A peptic ulcer is a sore on the lining of the stomach or duodenum,
which is the beginning of the small intestine. Peptic ulcers are
common: One in 10 Americans develops an ulcer at some time in his or
her life. One cause of peptic ulcer is bacterial infection, but some
ulcers are caused by long-term use of nonsteroidal anti-inflammatory
agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous
tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are
not caused by stress or eating spicy food, but these can make ulcers
worse.
What is Gastritis?
Gastritis is not a single disease, but several different conditions
that all have inflammation of the stomach lining. Gastritis can be
caused by drinking too much alcohol, prolonged use of nonsteroidal
anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or
infection with bacteria such as Helicobacter pylori (H. pylori).
Sometimes gastritis develops after major surgery, traumatic injury,
burns, or severe infections. Certain diseases, such as pernicious
anemia, autoimmune disorders, and chronic bile reflux, can cause
gastritis as well.
What is H. pylori?
Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.
H. pylori infection is common in the United States. About
20 percent of people under 40 years old and half of those over 60 years
have it. Most infected people, however, do not develop ulcers. Why H. pylori
does not cause ulcers in every infected person is not known. Most
likely, infection depends on characteristics of the infected person,
the type of H. pylori, and other factors yet to be discovered.
Researchers are not certain how people contract H. pylori, but they think it may be through food or water.
Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.
How does H. pylori cause a peptic ulcer?
H. pylori weakens the protective mucous coating of the
stomach and duodenum, which allows acid to get through to the sensitive
lining beneath. Both the acid and the bacteria irritate the lining and
cause a sore, or ulcer.
H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows H. pylori
to make its way to the "safe" area: the protective mucous lining. Once
there, the bacterium's spiral shape helps it burrow through the lining.
What are the symptoms of an ulcer?
Abdominal discomfort is the most common symptom. This discomfort usually
is a dull, gnawing ache
comes and goes for several days or weeks
occurs 2 to 3 hours after a meal
occurs in the middle of the night, when the stomach is empty
is relieved by eating
is relieved by antacid medications
Other symptoms include
weight loss
poor appetite
bloating
burping
nausea
vomiting
Some people experience only very mild symptoms, or none at all.
Emergency Symptoms
If you have any of these symptoms, call your doctor right away:
sharp, sudden, persistent stomach pain
bloody or black stools
bloody vomit or vomit that looks like coffee grounds
They could be signs of a serious problem, such as
perforation- when the ulcer burrows through the stomach or duodenal wall
bleeding- when acid or the ulcer breaks a blood vessel
obstruction- when the ulcer blocks the path of food trying to leave the stomach
How is an H. pylori-related ulcer diagnosed?
Diagnosing an Ulcer
H. pylori bacteriaTo see whether symptoms are caused by
an ulcer, the doctor may do an upper gastrointestinal (GI) series or an
endoscopy. An upper GI series is an x ray of the esophagus, stomach,
and duodenum. The patient drinks a chalky liquid called barium to make
these organs and any ulcers show up more clearly on the x ray.
An endoscopy is an exam that uses an endoscope, a thin, lighted tube
with a tiny camera on the end. The patient is lightly sedated, and the
doctor carefully eases the endoscope into the mouth and down the throat
to the stomach and duodenum. This allows the doctor to see the lining
of the esophagus, stomach, and duodenum. The doctor can use the
endoscope to take photos of ulcers or remove a tiny piece of tissue to
view under a microscope. This procedure is called a biopsy. If an ulcer
is bleeding, the doctor can use the endoscope to inject drugs that
promote clotting or to guide a heat probe that cauterizes the ulcer.
Diagnosing H. pylori
If an ulcer is found, the doctor will test the patient for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from that for an ulcer caused by NSAIDs.
H. pylori is diagnosed through blood, breath, stool, and tissue tests. Blood tests are most common. They detect antibodies to H. pylori bacteria. Blood is taken at the doctor's office through a finger stick.
Urea breath tests are an effective diagnostic method for H. pylori.
They are also used after treatment to see whether it worked. In the
doctor's office, the patient drinks a urea solution that contains a
special carbon atom. If H. pylori is present, it breaks down
the urea, releasing the carbon. The blood carries the carbon to the
lungs, where the patient exhales it. The breath test is 96 percent to
98 percent accurate.
Stool tests may be used to detect H. pylori infection in
the patient's fecal matter. Studies have shown that this test, called
the Helicobacter pylori stool antigen (HpSA) test, is accurate for
diagnosing H. pylori.
Tissue tests are usually done using the biopsy sample that is removed with the endoscope. There are three types:
The rapid urease test detects the enzyme urease, which is produced by H. pylori.
A histology test allows the doctor to find and examine the actual bacteria.
A culture test involves allowing H. pylori to grow in the tissue sample.
In diagnosing H. pylori, blood, breath, and stool tests are
often done before tissue tests because they are less invasive. However,
blood tests are not used to detect H. pylori following treatment because a patient's blood can show positive results even after H. pylori has been eliminated.
How are H. pylori peptic ulcers treated?
H. pylori peptic ulcers are treated with drugs that kill
the bacteria, reduce stomach acid, and protect the stomach lining.
Antibiotics are used to kill the bacteria. Two types of
acid-suppressing drugs might be used: H2 blockers and proton pump
inhibitors.
H2 blockers work by blocking histamine, which stimulates acid
secretion. They help reduce ulcer pain after a few weeks. Proton pump
inhibitors suppress acid production by halting the mechanism that pumps
the acid into the stomach. H2 blockers and proton pump inhibitors have
been prescribed alone for years as treatments for ulcers. But used
alone, these drugs do not eradicate H. pylori and therefore do not cure H. pylori-related
ulcers. Bismuth subsalicylate, a component of Pepto-Bismol, is used to
protect the stomach lining from acid. It also kills H. pylori.
Treatment usually involves a combination of antibiotics, acid
suppressors, and stomach protectors. Antibiotic regimens recommended
for patients may differ across regions of the world because different
areas have begun to show resistance to particular antibiotics.
The use of only one medication to treat H. pylori is not
recommended. At this time, the most proven effective treatment is a
2-week course of treatment called triple therapy. It involves taking
two antibiotics to kill the bacteria and either an acid suppressor or
stomach-lining shield. Two-week triple therapy reduces ulcer symptoms,
kills the bacteria, and prevents ulcer recurrence in more than 90
percent of patients.
Unfortunately, patients may find triple therapy complicated because
it involves taking as many as 20 pills a day. Also, the antibiotics
used in triple therapy may cause mild side effects such as nausea,
vomiting, diarrhea, dark stools, metallic taste in the mouth,
dizziness, headache, and yeast infections
in women, most side effects can be treated with medication withdrawal.
Nevertheless,
recent studies show that 2 weeks of triple therapy is ideal.
Early results of studies in other countries suggest that 1 week of
triple therapy may be as effective as the 2-week therapy, with fewer
side effects.
Another option is 2 weeks of dual therapy. Dual therapy involves two
drugs: an antibiotic and an acid suppressor. It is not as effective as
triple therapy.
Two weeks of quadruple therapy, which uses two antibiotics, an acid
suppressor, and a stomach-lining shield, looks promising in research
studies. It is also called bismuth triple therapy.
No one knows for sure how H. pylori spreads, so prevention is difficult. Researchers are trying to develop a vaccine to prevent infection.
Why don't all doctors automatically check for H. pylori?
Changing medical belief and practice takes time. For nearly 100
years, scientists and doctors thought that ulcers were caused by
stress, spicy food, and alcohol. Treatment involved bed rest and a
bland diet. Later, researchers added stomach acid to the list of causes
and began treating ulcers with antacids.
Since H. pylori was discovered in 1982, studies conducted around the world have shown that using antibiotics to destroy H. pylori cures peptic ulcers. The prevalence of H. pylori
ulcers is changing. The infection is becoming less common in people
born in developed countries. The medical community, however, continues
to debate H. pylori's role in peptic ulcers. If you have a peptic ulcer and have not been tested for H. pylori infection, talk to your doctor.
Points to Remember
A peptic ulcer is a sore in the lining of the stomach or duodenum.
The majority of peptic ulcers are caused by the H. pylori bacterium. Many of the other cases are caused by NSAIDs. None are caused by spicy food or stress.
H. pylori can be transmitted from person to person through close contact and exposure to vomit.
Always wash your hands after using the bathroom and before eating.
A combination of antibiotics and other drugs is the most effective treatment for H. pylori peptic ulcers.
Reprinted from National Digestive Diseases Information Clearinghouse.
