What Is a Peptic Ulcer? 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 foods.
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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.
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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.
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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.
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How Is an H. pylori-related Ulcer
Diagnosed? Diagnosing an Ulcer
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.
H. pylori bacteria
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.
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How Are H. pylori Peptic Ulcers Treated?
Drugs Used To Treat H. pylori Peptic
Ulcers
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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Can H. pylori Infection Be Prevented? 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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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.
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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.
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Additional Readings Graham DY, Rakel RE,
Fendrick AM, et al. Recognizing peptic
ulcer disease: keys to clinical and
laboratory diagnosis. Postgraduate
Medicine. 1999;105(3):113-133.
Lahaie RG, Gaudreau C. Helicobacter pylori
antibiotic resistance: trends over time.
Canadian Journal of Gastroenterology.
2000;14(10):895-899.
Manes G, Balzano A, Iaquinto G, et al.
Accuracy of the stool antigen test in the
diagnosis of Helicobacter pylori infection
before treatment and in patients on
omeprazole therapy. Alimentary
Pharmacology and Therapeutics.
2001;15(1):73-79.
McManus TJ. Helicobacter pylori: an
emerging infectious disease. Nurse
Practitioner. 2000;25(
:42-46.
National Institutes of Health, Office of
the Director. NIH Consensus Statement:
Helicobacter pylori in Peptic Ulcer
Disease. Vol. 12, No. 1. Bethesda, MD:
National Institutes of Health; 1994.
Saunders CS. H. pylori infection:
simplifying management. Patient Care.
1999;(20):118-134.
Vaira D, Holton J, Menegatti M, et al.
Review article: invasive and noninvasive
tests for Helicobacter pylori infection.
Alimentary Pharmacology and Therapeutics.
2000;14(suppl 3):13-22.
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company. Trade, proprietary, or company
names appearing in this document are used
only because they are considered necessary
in the context of the information
provided. If a product is not mentioned,
this does not mean or imply that the
product is unsatisfactory.
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