Stomach Ulcers

Dec 1, 2008
2008 / December 2008

For years, physicians believed that stomach ulcers were caused by stress, spicy foods and lifestyle. But in 1982, two Australian physicians identified a link between ulcers and a bacterium, Helicobacter pylori, or H. pylori. This discovery helped the medical community realize that ulcers are a curable infection.

Peptic ulcers are fairly common, occurring at any age but more often as we get older. They occur at the same rate in men and women. One in 10 Americans will develop an ulcer during his or her lifetime.

A peptic ulcer is a sore or a hole in the lining of the stomach or the duodenum, the beginning of the small intestine. An ulcer in the stomach is called a gastric ulcer, and an ulcer in the small intestine is called a duodenal ulcer.

When we eat, our stomachs produce hydrochloric acid and an enzyme called pepsin to digest food. Ulcers occur when the acid and the enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall.

The H. pylori bacterium is believed to be responsible for 70–90 percent of all peptic ulcers, causing inflammation of the stomach lining and making it vulnerable to infection. Infection is not the whole story, since only 20 percent of people infected with the bacterium actually develop ulcers.

Fecal-oral transmission is a common way for the bacterium to spread from person to person. Usually through poor personal hygiene, the infected stool of one person contaminates water or food, and the bacterium makes its way into the digestive tracts of individuals who consume this food or water. H. pylori has been found in the mouths of some infected people, leading researchers to believe that it may even spread from mouthto- mouth contact such as kissing.

The second common cause of ulcers is the use of non-steroidal antiinflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen. NSAIDs decrease the production of prostaglandin, the natural chemical which makes the stomach less acidic and stimulates mucous production. With less prostaglandin, ulcers are more likely to form. Ulcers caused by NSAIDs are common in the elderly.

While it is no longer believed that lifestyle factors are the main cause of ulcers, they do play a role, and a tendency to develop ulcers runs in families. Smoking places you at higher risk, particularly if you become infected with H. pylori. Alcohol may increase the production of acid and damage the lining of the stomach. Alcohol, smoking, caffeine and radiation therapy for cancer all weaken the protective mucosal barrier of the stomach — increasing the chances of getting an ulcer and hampering the healing of existing ulcers. Emotional stress or physical stress on the body caused by severe or critical injuries, burns, major surgery or disease can also put you at higher risk.

Peptic ulcers do not always cause symptoms. Sometimes, a serious complication such as bleeding is the first sign. The most common symptom is pain, usually in the middle part of the abdomen, above the navel and below the breast bone. It can feel like burning or gnawing, often occurring several hours after a meal and lasting from a few minutes to several hours. It may be worse at night and in the morning. Other symptoms include nausea, vomiting, loss of appetite and weight loss.

Contact a doctor or hotel concierge immediately for a physician or the closest hospital if you have any of these symptoms: sharp, sudden, constant stomach pain; bloody or black stools; bloody vomit; or vomit that looks like coffee grounds. They could be signs of a bleeding ulcer, perforation or obstruction.

Your physician may order one or more of these tests to diagnose an ulcer: a blood antibody test to check for infection, an endoscopy to view the stomach and intestines and take biopsies, or an upper-gastrointestinal X-ray to look for damage. Other tests for infection include a breath test and the examination of stool samples.

For ulcers caused by H. pylori, treatment requires “triple therapy” — two antibiotics and one acid suppressor for one to two weeks. This requires taking as many as 12 pills every day and can have side effects of nausea, vomiting, diarrhea, headache and yeast infections in women. Your physician will prescribe treatment based on your medical history, cost, convenience and any allergies you may have. This treatment is considered 80–90 percent effective.

If your ulcer occurred due to NSAIDs, stop taking any medication in this category. Healing will begin almost immediately. Your physician may recommend two to six weeks of medication to reduce acid damage. Avoid smoking and excessive alcohol, and limit the use of NSAIDs and caffeine.

Infection with H. pylori is extremely common in the United States. Prevention is a matter of avoiding contaminated food and water and practicing goof hand hygiene. Always wash your hands carefully with warm water and soap after using the bathroom, after changing a diaper and before and after preparing food. For more information, visit www.digestive.niddk.nih.gov.

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