A peptic ulcer is a sore on the lining of the stomach or duodenum. Peptic ulcers are common. One in ten Americans develops an ulcer at some point in his or her life. Peptic ulcers are not caused by stress or spicy foods, although these can make ulcers worse. Peptic ulcers can be caused by long-term use of NSAIDSs (non-steroidal anti-inflammatory drugs), such as ibuprofen, aspirin, naproxen, etc. Peptic ulcers can also be caused by cancerous tumors or bacterial infections.

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 twenty percent of people under age forty and half of those over age sixty have the infection. Most infected people do not develop ulcers, but some do. Why H. pylori does not cause ulcers in every infected person is not yet known.

Symptoms

Abdominal discomfort is the most common symptom of a peptic ulcer. This discomfort usually a dull, gnawing ache that comes and goes for several days or weeks. It tends to occur two to three hours after a meal, or in the middle of the night when the stomach is empty. It is usually relieved by eating and by antacid medications. Other symptoms include weight loss, poor appetite, bloating, burping, nausea and vomiting. Some people experience only mild symptoms, or none at all.

Complications

If you have any of the following symptoms, call your doctor right away:

• sharp, sudden, persistent stomach pain
• bloody or black stools
• bloody vomit or vomit that looks like coffee grounds

These symptoms 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 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 acid and the bacteria irritate the lining and cause a sore, or ulcer. H. pylori is able to survive in the 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.

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.

Diagnosis

To see whether symptoms are caused by an ulcer, the gastroenterologist may do an esophagogastroduodenoscopy (EGD). An EGD is an exam that uses a thin, lighted tube with a camera on the end that 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 to biopsy a piece of tissue. The doctor can also cauterize bleeding ulcers with a heat probe.

If an ulcer is found, the doctor will test for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from treatment for ulcers caused by other factors. Biopsies taken during the EGD will be sent to a pathologist to see if it tests positive for H. pylori.

Treatment

H. pylori ulcers are treated with a combination of drugs to kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are used to kill the bacteria and proton pump inhibitors (PPIs) suppress acid production by halting the mechanism that pumps acid into the stomach.

PPIs are often prescribed to treat ulcers, but in the case of H. pylori ulcers, PPIs alone are not capable of eradicating H. pylori . The use of only one medication to treat H. pylori is not recommended. At this time, the most proven effective treatment is a two-week course of treatment called triple therapy. It involves taking two antibiotics and a PPI. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in more than ninety percent of patients.

Unfortunately, patients may find triple therapy complicated because it involves taking many pills each day. Also, the antibiotics used may cause mild side effects. Nevertheless, studies show that two weeks of triple therapy is ideal.

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 through food, water or mouth-to-mouth contact
• A combination of antibiotics and other drugs is the most effective treatment for H. pylori peptic ulcers.

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