Treating H. Pylori and Peptic Ulcers

with Howard Hack, M.D., gastroenterologist, Columbia St. Mary’s

Last Updated: June 1, 2003

No doubt you’ve heard about, or know someone who has had, a peptic ulcer. Maybe you’ve experienced one yourself. About one in 10 Americans develops one. One cause is a bacterial infection, according to Dr. Howard Hack, a gastroenterologist with the West Bend Clinic, and Earnest & Hack, SC. “Other causes,” he said, “include the prolonged use of nonsteroidal anti-inflammatory agents such as ibuprofen and aspirin.”

The common belief that stress or spicy foods cause ulcers isn’t necessarily true, he explained. “These can give you acid, but whether they actually cause ulcers is still uncertain.”

H. pylori is a bacteria believed to be the cause of most peptic ulcers, which are sores on the lining of the stomach or the duodenum. It’s not certain how people contract H. pylori, but it may be through food or water. Researchers have found the bacteria in the saliva of some infected people.

Newer treatments
In diagnosing your ulcer, a doctor may X-ray your esophagus, stomach and duodenum. Or he may use an endoscope that provides a view of the lining of these organs. If an ulcer is found, the doctor will test for H. pylori. This is important because treatment for an ulcer caused by this infection differs from that for an ulcer caused by nonsteroidal anti-inflammatory agents. H. pylori is diagnosed through blood, breath, stool and tissue tests. Blood tests, the most common of these, detects antibodies to the H. pylori bacteria.

“Prior to 1976, the treatments for ulcer disease were bland diets and antacids. But today’s treatments include drugs that kill the bacteria, reduce stomach acid and protect the stomach lining. And antibiotics are used to kill the bacteria.”

According to Dr. Hack, two types of medications are used: H2 blockers and proton pump inhibitors. The former blocks histamine, which stimulates acid secretion The latter suppresses acid production by halting the mechanism that pumps the acid into the stomach.

“H. pylori is found in a lot of older individuals,” Dr. Hack said. “The older you are, the more likely you are to have it. In 70-year-olds, you’ll find that almost 70 percent have it. Among 90-year-olds, about 90 percent have it. But only 10 percent of 20-year-olds have it.

“People who tend to get this infection at an early age, say 15 years old, seem likely to develop ulcers. And those who develop it at younger ages are more prone to develop gastric cancer,” he said.

Symptoms
What are the symptoms of an ulcer? Dr. Hack said they may range from being silent, to bloating, a gnawing ache that comes and goes or abdominal pain – the major symptom. “Another serious symptom is intestinal bleeding. Usually when you have bleeding from the stomach or upper intestinal tract, the blood, when it’s exposed to stomach acid, turns black. Black, tarry stools will result. Nausea, and loss of appetite and weight can occur.”

In addition to bleeding, there are other emergency symptoms to note. If you have sharp, sudden or persistent stomach pain, or black stools, or bloody vomit or vomit that looks like coffee grounds, you should contact your doctor immediately, he said. These could be signs of a stomach perforation or an obstruction.

“If you’ve got any persistent symptoms, make sure your doctor evaluates them quickly and thoroughly. Don’t self diagnose or self-treat. There’s no way to know by the symptoms alone what you’re dealing with. You need to see a doctor who must test to learn what it is,” he cautioned.

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