Download Anti-aging Nutritional Medicine

Nutritional Management
of Upper GI Disorders
Mitchell A. Fleisher, M.D., D.Ht., D.A.B.F.M.
Review of the Fundamentals
UGI Disorders
Dyspepsia
 Symptoms include:

 Abdominal discomfort
 Indigestion
 Bloating
 Belching
 Nausea
 Regurgitation
UGI Disorders

Gastritis defined as acute or chronic inflammation
of gastric mucosa, with or without erosion
 Symptoms similar to dyspepsia, but more severe
and/or persistent
 Gastric and duodenal mucosa protected by:
 Mucus barrier on mucosa
 Bicarbonate buffering of acid
 Rapid removal of excess acid
 Rapid repair of mucosal tissue
UGI Disorders

Gastritis, due to:
 H. pylori infection
 Tobacco
 Alcohol
 Aspirin
 NSAIDs
 Stress
 Atrophy
UGI Disorders

Atrophic gastritis
 Loss of parietal cells in atrophic gastric mucosa due
to autoimmune activity
 Causes hypochlorhydria (decreased HCl production)
or achlorhydria (loss of HCl production)
 Decrease or loss of intrinsic factor secretion resulting
in B12 malabsorption, and pernicious anemia
Gastritis
Gastroesophageal Reflux Disease

GERD defined as symptoms and/or mucosal
damage caused by abnormal reflux of gastric
contents into esophagus
 Symptoms include burning sensation in the
stomach and/or chest, heartburn, regurgitation,
or both, esp. after meals, which are aggravated
by recumbency, bending forward, and relieved
by oral antacids
Hiatal Hernia

Defined as an outpouching of a portion of
the stomach into the chest through the
esophageal hiatus of the diaphragm
 Heartburn after heavy meals, certain foods,
esp. spicy, and/or reclining after meals
 May worsen GERD symptoms
Anatomy of Hiatal Hernia
and GERD
UGI Disorders





Peptic Ulcer Disease defined as erosion
through mucosa into submucosa
May be gastric and/or duodenal
Due to: H. pylori, Aspirin, NSAIDs, Stress
(severe burns, trauma, surgery, shock, renal
failure, radiation, prolonged ICU stay)
May be asymptomatic, or, symptoms similar to
dyspepsia or gastritis
Risks of hemorrhage, perforation, and
penetration into adjacent organs
Gastric and Duodenal Ulcers

Gastric ulcer formation involves inflammation of
acid-producing, parietal cells, but usually occurs
with low acid secretion
 Duodenal ulcers are associated with high acid
secretion, and low bicarbonate secretion
 Hemorrhage and increased mortality are more
often associated with gastric ulcers
Review of the Fundamentals

Diagnosis is empirical, though symptoms may
not correlate with the degree of UGI mucosal
inflammation and/or damage
 UGI Endoscopy is utilized to confirm ulceration
and/or dysplasia, e.g., Barrett's esophagitis, as
well as to rule out malignant pathology
 Negative endoscopic exam does not rule out
presence of GERD
Review of the Fundamentals

Upper gastrointestinal disorders, including
dyspepsia, GERD, gastritis, and peptic ulcer
disease, are very prevalent, affecting 45% of
Americans in a given, three month period

(Prevalence and socioeconomic impact of upper gastrointestinal disorders in
the United States: results of the U.S. Upper Gastrointestinal Study. Camilleri et
al. Clin. Gastroentrol. Hepatol. 2005 Jun;3(6):543-52.)
Review of the Fundamentals

Helicobacter pylori is a gram-negative, spiral,
flagellated microorganism that infects the
gastric mucosa, leading to chronic gastritis
 It has been linked to the increased risk for
development of ulcer disease in patients on
nonsteroidal anti-inflammatory drugs, and as a
potential contributor to functional, non-ulcer
dyspepsia and GERD

(http://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori)
Review of the Fundamentals

Helicobacter pylori infection is the primary,
causative and/or contributing, pathogenetic
agent in a very large percentage of upper
gastrointestinal disorders
 Research reveals that most ulcers, i.e., 80%
of stomach ulcers, and 90% of duodenal
ulcers, develop due to Helicobacter pylori
infection

(http://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori)
Helicobacter pylori
Bacterium
Helicobacter pylori
Invasion of Gastric Mucosa
Helicobacter pylori
Gastric Cytopathology
Destruction of Mucus Barrier and Mucosal Erosion
Helicobacter pylori
Gastritis
Endoscopic View of Infected Gastric Mucosa
Helicobacter pylori
Gastric Histopathology
Destruction of Gastric Mucosal Architecture
Problems with Conventional Pharmacotherapy
of UGI Disorders




Neutralization or inhibition of gastric acid by antacids,
H2 blockers and/or proton pump inhibitors leads to lack
of activation of gastric protease enzymes
When neutralized, gastric chyme enters duodenum, the
usual, acidic stimulus to bile and pancreatic digestive
enzyme secretion is absent causing undersecretion
Results in inadequate digestion and malabsorption of
proteins, lipids, carbohydrates, and fat-soluble vitamins,
with subsequent, relative malnutrition
Suboptimal macronutrient and micronutrient
assimilation undermines the protective, mucus barrier,
and promotes poor healing of injured, UGI mucosa
Problems with Conventional Pharmacotherapy
of UGI Disorders

Dr. David Graham, M.D., a world renowned, medical authority
on Helicobacter pylori infection stated in a 2008 report:
 "Traditional triple therapy remains effective only when used to treat
infections with susceptible organisms.”
 "The prevalence of antibiotic resistance has increased to such an
extent that, to maintain acceptable cure rates, all patients should be
considered as having resistant infections.” (i.e., if you have H. pylori,
it is highly likely that you have a resistant strain that will not be killed
by conventional triple therapy)
 "Therapies that do not reliably yield 90% cure rates should not be
prescribed empirically; triple therapies that contain combinations of a
PPI, amoxicillin, clarithromycin or metronidazole now typically
yield cure rates less than 80% and are no longer acceptable as
empiric therapy.”

Graham, D. and Shiotani, A. New Concepts of Resistance in the Treatment of
Helicobacter pylori. Nature Clinical Practice Gastro &
Hep. 2008, http://www.medscape.com/viewarticle/574479
Problems with Conventional Pharmacotherapy
of UGI Disorders
There are multiple, adverse drug reactions
Problems with Conventional Pharmacotherapy
of UGI Disorders
Gaby, A. R. helicobacter pylori Eradication: are there alternatives to antibiotics?
Altern Med Rev. 2001 6 (4):355-366
Therapy of UGI Disorders

Dyspepsia
 Avoid offending foods
 Check for food sensitivities
 Avoid overindulgence
 Eat slowly and chew food thoroughly
Therapy of UGI Disorders

Gastritis
 Avoid foods and drugs that increase gastric acid
secretion, e.g., chocolate, black or red pepper,
coffee (even decaf.), caffeine, alcohol, tobacco
 Identify foods that irritate gastric mucosa, or are
not generally tolerated by the individual patient
 Eliminate food allergens from diet
 Support gastric mucosal barrier
 Eradicate H. pylori infection
Therapy of UGI Disorders

GERD
 Restrict foods that decrease LES pressure, e.g.,
chocolate, coffee, mint, high fat content food
 Avoid or greatly limit alcohol intake
 Avoid eating within 3 hours before bedtime
 Eat smaller, more frequent meals
 Remain upright after eating for one hour
 Wear loose-fitting clothing around waist
 Raise the head of bed for sleep, i.e., use 30 to 45
degree wedge pillow, etc.
 Initiate smoking cessation (lowers LES pressure)
 Initiate weight reduction, if overweight or obese
Therapy of UGI Disorders

Peptic Ulcer Disease
 Follow general guidelines for gastritis
 Must avoid all alcohol and tobacco use
 Must avoid aspirin, NSAIDs, corticosteroids
 Critical to eradicate H. pylori infection due to
high incidence of recurrence of PUD
Nutriceutical Therapy of UGI Disorders

Gastro Pro
 Specially designed, nutriceutical complex, containing
Deglycyrrhizinated licorice root (DGL), Neem Leaf
Powder (Azadirachta indica), Mastic Gum (Pistacia
lentiscus), Bovine Colostrum, and L-Glutamine
 Significantly supports healthy gastrointestinal system
integrity and function, especially of the stomach,
esophagus and intestines
 Indicated for acute and chronic gastritis, peptic ulcers,
GERD, inflammatory bowel disease, and intestinal
permeability disorders, particularly those caused by
Helicobacter pylori infections
Mechanisms of Action of Gastro Pro

DGL
 A human study concluded that Deglycyrrhizinated licorice
root (DGL) is more effective at alleviating duodenal ulcers
than Cimetidine

Brogden, R. N., et al. Deglycyrrhizinised liquorice: a report of its
pharmacological properties and therapeutic efficiency in peptic ulcer. Drugs.
8(5):330-339, 1974
 Another human study concluded that DGL caused a reduction
in gastric ulcer size in 78% of subjects and caused complete
healing of gastric ulcers in 44% of subjects

Glick, L. Deglycyrrhizinated liquorice in peptic ulcer. The Lancet. 2:817, 1982
 DGL is useful for repairing the damaged cells in intestinal
permeability

Tewari, S. N., et al. Deglycyrrhizinated licorice in duodenal ulcer. Practitioner. 210:820823, 1973)
Mechanisms of Action of Gastro Pro

Neem Leaf Powder (Azadirachta indica)
 Helps to alleviate peptic ulcer disease (PUD), i.e., gastric and
duodenal ulcers, through the suppression of Helicobacter
pylori infections that are responsible for many cases of PUD


Subapriya, R., et al. Medicinal Properties of Neem Leaves: A Review. Current Medicinal
Chemistry-Anti-Cancer Agents, Vol. 5, No. 2, March 2005, pp. 149-156(8)
Kiranmai M, et al. Evaluation of Anti-helicobacter pylori activity and total flavonoids
content of Azadirachta indica extracts. Department of Pharmaceutical Chemistry, Nizam
Institute of Pharmacy, Pochampally(M), Deshmukhi, Nalgonda-508284
Mechanisms of Action of Gastro Pro

Mastic Gum (Pistacia lentiscus)
 A double-blind clinical trial was carried out on thirty-eight patients

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with symptomatic and endoscopically proven duodenal ulcer to
compare the therapeutic responses to mastic gum and placebo
administered for two weeks
Symptomatic relief was obtained in sixteen (80%) patients on mastic
gum and in nine (50%) patients on placebo, while endoscopically
proven healing occurred in fourteen (70%) patients on mastic and
four (22%) patients on placebo
The differences between treatments were highly significant
Mastic gum was well tolerated and did not produce side effects
The authors concluded that mastic gum has a significant, ulcer
healing effect
In addition to helping heal peptic ulcers caused by Helicobacter
pylori, mastic gum can also promote healing of PUD caused by other
factors, including NSAIDs and stress

Al-Habbal, M. J., et al. A double-blind controlled clinical trial of mastic and placebo in the
treatment of duodenal ulcer. J. Clin Exp Pharm Physiol. 11:541-544, 1984
Mechanisms of Action of Gastro Pro

Mastic Gum (Pistacia lentiscus)
 Other research has shown that, even in low doses, mastic gum (1,000-
2,000 mg per day for two weeks) can promote very rapid healing of PUD
 Mastic gum is highly active against Helicobacter pylori infection
 It kills seven strains of Helicobacter pylori irrespective of the strain’s
degree of susceptibility to nitroimidazole antibiotics (some strains of
Helicobacter pylori have developed resistance to the effects of
nitroimidazoles)
 Effectiveness of mastic gum against Helicobacter pylori is regarded as
equal to or better than conventional, pharmaceutical antibiotics



Dabos, KL, et al. The effect of mastic gum on Helicobacter pylori: a randomized pilot study.
PhytoMedicine. 2010 Mar;17(3-4):296-9
Huwez, F. U., et al. Mastic gum kills Helicobacter pylori. New England Journal of Medicine.
339(26):1946, 1998
Marone, P., et al. Bactericidal activity of Pistacia lentiscus mastic gum against Helicobacter
pylori. J. Chemother. 13(6):611-614, 2001
Mechanisms of Action of Gastro Pro

Bovine Colostrum

Helicobacter pylori infection is known to be the primary, causative
agent of chronic gastritis and duodenal ulcers, and has been
linked to gastric adenocarcinoma and lymphoma of the stomach
In a controlled trial, bovine colostrum was shown to inhibit the
ability of H. pylori to bind to receptors on the intestinal surface,
blocking a critical step in pathogenesis
The authors suggest that bovine colostrum may be an effective
preventive agent against Helicobacter pylori-induced ailments


 Bitzan, et al. Inhibition of Helicobacter pylori and Helicobacter mustelae binding to lipid receptors
by bovine colostrum. J Infect Dis. 177:955-961, 1998
Mechanisms of Action of Gastro Pro

Bovine Colostrum

Non-steroidal anti-inflammatory drugs (NSAIDs) cause GI injury
Bovine colostrum is a rich source of growth factors
A study examined whether spray dried, defatted colostrum could
reduce gastrointestinal injury caused by indomethacin
The authors concluded that bovine colostrum could provide a
novel, inexpensive approach for the prevention and treatment of
the injurious effects of NSAIDs on the gut, and may also be of
value for the treatment of other ulcerative bowel conditions
Recent studies suggest that colostral fractions, or individual
peptides present in bovine colostrum, might be useful for the
treatment of a wide variety of gastrointestinal conditions, including
inflammatory bowel disease



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 Playford, R. J., et al. Colostrum and milk-derived peptide growth factors for the treatment of
gastrointestinal disorders. American Journal of Clinical Nutrition. 72(1):5-14, 2000
 Playford, R. J., et al. Bovine colostrum is a health food supplement which prevents NSAID
induced gut damage. Gut. 44(5):653-658, 1999
Mechanisms of Action of Gastro Pro

L-Glutamine
 Most abundant, conditionally essential amino acid in body
 Significantly enhances the general health of the entire GI
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

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tract, which uses it as its primary, cellular energy source
Required for the proper function of the gallbladder and
pancreas
Alleviates intestinal permeability due its role as a fuel for
enterocytes, second only to short-chain fatty acids
Serves as an important, nitrogen source for the cells of the
small intestine
Plays a major role in maintaining mucosal cell integrity and
gut barrier function

Souba, W. W. Glutamine: Physiology, Biochemistry and Nutrition in
Critical Illness. Landes Co. Austin, Texas, USA. 1992
Mechanisms of Action of Gastro Pro

L-Glutamine

Has been clinically demonstrated to support the healing of
gastritis and peptic ulcers
Therapeutic doses of glutamine increase mucosal thickness and
intestinal villous height, as well as increasing the secretion of
IgA, which serves to decrease bacterial adherence and bacterial
translocation, and strengthen the intestinal wall
Useful for repairing damage to the intestines in irritable bowel
syndrome and inflammatory bowel disease
Glutamine deficiency can result in atrophy of the gut mucosa,
decreased gut-associated lymphoid tissue (GALT), and increased
intestinal permeability

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 Miller, A. L. Therapeutic considerations of L-glutamine: a review of the literature.
Alternative Medicine Review. 4:239-248, 1999
 Shive, W., et al. Glutamine in treatment of peptic ulcer. Tex J Med. 53:840-843, 1957
Recommended Indications for Gastro Pro

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Supports prevention and control of inflammatory
disorders of the gastrointestinal system
Helps prevent and/or eliminate Helicobacter pylori
infections of the gastrointestinal tract
Promotes healing of acute and chronic inflammation of
the gastrointestinal system
Supports healthy, gastrointestinal functional integrity,
normal digestion and intestinal permeability
Helps prevent and/or promote healing of acute and
chronic gastritis, peptic ulcers, GERD and
inflammatory bowel disorders
Recommended Dosage of Gastro Pro

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For gastrointestinal disorders due to Helicobacter pylori
infection, dosage is four capsules three times daily
between meals on a nearly empty stomach for two to
four weeks, then four capsules twice daily for three
months, and then two capsules twice daily thereafter for
prevention of recurrence
Children between 2 and 6 years old may be given half of
the above-recommended adult dosages
Contents of capsules may be mixed into a small amount
of applesauce or other fruit jam or preserves for ease of
administration in children and/or the elderly
Nutriceutical Therapy of UGI Disorders



In addition to Gastro Pro:
For Dyspepsia and GERD, give digestive enzymes
and probiotics
For Atrophic Gastritis, give digestive enzymes,
probiotics, acidifier and sublingual vitamin B12
 Digestin 1 to 2 capsule(s) with every meal
 AcidaZyme 1 to 2 capsule(s) with every meal
 Broad Spectrum Probiotic 1 to 2 tablet(s) daily
 B-12 Lingual 1 to 2 tablet(s) daily
 B-12 Intrinsic Factor 1 to 2 capsule(s) daily
Gastro Pro and above nutraceutical agents are available
from Progressive Labs at (800) 527-9512, order #7876
"The doctor of the
future will give no
medicine, but will
interest his patients in
the care of the human
frame, in diet, and in the
cause and prevention of
disease."
Thomas Edison