Peptic Ulcer

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Peptic Ulcer

Need to Know

Peptic Ulcer
Ulcer pain? Undo the damage. Peptic ulcers can cause serious discomfort and damage to the digestive system if left untreated. According to research or other evidence, the following self-care steps may be helpful.
  • Avoid irritants

    Avoid smoking, aspirin and related drugs (nonsteroidal anti-inflammatory drugs), alcohol, coffee (including decaf), and tea to improve ulcer healing

  • Fight recurrences with fiber

    Reduce the risk of new duodenal ulcers by getting enough fiber

  • Give zinc a go

    Take 25 to 50 mg of this mineral a day to speed the repair of damaged tissue

  • Get a checkup

    See a doctor to find out whether your ulcer is related to Helicobacter pylori infection

About

About This Condition

Peptic ulcers are erosions or open sores in the mucous lining of the stomach or duodenum (the first part of the small intestine). The term “peptic” distinguishes peptic ulcers from ulcerations that affect other parts of the body (e.g., diabetic leg ulcers). 

Peptic ulcer should never be treated without proper diagnosis. They are usually caused by infection from Helicobacter pylori (H. pylori). People with peptic ulcer due to infection should discuss conventional treatment directed toward eradicating the organism—various combinations of antibiotics, acid blockers, and bismuth—with a medical doctor. Ulcers can also be caused or aggravated by stress, alcohol, smoking, and dietary factors.

Symptoms

Peptic ulcers are occasionally painless. However, the most common symptom is a dull ache in the upper abdomen that usually occurs two to three hours after a meal; the ache is relieved by eating. Other common symptoms include weight loss, bloating, belching, and nausea. Untreated, peptic ulcers often bleed and may cause sharp burning pain in the area of the stomach or just below it.

Holistic Options

Emotional stress has been shown to increase acid production in the stomach.1 The reported association between stress and peptic ulcer might be attributable to a stress-induced increase in gastric acidity.2 , 3 During the air raids of London in World War II, British physicians observed an increase of more than 50% in the incidence of ruptured peptic ulcers.4 , 5 More recently, an increased incidence of bleeding stomach ulcers was seen in survivors of the Hanshin-Awaji earthquake in Japan.6 Whether stress reduction techniques or psychological counseling helps prevent ulcers or ulcer recurrence has not been adequately studied in medical trials.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why Get started
Fight recurrences with fiber Reduce the risk of new duodenal ulcers by getting enough fiber. Fruits, vegetables, and whole grain breads and are good fiber sources.

Fight recurrences with fiber

Fiber slows the movement of food and acidic fluid from the stomach to the intestines, which should help those with duodenal, though not stomach, ulcers.7 When people with recently healed duodenal ulcers were put on a long-term (six-month), high-fiber diet, the rate of ulcer recurrence was dramatically reduced in one controlled study,8 though short-term (four-week) use of fiber in people with active duodenal ulcers led to only negligible improvement.9
Sidestep salt Salt is a stomach and intestinal irritant, so avoiding it may help improve ulcer symptoms.

Sidestep salt

Salt is a stomach and intestinal irritant. Higher intakes of salt have been linked to higher risk of stomach (though not duodenal) ulcer.10 As a result of these reports, some doctors suggest that people with ulcers should restrict the use of both sugar and salt, although the benefit of such dietary changes remains unknown.
Steer clear of sugar Sugar has been reported to increase stomach acidity, which could aggravate ulcer symptoms.

Steer clear of sugar

People with ulcers have been reported to eat more sugar than people without ulcers,11 though this link may only occur in those with a genetic susceptibility toward ulcer formation.12Sugar has also been reported to increase stomach acidity,13 which could aggravate ulcer symptoms.

Try some cabbage juice People have found relief from symptoms by drinking a quart of cabbage juice per day for 10 to 14 days. Carrot juice may be added to improve the flavor.

Try some cabbage juice

Many years ago, researchers reported that cabbage juice accelerated healing of peptic ulcers.14 , 15 , 16 , 17 Drinking a quart of cabbage juice per day was necessary for symptom relief in some reports. Although only preliminary modern research supports this approach,18 many doctors claim considerable success using one quart per day for 10 to 14 days, with ulcer symptoms frequently decreasing in only a few days. Carrot juice may be added to improve the flavor.
Uncover allergies Avoiding food allergens may be helpful for people with peptic ulcers. Talk to a doctor about possible food sensitivities; once you’ve identified problem foods, a low-allergen diet can help you avoid them.

Uncover allergies

The relationship between food allergies and peptic ulcers has been reported at least as far back as the 1930s.19 Exposing the lining of the stomach to foods to which a person is allergic has been reported to cause bleeding in the stomach.20 Although additional research is needed, avoiding food allergens may be helpful for people with peptic ulcers. Consult with a doctor to determine food sensitivities.

Supplements

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


Supplement Amount Why
Chewable DG Licorice
 250 to 500 mg chewable DGL before meals and bedtime 3 stars   Licorice root has a long history of use for soothing inflamed and injured mucous membranes in the digestive tract. Flavonoids in licorice may also inhibit growth of H. pylori.


3 stars  Chewable DG Licorice

250 to 500 mg chewable DGL before meals and bedtime

Licorice root has a long history of use for soothing inflamed and injured mucous membranes in the digestive tract. Licorice may protect the stomach and duodenum by increasing production of mucin, a substance that protects the lining of these organs against stomach acid and other harmful substances.21 According to laboratory research, flavonoids in licorice may also inhibit growth of H. pylori.22

Chamomile has a soothing effect on inflamed and irritated mucous membranes. It is also high in the flavonoid apigenin—another flavonoid that has inhibited growth of H. pylori in test tubes.23 Many doctors recommend drinking two to three cups of strong chamomile tea each day. The tea can be made by combining 3 to 5 ml of chamomile tincture with hot water or by steeping 2 to 3 tsp of chamomile flowers in the water, covered, for 10 to 15 minutes. Chamomile is also available in capsules; two may be taken three times per day.

Supplement Amount Why
Mastic
 1 gram mastic powder taken before breakfast and at bedtime 3 stars   The gummy extract of Pistachia lentiscus


3 stars  Mastic

1 gram mastic powder taken before breakfast and at bedtime

The gummy extract of Pistachia lentiscus, also known as mastic or gum mastic, has been shown in one preliminary study and one double-blind study to heal peptic ulcers.24 , 25 This may be related to its ability to kill H. pylori in test tubes.26

Supplement Amount Why
Banana Powder
 1 gram four times per day 2 stars   Ayurvedic doctors in India have traditionally used dried banana powder to treat ulcers. Banana powder appears to protect the lining of the stomach from acid.
Neem
 30 to 60 mg of freeze-dried bark extract twice per day 2 stars   Neem bark extract led to a significant reduction in stomach acid levels and near complete healing of all people with duodenal ulcers in one trial.

2 stars  Neem

30 to 60 mg of freeze-dried bark extract twice per day

Administration of 30 to 60 mg of freeze-dried neem bark extract twice per day led to a significant reduction in stomach acid levels and near complete healing of all people with duodenal ulcers over ten weeks time in a preliminary clinical trial.27

Chamomile has a soothing effect on inflamed and irritated mucous membranes. It is also high in the flavonoid apigenin—another flavonoid that has inhibited growth of H. pylori in test tubes.28 Many doctors recommend drinking two to three cups of strong chamomile tea each day. The tea can be made by combining 3 to 5 ml of chamomile tincture with hot water or by steeping 2 to 3 tsp of chamomile flowers in the water, covered, for 10 to 15 minutes. Chamomile is also available in capsules; two may be taken three times per day.

Supplement Amount Why
Vitamin A
 Take under medical supervision: 150,000 IU per day 2 stars   Vitamin A is needed to heal the linings of the stomach and intestines. In one trial, supplementing with vitamin A improved healing in a small group of people with stomach ulcer.


2 stars  Vitamin A

Take under medical supervision: 150,000 IU per day

Vitamin A is needed to heal the linings (called mucous membranes) of the stomach and intestines. In one controlled trial, vitamin A supplementation facilitated healing in a small group of people with stomach ulcer.29 The amount used in that study (150,000 IU per day) can be toxic and may also cause birth defects. Such a high dose should not be taken by a pregnant woman, by a woman who could become pregnant, or by anyone else without careful supervision from a doctor. Objective evidence of ulcer healing from taking vitamin A has been reported by the same research group.30 The effect of lower amounts of vitamin A has not been studied in people with peptic ulcer.

Supplement Amount Why
Zinc
 25 to 50 mg daily 2 stars   Supplementing with zinc may help speed the repair of damaged stomach tissue.


2 stars  Zinc

25 to 50 mg daily

Zinc is also needed for the repair of damaged tissue and has protected against stomach ulceration in animal studies.31 In Europe, zinc combined with acexamic acid, an anti-inflammatory substance, is used as a drug in the treatment of peptic ulcers.32 In a small controlled trial, high amounts of zinc accelerated the healing of gastric ulcers compared with placebo.33 Some doctors suspect that such an exceptionally high intake of zinc may be unnecessary, suggesting instead that people with ulcers wishing to take zinc supplements use only 25 to 50 mg of zinc per day. Even at these lower levels, 1 to 3 mg of copper per day must be taken to avoid copper deficiency that would otherwise be induced by the zinc supplementation.

Supplement Amount Why
Zinc-L-Carnosine
 150 mg of zinc carnosine complex twice per day 2 stars   Studies have shown that a zinc salt of the amino acid carnosine protects against ulcer formation and promotes the healing of existing ulcers.


2 stars  Zinc-L-Carnosine

150 mg of zinc carnosine complex twice per day

Experimental animal studies have shown that a zinc salt of the amino acid carnosine exerts significant protection against ulcer formation and promotes the healing of existing ulcers.34 , 35 However, because zinc by itself has been shown to be helpful against peptic ulcer, it is not known how much of the beneficial effect was due to the carnosine.36 , 37 Clinical studies in humans demonstrated that this compound can help eradicate H. pylori, an organism that has been linked to peptic ulcer and stomach cancer.38 The amount of the zinc carnosine complex used in research studies for eradication of H. pylori is 150 mg twice daily.

Supplement Amount Why
Calendula
 Refer to label instructions 1 star   Calendula is another plant with anti-inflammatory and healing activities that can be used as part of a traditional medicine approach to peptic ulcers. The same amount as chamomile can be used.

1 star  Calendula

Calendula is another plant with anti-inflammatory and healing activities that can be used as part of a traditional medicine approach to peptic ulcers. The same amount as chamomile can be used.

Supplement Amount Why
Carnosine
 Refer to label instructions 1 star  

Carnisone may protect against ulcer formation and promote the healing of existing ulcers.



1 star  Carnosine

Experimental animal studies have shown that a zinc salt of the amino acid carnosine exerts significant protection against ulcer formation and promotes the healing of existing ulcers.39 , 40 However, because zinc by itself has been shown to be helpful against peptic ulcer, it is not known how much of the beneficial effect was due to the carnosine.41 , 42 Clinical studies in humans demonstrated that this compound can help eradicate H. pylori, an organism that has been linked to peptic ulcer and stomach cancer.43 The amount of the zinc carnosine complex used in research studies for eradication of H. pylori is 150 mg twice daily.

Supplement Amount Why
Chamomile
 Refer to label instructions 1 star   Chamomile has a soothing effect on inflamed and irritated mucous membranes. It is also high in the flavonoid apigenin, which has inhibited growth of H. pylori in test tubes.

1 star  Chamomile

Chamomile has a soothing effect on inflamed and irritated mucous membranes. It is also high in the flavonoid apigenin—another flavonoid that has inhibited growth of H. pylori in test tubes.44 Many doctors recommend drinking two to three cups of strong chamomile tea each day. The tea can be made by combining 3 to 5 ml of chamomile tincture with hot water or by steeping 2 to 3 tsp of chamomile flowers in the water, covered, for 10 to 15 minutes. Chamomile is also available in capsules; two may be taken three times per day.

Supplement Amount Why
Comfrey
 Refer to label instructions 1 star   Comfrey has history of traditional use for treating gastrointestinal problems, including stomach ulcers.


1 star  Comfrey

Comfrey has a long tradition of use as a topical agent for improving healing of wounds and skin ulcers.45 , 46 It is also used for people with gastrointestinal problems, including stomach ulcers, though these traditional uses have yet to be tested in scientific studies. People should only use comfrey preparations made from the leaves and avoid those made from the root.


Supplement Amount Why
Corydalis
 Refer to label instructions 1 star   Corydalis extracts are useful in relieving pain and in treating stomach ulcers.


1 star  Corydalis

Extracts of the herb corydalis are not only helpful as pain-relief agents but also may be useful in the treatment of stomach ulcers. In a study of people with stomach and intestinal ulcers or chronic inflammation of the stomach lining, 90 to 120 mg of corydalis extract per day (equal to 5 to 10 grams of the crude herb) was found to be effective in 76% of the participants.47

Supplement Amount Why
DMSO
 Refer to label instructions 1 star   DMSO is believed to have antioxidant activity and was found in one study to reduce relapse rates better than the ulcer drug cimetidine (Tagamet).


1 star  DMSO

Oral supplementation with dimethyl sulfoxide (DMSO) reduced relapse rates for peptic ulcer significantly better than did placebo or the ulcer drug cimetidine (Tagamet) in one study.48 Previous research showed that DMSO in combination with cimetidine was more effective than cimetidine alone.49 These trials used 500 mg of DMSO taken four times per day. The authors of these trials believe the antioxidant activity of DMSO may have a protective effect. Oral supplementation with DMSO should not be attempted without the supervision of a doctor.

Supplement Amount Why
Garlic
 Refer to label instructions 1 star   Garlic has been reported to have anti-Helicobacter activity in test-tube studies and may be helpful for peptic ulcers.

1 star  Garlic

Garlic has been reported to have anti-Helicobacter activity in test-tube studies.50 , 51 In a preliminary trial, garlic supplementation (300 mg in tablets three times daily for eight weeks) failed to eradicate H. pylori in participants with active infections.52 In another preliminary trial, participants with active H. pylori infections added 10 sliced cloves of garlic to a meal.53 The addition of garlic failed to inhibit the growth of the organism. Further trials using garlic extracts are needed to validate the anti-Helicobacter activity of garlic observed in test tubes. Until then, evidence to support the use of garlic for H. pylori-related peptic ulcers remains weak.

Supplement Amount Why
Glutamine
 Refer to label instructions 1 star   Glutamine, an amino acid, is the main energy source for cells that line the small intestine and stomach. Supplementing with it may help people overcome peptic ulcers.

1 star  Glutamine

Glutamine , an amino acid, is the principal source of energy for cells that line the small intestine and stomach. More than 40 years ago, glutamine was reported to help people with peptic ulcer in a preliminary trial.54 Glutamine has also prevented stress ulcers triggered by severe burns in another preliminary study.55 Despite the limited amount of published research, some doctors suggest 500 to 1,000 mg of glutamine taken two to three times per day to help people overcome peptic ulcers.

Supplement Amount Why
Marshmallow
 Refer to label instructions 1 star   High-mucilage-containing herbs such as marshmallow have a long history of use for irritated or inflamed mucous membranes in the digestive system.

1 star  Marshmallow

Marshmallow is high in mucilage. High-mucilage-containing herbs have a long history of use for irritated or inflamed mucous membranes in the digestive system, though no clinical research has yet investigated effects in people with peptic ulcer.

Supplement Amount Why
Plantain
 Refer to label instructions 1 star   Because of plantain’s anti-inflammatory and healing effects, it may be beneficial in some people with peptic ulcer.


1 star  Plantain

Because of the anti-inflammatory and healing effects of plantain, it may be beneficial in some people with peptic ulcer. Clinical trials have not been done to confirm this possibility.

Supplement Amount Why
Vitamin C
 Refer to label instructions 1 star   Vitamin C may be useful in treating peptic ulcers because of its ability to help eradicate H. pylori


1 star  Vitamin C

Little is known about the effects of vitamin C supplementation for people with peptic ulcer. People with gastritis, a related condition, have been found to have low levels of vitamin C in their stomach juice. Vitamin C may also help eradicate H. pylori in people with gastritis. Vitamin C may one day prove to have a therapeutic effect for people with peptic ulcer; however, further research in this area is needed.

References

1. Bresnick WH, Rask-Madsen C, Hogan DL, et al. The effect of acute emotional stress on gastric acid secretion in normal subjects and duodenal ulcer patients. J Clin Gastroenterol 1993;17:117–22.

2. Lam SK, Hui WM, Shiu LP, Ng MM. Society stress and peptic ulcer performation. J Gastroenterol Hepatol 1995;10:570–6.

3. Piper DW, Tennant C. Stress and personality in patients with chronic peptic ulcer. J Clin Gastroenterol 1993;16:211–4.

4. Stewart DN, de R. Winser DM. Incidence of perforated peptic ulcer. Effect of heavy air raids. Lancet 1942;2:259–61.

5. Spicer CC, Stewart DN, de R. Winser DM. Perforated peptic ulcer during the period of heavy air raids. Lancet 1944;1:14.

6. Aoyama N, Kinoshita Y, Fujimoto S, et al. Peptic ulcers after the Hanshin-Awaji earthquake: Increased incidence of bleeding gastric ulcers. Am J Gastroenterol 1998;93:311–6.

7. Grimes DS, Goddard J. Gastric emptying of wholemeal and white bread. Gut 1977;18:725–9.

8. Rydning A, Berstad A, Aadland E, Odegaard B. Prophylactic effect of dietary fiber in duodenal ulcer disease. Lancet 1982;2(8301):736–9.

9. Ryndning A, Berstad A. Fiber diet and antacids in the short-term treatment of duodenal ulcer. Scand J Gastroenterol 1985;20:1078–82.

10. Sonnenberg A. Dietary salt and gastric ulcer. Gut 1986;27:1138–42.

11. Katchinski BD, Logan RFA, Edmond M, Langman MJS. Duodenal ulcer and refined carbohydrate intake: a case-control study assessing dietary fiber and refined sugar intake. Gut 1990;31:993–6.

12. Suadicani P, Hein HO, Gyntelberg F. Genetic and life-style determinants of peptic ulcer. A study of 3387 men aged 54 to 74 years: The Copenhagen Male Study. Scand J Gastroenterol 1999;34:12–7.

13. Yudkin J. Eating and ulcers. BMJ 1980;Feb 16:483 [letter].

14. Cheney G. Rapid healing of peptic ulcers in patients receiving fresh cabbage juice. Cal Med 1949;70:10.

15. Doll R, Pygott F. Clinical trial of Robaden and of cabbage juice in the treatment of gastric ulcer. Lancet 1954;2:1200.

16. Thaly H. A new therapy of peptic ulcer: The anti-ulcer factor of cabbage. Gaz Med Fr 1965;72:1992–3.

17. Dunaevskii GA, Migonova DK, Rozka IM, Chibisova SM. Value of preserved juice of white cabbage in the complex therapy of peptic ulcer. Vopr Pitan 1970;29:29–33.

18. Noess K. Ulcer-fiber-cabbage and vitamin U. Tidsskr Nor Laegeforen 1986;106:693–4.

19. Kern RA, Stewart G. Allergy in duodenal ulcer: incidence and significance of food hypersensitivities as observed in 32 patients. J Allergy 1931;3:51.

20. Reimann HJ, Lewin J. Gastric mucosal reactions in patients with food allergy. Am J Gastroenterol 1988;83:1212–9.

21. Goso Y, Ogata Y, Ishihara K, Hotta K. Effects of traditional herbal medicine on gastric mucin against ethanol-induced gastric injury in rats. Comp Biochem Physiol 1996;113C:17–21.

22. Beil W, Birkholz W, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

23. Beil W, Birkholz C, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

24. Al-Said MS, Ageel AM, Parmar NS, Tariq M. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Ethnopharmacol 1986;15:271–8.

25. Huwez FU, Al-Habbal MJ. Mastic in treatment of benign gastric ulcers. Gastroenterol Japon 1986;21:273–4.

26. Huwez FU, Thirlwell D, Cockayne A, Ala’Aldeen DA. Mastic gum kills Helicobacter pylori. New Engl J Med 1998;339:1946 [letter].

27. Bandyopadhyay U, Biswas K, Sengupta A, et al. Clinical studies on the effect of Neem (Azadirachta indica) bark extract on gastric secretion and gastroduodenal ulcer. Life Sci 2004;75:2867–78.

28. Beil W, Birkholz C, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

29. Patty I, Benedek S, Deak G, et al. Controlled trial of vitamin A therapy in gastric ulcer. Lancet 1982;2(8303):876 [letter].

30. Patty I, Tarnok F, Simon L, et al. A comparative dynamic study of the effectiveness of gastric cytoprotection by vitamin A, De-Nol, sucralfate and ulcer healing by pirenzepine in patients with chronic gastric ulcer (a multiclinical and randomized study). Acta Physiol Hung 1984;64:379–84.

31. Pfeiffer CJ, Cho CH, Cheema A, Saltman D. Reserpine-induced gastric ulcers: protection by lysosomal stabilization due to zinc. Eur J Pharmacol 1980;61:347–53.

32. Jimenez E, Bosch F, Galmes JL, Banos JE. Meta-analysis of efficacy of zinc acexamate in peptic ulcer. Digestion 1992;51:18–26.

33. Frommer DJ. The healing of gastric ulcers by zinc sulphate. Med J Aust 1975;2:793–6.

34. Nishiwaki H, Kato S, Sugamoto S, et al. Ulcerogenic and healing impairing actions of monochloramine in rat stomachs: effects of zinc L-carnosine, polaprezinc. J Physiol Pharmacol 1999;50:183–95.

35. Arakawa T, Satoh H, Nakamura A, et al. Effects of zinc L-carnosine on gastric mucosal and cell damage caused by ethanol in rats. Correlation with endogenous prostaglandin E2. Dig Dis Sci 1990;35:559–66.

36. Cho CH, Ogle CW. A correlative study of the antiulcer effects of zinc sulphate in stressed rats. Eur J Pharmacol 1978;48:97–105.

37. Frommer DJ. The healing of gastric ulcers by zinc sulphate. Med J Aust 1975;2:793–6.

38. Kashimura H, Suzuki K, Hassan M, et al. Polaprezinc, a mucosal protective agent, in combination with lansoprazole, amoxicillin, and clarithromycin increases the cure rate of Helicobacter pylori infection. Aliment Pharmacol Ther 1999;13(4):483–7.

39. Nishiwaki H, Kato S, Sugamoto S, et al. Ulcerogenic and healing impairing actions of monochloramine in rat stomachs: effects of zinc L-carnosine, polaprezinc. J Physiol Pharmacol 1999;50:183–95.

40. Arakawa T, Satoh H, Nakamura A, et al. Effects of zinc L-carnosine on gastric mucosal and cell damage caused by ethanol in rats. Correlation with endogenous prostaglandin E2. Dig Dis Sci 1990;35:559–66.

41. Cho CH, Ogle CW. A correlative study of the antiulcer effects of zinc sulphate in stressed rats. Eur J Pharmacol 1978;48:97–105.

42. Frommer DJ. The healing of gastric ulcers by zinc sulphate. Med J Aust 1975;2:793–6.

43. Kashimura H, Suzuki K, Hassan M, et al. Polaprezinc, a mucosal protective agent, in combination with lansoprazole, amoxicillin, and clarithromycin increases the cure rate of Helicobacter pylori infection. Aliment Pharmacol Ther 1999;13(4):483–7.

44. Beil W, Birkholz C, Sewing KF. Effects of flavonoids on parietal cell acid secretion, gastric mucosal prostaglandin production and Helicobacter pylori growth. Arzneimittelforschung 1995;45:697–700.

45. Mills SY. Out of the Earth: The Essential Book of Herbal Medicine. New York: Viking Arkana, 1991, 544–7.

46. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers Ltd, 1988, 334–5.

47. Chang HM, But PPH. Pharmacology and Applications of Chinese Materia Medica vol 1. Singapore: World Scientific Inc., 1986, 521.

48. Salim AS. The relationship between Helicobacter pylori and oxygen-derived free radicals in the mechanism of duodenal ulceration. Internal Med 1993;32:359–64.

49. Salim AS. Allopurinol and dimethyl sulfoxide improve treatment outcomes in smokers with peptic ulcer disease. J Lab Clin Med 1992;119:702–9.

50. Sivam GP, Lampe JW, Ulness B, et al. Helicobacter pylori--in vitro susceptibility to garlic (Allium sativum) extract. Nutr Cancer 1997;27:118–21.

51. Chung JG, Chen GW, Wu LT, et al. Effects of garlic compounds diallyl sulfide and diallyl disulfide on arylamine N-acetyltransferase activity in strains of Helicobacter pylori from peptic ulcer patients. Am J Chin Med 1998;26:353–64.

52. Ernst E. Is garlic an effective treatment for Helicobacter pylori infection? Arch Intern Med 1999;159:2484–5 [letter].

53. Graham DY, Anderson SY, Lang T. Garlic or jalapeno peppers for treatment of Helicobacter pylori infection. Am J Gastroenterol 1999;94:1200–2.

54. Shive W, Snider RN, DuBilier B, et al. Glutamine in treatment of peptic ulcer. Texas State J Med 1957;Nov:840.

55. Yan R, Sun Y, Sun R. Early enteral feeding and supplement of glutamine prevent occurrence of stress ulcer following severe thermal injury. Chung Hwa Cheng Hsing Shao Shang Wai Ko Tsa Chih 1995;11:189–92.

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