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H. Pylori And Peptic Ulcer Fact Book
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 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 spicy food or
stress.
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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 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 some
infected people's saliva, 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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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 food.
- 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.
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How Is an H. pylori-related Ulcer Diagnosed?
Diagnosing an UlcerTo 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.
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| H. pylori
bacteria | |
Diagnosing H. pyloriIf 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 mainly used after treatment to see whether it worked, but they
can be used in diagnosis too. 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 the 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
UlcersAntibiotics: metronidazole, tetracycline,
clarithromycin, amoxicillin
H2 blockers: cimetidine,
ranitidine, famotidine, nizatidine
Proton pump
inhibitors: omeprazole, lansoprazole,
rabeprazole
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.
- 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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