Peptic Ulcer

Dr Swami Karmananda Saraswati, MB, BS (Syd.)

Peptic ulcer is a small hole burned into the wall of the stomach or duodenum. Medical science recognises two distinct types of peptic ulcer - gastric and duodenal - depending on the site in which it develops. Each has somewhat differing symptomatology and patterns of incidence.

1. Gastric ulcer

Gastric ulcer occurs in the stomach wall. Its symptoms are a gnawing mid-sternal pain, occurring especially before, mealtimes and classically irritated by food. Thus there is associated loss of appetite and weight. The pain and the condition are aggravated by spicy diet, alcohol and smoking, and temporary relief is obtained from a glass of milk.

The patient is commonly a male, young to middle aged, who is thin or underweight with a very tense and anxious personality. This is a disorder whose prime cause is excessive mental stress. It frequently occurs in individuals with serious, competitive, overly anxious personalities who are heavily involved in a competitive office environment. They are unable to relax and leave behind their gnawing achievement, work orientated anxieties even for a moment, night or day, and almost universally aggravate the condition by indulging in excessive smoking and drinking, so as to 'calm down'. Unfortunately both these habits are gastric irritants in their own right and further irritate and aggravate the ulcer. This type of person is a worrier through and through, and gastric ulcer is a disease generated by obsessive worry over success, failure, performance, profit, fidelity, illness, betrayal, etc. The object of worry will vary from case to case, but the factor of unrelenting worry is common to all.

2. Duodenal ulcer

The symptomatology of this ulcer, occurring in the wall of the first part of the small intestine, into which the gastric contents are emptied via the pyloric valve, are somewhat different. The pain is a deeper central abdominal pain which is relieved rather than aggravated by food. For this reason the sufferer is frequently overweight. He or she is frequently awakened early in the morning with pain, which is often temporarily relieved by milk. He or she often complains of increase in appetite and weight.

The definitive diagnosis of ulcer is made on barium meal X-ray, in which a clearly defined ulcer crater, filled with opaque dye and thus appearing white, is frequently seen either in the gastric or in the duodenal wall.

The mechanism of ulcer pain

The characteristic gnawing pain of peptic ulcer is produced when the acidic gastric secretions are liberated into the stomach or duodenum and find entry to the ulcer pit, where they cause intense irritation to nerves which lie bare and exposed in the ulcer floor. The ulcer itself develops because of constant outpouring of acidic gastric secretions, which ultimately overcome the resistance of the mucus cell lining and begin to burn one or more holes into the wall. This excessive acid outpouring is caused by mental factors.

A rare but serious complication of peptic ulcer is perforation and haemorrhage. These can occur where the penetrating acid burns its way into a major blood vessel exposed by the ulcer, so that an enormous quantity of blood is rapidly lost, or where the ulcer penetrates right through the wall, spilling the gastric contents into the sterile abdominal cavity. Both these complications frequently result in death, and are surgical emergencies. Fortunately, such complications are relatively rare.

The cause of ulcers

Medical science and yoga are in accordance in recognising that peptic ulcer is a psychosomatic disease, generated as mental stress is relayed into the body's organ systems and physiological mechanisms via the vagus nerve, the parasympathetic limb of the autonomic nervous system. In a mind possessed of gnawing, constant mental fears and anxieties, worries and turmoils, nerve impulses continually pass from the brain centres down the vagus nerve to stimulate a constant gastric acid secretion and turning over of the stomach. This goes on night and day, irrespective of whether food is present in the stomach or not. As a result, the mucosal resistance of the gastric or duodenal wall diminishes and the acid begins to auto-digest the wall. Thus an ulcer begins, which registers as pain when nerve fibres are exposed, like live electricity wires behind a wall panel. The whole process and psychological temperament is summed up in the expressions 'What's eating you?', for the ulcer sufferer is literally eating himself up with anxiety.

Management of ulcer

Obviously the ulcer sufferer finds himself in a mess from which he knows not how to escape. Medical measures alone are usually enough to bring a temporary remission of symptoms and anxiety, but ulcers regularly recur when the stressful former occupation and lifestyle are resumed. For this reason, many doctors recommend surgical rectification of any gastric ulcer which has recurred more than once before. Ulcer surgery is major surgery - it usually involves severance of the parasympathetic nerves to the digestive organs, and removal of part of the stomach itself. Even then further ulcers can occur.

Doctors who utilise yoga in their practice have found that a combination of conservative medical management and yogic practices is the most effective way in which an ulcer can heal itself. Crippling anxiety problems can be effectively resolved and a more stress-free lifestyle can be evolved, even in the midst of the pressures and demands of modern city life. The addition of yogic practice to conventional medical management enables the ulcer sufferer to implement specific lifestyle alterations which prevent a recurrence of ulcer and the prospect of major surgery as well.

Steps in ulcer therapy

1. Complete rest with change of environment: This enables the sufferer to shift his mind completely from the tension of his work, interrelationships etc. A minimum of one month is usually necessary, and an ashram environment is ideal for this purpose. Initially, the ulcer sufferer should rest completely, sleeping at inclination, walking as desired without any exertion, and completely freed of any former commitments or responsibilities. Enormous mental relief is experienced almost immediately.

2. Simple, bland diet: free from spices. Initially a light, liquid diet of vegetable broth, milk and bland fruits is most suitable, with abstinence from smoking and alcohol. Antacid preparations can be utilised initially in conjunction with yoga therapy, but should be discarded after healing occurs and symptoms disappear.

3. Relaxation: Daily practice of yoga nidra (inducing deep mental and emotional relaxation) is most important in resolution of inner anxieties and conflicts.

4. Simple relaxing asanas and pranayama: Can be introduced after two weeks, when initial healing has occurred and pain is relieved. These must be performed in a non-competitive, enjoyable way, with emphasis on relaxation and awareness. Pawanmuktasana parts I and II should be initially practised daily for two weeks, followed by surya namaskara to capacity in the second two weeks. Brahmari pranayama and nadi shodhana should follow.

An evening walk is most beneficial.

5. Karma yoga: Performance of some simple task in a non-competitive environment, e.g. carpentry or gardening for a few hours, are excellent prescriptions for a formerly very tense desk worker. Karma yoga brings mental release, relaxation and creative expression.

6. Shatkriyas: Neti and laghoo shankhaprakshalana can be introduced after some time, but kunjal is contraindicated in all ulcer sufferers because of the risk of disturbing the healing ulcer. Any patient with a history of vomiting blood or passing blood with the stool should not be prescribed kunjal kriya except under expert guidance.

Long term outlook

The long term prognosis for the ulcer sufferer is excellent, provided he accepts the yogic lifestyle fully, upon re-entering his stressful home and work situation. Otherwise recurrence is a distinct possibility, and surgery may be indicated.

Yoga can definitely help the ulcer sufferer. It will show the way to a more balanced and enjoyable lifestyle, based on daily practice of asana, pranayama and relaxation, sound simple diet, freedom from slavish habits and the anxieties and tensions that necessitate them. Disease arrives when such a lifestyle is lost, and disappears as it is regained and the pranic energy, so vital for regeneration and good health, begins to increase.