Bacterial Infection the Likely Culprit in Ulcer Formation

Many chronic health problems can steal some of the pleasure out of our lives, and those that affect our everyday lifestyles and habits are sometimes the most insidious. Among these are peptic ulcer disease. If you've had to live with symptoms such as burning pain in your belly before or after you eat, frequent vomiting, nausea, bloating and gas, you could be one of the many who have had to endure this problem. At times these persistent stomach problems, also called dyspepsia, are so bad that sufferers may even try to avoid eating.

Ulcers are created when the mucous membrane lining an organ or tissue is impaired as a result of inflammation. Peptic ulcers, caused by damage from gastric acids, afflict about 4 million Americans, or approximately 1.4% of the population. Peptic ulcers that form in the stomach are referred to as gastric ulcers, while those that form in the duodenum (the top part of the small intestine) are referred to as duodenal ulcers. Most ulcer patients experience pain or burning in the upper abdomen, just above the belly button.

H. Pylori A Common Cause Of Ulcers
Until recently, patients and even many physicians thought peptic ulcers were caused by stress and by the habit of eating spicy foods. Although these may aggravate pain and increase stomach acid if ulcers already exist, they are no longer thought to be the sole cause of the disease. The culprit? In about 9 of 10 cases, it's an infection from bacteria that can live in stomach acid. These bacteria are called Helicobacter pylori, more commonly referred to as H. pylori.

Two associate professors at the Medical College of Wisconsin Department of Family and Community Medicine, Linda N. Meurer, MD, MPH, and Douglas J. Bower, MD, co-authored an article titled "Management of Helicobacter Pylori Infection," which appeared in the April 1, 2002, issue of American Family Physician, a journal of the American Academy of Family Physicians. In their article, they advise other physicians of the importance of eradicating the H. pylori organism to promote healing of the ulcer and to help reduce the risk of recurrence and complications.

Not all patients with persistent stomach irritation necessarily have an ulcer, the authors note. However, unless symptoms include danger signs of bleeding or cancer, your doctor might request a blood test to determine if H. pylori infection is present.

Antibiotic Treatment
If a blood test does show infection with H. pylori, treatment includes a combination of antibiotics and acid-reducing medicines. "You should take these medicines for at least 10 to 14 days," the Medical College physicians advise. The most effective combinations include at least two antibiotics plus the acid reducers. The acid-reducing medicines help relieve pain and help the antibiotics work better.

There are two important reasons to eliminate H. pylori infection, the doctors say. First, it can cure the ulcer and ease the patient's discomfort. "Many people take antacids or other medicines for a long time before they get treated for H. pylori infection. After being treated for this infection, they don't need to take as much medicine for their stomach," Drs. Meurer and Bower said.

Second, they noted, when left untreated, H. pylori infection can lead to stomach cancer. Cancer is more common among patients who:

• are older than 45
• have rectal bleeding
• have lost more than 10% of their body weight (this does not include people on weight reduction plans)
• are anemic
• have jaundice
• have a family history of stomach cancer
• have a previous history of peptic ulcer
• are anorexic or feel full after eating just small amounts

"The first try at getting rid of H. pylori infection is usually the most successful, so it is important to do it right," Drs. Meurer and Bower write. Treatment could fail if the bacteria resist the antibiotics or if the patient doesn't take all of the medicine as prescribed by their health care provider. Ulcers caused by H. pylori may not heal completely, or might heal but could soon return unless the bacteria are killed. Gastric ulcers may take two or three months to heal completely, and duodenal ulcers typically take about six weeks. If H. pylori is completely killed, recurrence and re-infection are uncommon.

Other Tests
For some patients at higher risk for cancer, those with complicated ulcer disease, or patients with inconclusive follow-up tests, other testing procedures might be ordered. These could include an endoscopy or an X-ray test called an upper G.I. (gastrointestinal) series. During an endoscopy, a gastroenterologist inserts a flexible, lighted tube with a tiny camera into the stomach and intestines while the patient is sedated. This lets the doctor examine the walls of the stomach and duodenum and even take a biopsy if it's indicated.

H. pylori isn't always the cause of ulcers. Some patients, especially elderly patients, can develop ulcers as a result of taking aspirin or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, for instance) or naproxen (Aleve or other brand names). "Stay away from cigarettes, alcohol, caffeine, spicy foods, and coffee or tea (regular or decaffeinated)," the authors advise.

Can H. pylori infection be prevented? No one knows for sure how H. pylori spreads, so prevention is difficult. But researchers are trying to develop a vaccine to prevent infection, hoping that it might become available in six to eight years.

This article includes information from the Medical College of Wisconsin Department of Family and Community Medicine.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.