Peptic Ulcer
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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.
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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.
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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.
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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.
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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
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To 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.
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| H. pylori bacteria |
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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.
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Antibiotics: metronidazole, tetracycline,
clarithromycin, amoxicillin H2 blockers: cimetidine, ranitidine,
famotidine, nizatidine
Proton pump inhibitors: omeprazole, lansoprazole,
rabeprazole, esomeprazole, pantoprozole
Stomach-lining protector: bismuth
subsalicylate |
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.
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No one knows for sure how H. pylori spreads, so prevention
is difficult. Researchers are trying to develop a vaccine to prevent
infection.
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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.
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- 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.
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