcers. Garlic is known to lower cholesterol naturally.
    Blue Scullcap (Scutellaria Lateriflora), Standardized, Nature's Way, 100 mg, 60 VCaps

    Scullcap is most commonly used as a sedative and it can take the edge off anxiety and promote sleep for those who struggle with insomnia.
    Calming Tea With Organic Chamomile For Daily Stress Relief, Yogi Tea, Caffeine Free, Certified Organic, 16 Tea Bags

    Calming tea by Yogi Tea is a safe and time-tested Ayurvedic formula designed to ease stress and tension, encouraging a state of relaxed alertness without drowsiness.
    Cat's Claw Bark (Uncaria Tomentosa) Powder, 4 oz. Bulk

    Cat's Claw Bark (Uncaria tomentosa) was reputed to be a super drug in the Andean region of South America. It has a long history of indigenous use for arthritis and rheumatism as well as other types of inflammation associated with various stomach disorders and ulcers where it was clinically shown to be effective.
    Cat's Claw Bark, Nature's Way, 485 mg, 100 Caps

    Cat's Claw Bark is a traditional tonic herb for well being, Cat's Claw was historically used by the indigenous people of South America to stimulate the immune system in a variety of serious ailments.
    Cat's Claw Extract, Standardized, Nature's Way, 335 mg, 60 Caps

    Nature's Way Cat's Claw extract, also known as Una de Gato is derived from the bark of plants wild-harvested in Peru and Brazil.
    Cayenne Extra Hot Formula Supplement, Nature's Way, 100,000 HU, 450 mg, 100 Caps

    Cayenne Extra Hot Formula Supplement is a blood warming herb that has an invigorating effect on several body systems including Chronic laryngitis, pain relief, poor circulation, skin irritation and urinary urgency.
    Cayenne & Goldenseal Supplement, Nature's Way, 100 Caps

    Cayenne & Goldenseal Supplement is a proprietary blend of Certi-FIERY Cayenne and five other synergistic herbals.
    Cayenne Pepper Supplement, Nature's Way, 450 mg, 180 Caps

    Cayenne Pepper Supplement is a blood warming herb that has an invigorating effect on several body systems.
    Cayenne Pepper Tincture, 2 fl. oz.

    A strong stimulant, Cayenne is a digestive and heart tonic. Relaxes the stomach and colon, helps to heal ulcers, improves circulation, and stops bleeding. It stimulates the heart, increasing and strengthening the pulse.
    Chamomile Tea, Caffeine Free, Yogi Tea, Certified Organic, 16 Tea Bags

    Organic Chamomile tea by Yogi Tea with its subtle fragrance and flavor, is a great way to ease your daily tensions.
    Choline Supplement, 100% Natural, Nature's Way, 500 mg, 100 Tabs

    Nature's Way Choline Supplement is 100% natural choline with improved absorption.
    Cinnamon Bark (Cinnamonum Verum), NOW Foods, 600 mg, 240 Caps

    Experiments conducted by the USDA have shown that this - the variety we call "True Cinnamon" can lower blood sugar by mimicking insulin, activating insulin receptors and working with insulin in the cells to reduce blood sugar by up to 20%.
    Comfrey Leaf Powder, 4 oz. Bulk

    One of the most well-known healing plants, especially for its ability to heal tissue and bone.
    Comfrey Leaf Tincture, 2 fl. oz.

    Comfrey contains allantoin, which promotes the growth of connective tissue, bone, cartilage, and is easily absorbed through the skin.
    Curcumin, NOW Foods, 665 mg, 60 VCaps

    Through its antioxidant mechanisms, Curcumin supports colon health, exerts neuroprotective activity and helps maintain a healthy cardiovascular system.
    Digest Ease - Promotes Healthy Digestion, Banyan Botanicals, 90 Tabs

    Digest Ease is a dynamic combination of herbs designed to strengthen digestion without aggravating pitta. Excess pitta causes increased heat, sharpness and oiliness in the digestive tract. These qualities aggravate and inflame the digestive fire, creating acidic conditions, which can lead to discomfort. Cooling and soothing to the internal membranes, Digest Ease neutralizes acid and removes excess heat from the system.
    Digestive Enzymes, 750 mg, 100 Caps

    Since cooking destroys many of the digestive enzymes in food, taking plant fiber-based digestive enzymes aids in digesting even the heaviest meal.
    Enzymes, All Complete, 250 mg, 90 Caps

    All Complete Enzymes, dietary supplement, is an important combination of critical enzymes that help support normal digestive function, cholesterol levels, fat metabolism and more, all in one convenient tablet.
    Garlicin HC Supplement, Healthy Circulation Formula With Odor Free Garlic, Nature's Way, 90 Enteric-Coated Tabs

    Garlicin HC garlic supplement supports cardiovascular health with the help of hawthorn, cayenne and vitamin E.
    Garlic Oil Tincture, Alcohol-Free, Nature's Way, 1 fl. oz.

    Garlic oil is often used to soothe the ear and as an antibiotic but most often used as a food and herb and also to lower serum cholesterol and blood pressure and to improve circulation as well as possibly inhibiting the growth of ulcer causing bacteria.
    Holy Basil Extract, NOW Foods, 500 mg, 90 VCaps

    Holy Basil has been used to enhance the body's ability to respond to stress and minimize the negative effects of stress on the body.
    IntestinEase, TCM Intestines & Colon Formula, Zhushao Anchang, 100% Natural, 400 mg, 60 Caps

    This famous IntestinEase, TCM Intestines and Colon Formula is made of extracts from atractylodes, common peony root, siler, cimicifuge and tangerine peel.
    Kombucha Miracle Fungus - Kombucha Tea Benefit's, By Harald Tietze, Paperback

    One time best seller, Kombucha Miracle Fungus is all about synergy and Kombucha Tea Benefit's it is an easy read for those interested in the synergy Kombucha offers or Kombucha benefit's.
    Kombucha 2000, Concentrated, 30 Caps

    Concentrated Kombucha Capsules are new to the market, but Kombucha 2000 is one of the very first successful kombucha tea producers in the United States.
    Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps

    Lactobacillus Acidophilus Supplement taken as a dietary supplement may help to detoxify and to rebuild a balanced intestinal flora.
    L-Glutamine, Amino Acid Supplement, NOW Foods, 500 mg, 120 Caps

    L-Glutamine is an important amino acid and natural Growth Hormone Releaser that helps brain function, and may be used for combating effects of alcoholism, alleviating hypoglycemia, fatigue reduction, improving exercise endurance, benefiting the liver and intestines, maintaining a healthy gastrointestinal tract, and strengthening the immune system.
    Licorice Root (Glycyrrhiza Glabra) Powder, 4 oz. Bulk

    Licorice Root (Glycyrrhiza glabra) is famous for its delicious distinctive flavor, licorice is essential in innumerable candy, confection and beverage recipes and makes an estimable liquor.
    Manuka Honey Bio Active 10+, 500 g

    Comvita Bio Active 10+ Manuka Honey contains a high level of antibacterial activity not found in other honeys. For digestive health and to assist the digestive process.
    Multiflora Honey, 100% Pure, New Zealand Honey, 1.1 lb.

    Pure New Zealand Honey is made with the help of wild flowers to produce a rich natural taste that is all its own.
    Myrrh Gum (Commiphora Myrrha) Powder, 4 oz. Bulk

    The anti-infectious nature of Myrrh plays an active role in many of today's herbal formulations.
    PainEase (Analgesic Formula), 100% Natural, 350 mg, 60 Caps

    Made of corydalis tuber and angelica root, this well-known formula is used in Chinese medicine for its tranquilizing, analgesic, antibacterial, and anti-hypoxia properties to regulate the Qi, promote normal blood circulation, protect mucous membrane of the stomach and to stop pain.
    Red Reishi Mushroom Tincture, 2 fl. oz.

    Herbal Remedies offers the highest quality tinctures available, such as this Reishi Mushroom tincture. Red Reishi is called Ling Zhi and it is believed to be one of the ingredients for youth elixirs.
    Samento Liquid Extract (Uncaria Tomentosa), 0.5% POA, 1 fl. oz.

    Beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
    Samento (Uncaria Tomentosa), Extra Strength (100 Times More Effective Than Regular Cat's Claw!), 0.5% POA, 600 mg, 30 Caps

    Samento is beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.
    Slippery Elm Bark Powder (Ulmus Rubra), 4 oz. Bulk

    Slippery Elm Bark is a soothing nutritive demulcent which is perfectly suited for sensitive or inflamed mucous membrane linings in the digestive system.
    Spirulina Digest & Flora, 180 Caps

    Provides an all-inclusive proprietary formula to support gastrointestinal function, antioxidant protection and immunity.
    Stomach Fortifier, Balanceuticals, TCM Formula, 100% Natural, 60 Caps

    Chinese medicine uses it to strengthen the spleen and stomach, normalize peristalsis of the stomach and intestines, promote absorption of water and chlorine ion, improve metabolism, nurture the lung, balance bowel movement and increase energy.
    Stomach Peace, TCM Formula (Ganweishu), 100% Natural, 400 mg, 60 Caps

    In China this product is extensively used for gastritis, peptic ulcer, abdominal pain, hepatitis, cholecystitis, costal neuralgia, kidney stone, cystitis, epilepsy, neurasthenia, anti-shock, anti-arrhythmia, mastitis, otitis media, costal chondritis, obstruction of Fallopian tube, chronic annexitis, hyperthyroidism and impotence.
    Sutherlandia (Sutherlandia Frutescens), 300 mg, 60 Tabs

    Sutherlandia powerfully assists the body to mobilize its own immunological physiological resources to cope with diverse physical, mental and chemical stressors.
    Turmeric Extract (Curcuma Longa), Standardized to 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs

    Nature's Way standardized Turmeric extract is a technically advanced herbal extract standardized to 95% curcuminoids. This is the highest concentration of curcuminoids available.
    Ulcetrol With PepZin G1 & Mastic Gum, NOW Foods, 60 Tabs

    NOW Ulcetrol is a dietary supplement designed to protect and support a healthy stomach lining.
    Vitamin E, Natural D-Alpha-Tocopherol, 400 IU, 100 Softgels

    Vitamin E has potent antioxidant activity, supplies oxygen to the blood, aids in strengthening capillary walls, and plays a beneficial role in cancer and cardiovascular disease prevention, anti-aging benefits, circulation, wound-healing, immune function, nervous system function, PMS, hot flushes, diabetes, vascular disease, eye health, tissue repair, athletic performance, leg cramps, skin and hair health, and alleviating fatigue.
    White Willow Bark, Standardized Extract, 450 mg, 60 Caps

    Nature's Way Standardized White Willow Bark is a maximum potency (15%) extract from the inner bark of the tree.
    Whole Leaf Aloe Vera Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter

    Nature's Way Whole Leaf Aloe Vera Juice offers you the rich benefits of the most potent part of the aloe plant. Whole Leaf Aloe Vera Juice contains an abundance of advantageous components not found in most aloe gel filler products.





  • Herbal Remedies: Peptic Ulcer Information


  • Herbal Remedies: Ulcer / Gastric Ulcer / Peptic Ulcer Information


  • Herbal Remedies: Ulcer / Gastric Ulcer / Peptic Supplements & Products


  • Herbal Remedies: Gastritis / Dyspepsia Supplements & Products


  • Herbal Remedies: Probiotics Supplements & Products




  • NOTIFY YOUR HEALTH CARE PROVIDER IF...

    An ulcer is not something that you should treat on your own, without a health care provider's help. Over-the-counter antacids and acid blockers may relieve the gnawing pain, but the relief is short-lived. If you have signs or symptoms of an ulcer, see your health care provider. With a practitioner's help, you can find prompt relief of ulcer pain as well as a complete healing of the ulcer.

    Contact your health care provider if you have an ulcer and you start having symptoms of anemia such as weakness, fatigue and paleness.

    Contact your health care provider if you have an ulcer and you have stools which are bloody, black, tarry. Also there may be vomiting which is bloody, or appears like coffee grounds. These are indicative of bleeding.

    Know the symptoms of shock such as cold and clammy perspiration, extreme weakness and fainting. Shock may occur if your ulcer is bleeding profusely. Call for emergency help immediately.

    MoonDragon's Health & Wellness: Shock

    If you have an ulcer and you start having acute back pain, this may be due to perforating ulcer. Contact your health care provider immediately.

    Because symptoms of indigestion can be a sign of a more serious health problem, call your health care provider if you have any of the following symptoms:
    • Vomiting or blood in vomit (the vomit may look like coffee grounds).
    • Weight loss.
    • Loss of appetite.
    • Black, tarry stools or visible blood in stools.
    • Severe pain in upper right abdomen.
    • Discomfort unrelated to eating.

    Symptoms similar to heartburn or indigestion may be caused by heart attacks. If indigestion is accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck or arm, seek medical attention immediately.

    Notify your health care provider if...
    • Symptoms last longer than 2 weeks.
    • The pattern of indigestion symptoms changes noticeably.
    • Abdominal pain persists longer than 6 hours.
    • Symptoms include unexplained weight loss, bleeding, or jaundice.
    • symptoms include jaw pain, chest pain, back pain, profuse sweating, anxiety, or a feeling of impending doom (possible heart attack symptoms).





    HERBAL INFORMATION SOURCES

  • Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
    - by Phyllis A. Balch, James F. Balch

  • Eastern/Central Medicinal Plants
    - by Steven Foster, James A. Duke

  • The Complete Medicinal Herbal
    - by Penelope Ody

  • Planetary Herbology
    - by Michael Tierra, C.A., N.D., O.M.D

  • Back to Eden
    - by Jethro Kloss

  • The Old Herb Doctor
    - by Joseph E. Meyer

  • Secrets of the Chinese Herbalists
    - by Richard Lucas

  • Earl Mindell's Herb Bible (1992 Edition)

  • Earl Mindell's New Herb Bible
    - by Earl Mindell

  • The Rodale Herb Book
    - edited by William H. Hylton

  • Indian Herbalogy of North America
    - by Alma R. Hutchens

  • The Magic of Herbs
    - by David Conway

  • The Yoga of Herbs
    - by Dr. David Frawley and Dr. Vasant Lad

  • The Herb Book
    - by John Lust





    HELPFUL RELATED MOONDRAGON LINKS

    Allergies
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    Irritable Bowel Syndrome
    Lactose Intolerance (Lactase Deficiency)
    Motion Sickness
    Pancreatitis
    Ulcerative Colitis

    MoonDragon's Health Index Page





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    HELPFUL PRODUCTS & FURTHER EDUCATION

  • Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
    -- by Phyllis A. Balch, James F. Balch - 2nd Edition

  • Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
    -- by Phyllis A. Balch, James F. Balch - 4th Edition

  • Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
    -- by Phyllis A. Balch

  • The Complete Guide to Natural Healing



    If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.

    Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.






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