If you think you're an ulcer sufferer, smile and read on. The news has been out for awhile that bacteria, not stress or jalepeno-garlic bread, is the more likely culprit. Yet, we find ourselves still clinging to old beliefs and grandma's remedies.

It's time to upgrade our ulcer education.

Most ulcers are caused by an infection with the Helicobacter pylori bacterium
(H.pylori ) that can be treated with antibiotics. This bacterium is the source of 70 percent of ulcer cases.

The other 30 percent are caused by a rather modern habit: chronic use of prescription and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen, naproxen and prescriptive Cox-2 inhibitors, such as Celebrex.

You Can Catch an Ulcer?

A peptic ulcer is a sore in the lining of the stomach or the duodenum, a part of the small intestine. As the sore develops, the surface of the protective mucous membrane breaks down and dies, leaving a raw, inflamed area. H.pylori can create the condition that allows a sore like this to form.

"[Discovering] that an ulcer is an infectious disease changed everything, especially treatment," explains Wallace A. Gleason, professor and director of the Division of Pediatric Gastroenterology and Nutrition at The University of Texas Medical School at Houston.

Treating the H. pylori infection with antibiotics can shorten the ulcer's healing time and can reduce recurrence for the 25 million Americans who suffer with ulcers. In the U.S. there are 350,000 to 500,000 new cases each year and one million ulcer-related hospitalizations annually.

So, How Did I Catch it?

The body is invaded by H. pylori through the digestive tract and takes up residence in the stomach lining. Research suggests that individuals are infected in childhood, through fecal hand-to-mouth contamination (yet another reason to wash hands religiously after using the bathroom and before eating.) Untreated ulcers can result in internal bleeding or stomach cancer.

If a person lives in or visits a developing country, contact could be through a contaminated, or less-than-desirable water supply. In the U.S., it could be a hygiene slip-up, from unwashed hands after changing diapers to caring for someone sick who is vomiting and/or has diarrhea. Children may pass it to each other in a day care environment.

Not Every Stomachache is an Ulcer

For many patients, the first symptom can be a burning sensation or pain in the stomach between the breastbone and the belly button. It occurs 2-3 hours after meals but can occur in the middle of the night. Other symptoms are weight loss, poor appetite, bloating, burping, nausea and vomiting. Some patients have no symptoms at all.

"We are careful in diagnosing ulcers because reflux disease causes the same symptoms," Gleason says. Gastroesophageal reflux is a backflow of acid from the stomach into the swallowing tube or esophagus. The usual symptom, similar to ulcers, is heartburn, an uncomfortable burning sensation behind the breastbone, most commonly occurring after a meal. It also can be the reason for bad breath.

Testing and Treatment

One critical diagnostic question to ask patients is if anyone else in the house has an ulcer.

The H. pylori bacteria can be identified by tests of breath, stool or blood. The blood test is the most common because it detects antibodies to H. pylori . All are less invasive than an endoscope. This exam uses a thin, lighted tube with a tiny camera on the end. The tube goes down the throat (esophagus) to the stomach and duodenum. Pictures can be taken of the ulcer(s), or tissue can be biopsied for study.

H. pylori is treated with antibiotics specific to this bacteria. Then, patients are given medications that reduce stomach acid and protect the stomach lining so that the ulcer can heal. Acid-suppressing drugs such as "H2 blockers" keep histamines – which stimulate acid secretion – in check. Proton pump inhibitors halt the mechanism that pumps the acid into the stomach.

The treatment for this ulcer originally required 4 weeks of antibiotics and an H2 blocker or proton pump inhibitor. But month-long treatments present patient compliance problems. "It was our experience that there was a 50 percent chance of recurrence. Now, the patient takes three medications for two weeks and one of those meds for another two weeks." If there is a recurrence, an endoscopy is performed.

Current ulcer treatments don't even resemble older methods before the discovery of H. pylori. "When I was in medical school," Gleason says, "it was believed that ulcers resulted from too much acid secretion in the stomach, so surgery was recommended to alter that action by cutting out the part of the stomach which makes acid. It was never a complete solution because there were complications."

Antacids were developed, and in the 1970s, the H2 blockers came along which directly countered the gastric acid secretion, greatly easing symptoms.

"We think we are seeing less gastric cancer in developed countries because we are eradicating H. pylori in symptomatic people."

The treatment is different, depending on the type of ulcer. NSAID-induced ulcers can heal once the patient quits taking those drugs. Taking antacids neutralizes the stomach acid. Using H2 blockers or proton pump inhibitors decreases the amount of acid the stomach produces, which helps the healing process.

"What we eat and drink does not cause ulcers, which was the old belief," Gleason comments. "A person does feel better after eating because the food is a buffer against the acid.

And stress? Though maybe not an ulcer's cause, Gleason says, "Stress has a negative effect on all health conditions."

UPDATED: 9-07-2004

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