Peptic ulcer disease (PUD) is a very common ailment, affecting
one out of eight persons in the United States. The causes
of PUD have gradually become clear and with this understanding
have come new and better ways to treat ulcers and even cure
them
Anatomy and Function of the Stomach
The stomach produces a very strong acid. This acid digests and breaks down
food before it enters the small intestine (duodenum). The lining of the
stomach is covered by a thick protective mucous layer which prevents the
acid from injuring the wall of the stomach.
What Causes Peptic Ulcers?
An ulcer is an open sore in the lining of the stomach or intestine, much
like mouth or skin ulcers. Peptic ulcers are eventually caused by acid
and pepsin, a digestive stomach enzyme. These ulcers can occur in the stomach,
where they are called gastric ulcers. Or they can occur in the first portion
of the intestine beyond the stomach. These are called duodenal ulcers.
In the end, it is acid that causes the injury to the bowel
wall. However, a revolutionary and startling recent discovery
is that most peptic ulcers result from a stomach infection
caused by the bacteria, Helicobacter pylori.
Helicobacter Pylori (H. Pylori)
This funny-sounding name identifies the basic cause of
most peptic ulcers, excluding those caused by aspirin or arthritis
drugs. The bacteria has a twisted spiral shape (Helico) and
infects the mucous layer lining of the stomach. This is a true
infection and produces an inflammation in the stomach wall
called gastritis. The body even develops an antibody in the
blood against it. The bacteria is probably acquired through
ingesting contaminated food or a contaminated drinking glass.
It is only after H. pylori bacteria injures the protective
mucous layer of the stomach that an ulcer develops.
Aspirin and Arthritis Medications
Arthritis medications include ibuprofen (Advil), Feldene, Naprosyn, Voltaren,
Indocin, Lodine, and many others. As with aspirin, they can damage the
mucous layer of the stomach, after which the stomach acid causes the final
injury.
So, H. pylori and the above drugs are the two major factors
that bring on ulcers. There also is a small group of patients
that produces very large amount of acid uncontrollably, thereby
causing ulcers. A stomach cancer may look and act like a
peptic ulcer. Finally, some people get ulcers for unknown
reasons.
Symptoms
Ulcers cause gnawing, burning pain in the upper abdomen. These symptoms frequently
occur several hours following a meal, after the food leaves the stomach
but while acid production is still high. The burning sensation can occur
during the night and be so extreme as to wake the patient. Instead of pain,
some patients experience intense hunger or bloating. Antacids and milk
usually give temporary relief. Other patients have no pain but have black
stools, indicating that the ulcer is bleeding. Bleeding is a serious complication
of ulcers.
Diagnosis of a Peptic Ulcer
A diagnosis of peptic ulcers can be suspected from the patient's medical
history. However, the diagnosis should always be confirmed either by an
upper intestinal endoscopy, which allows direct examination of the ulcer
through a fiberoptic instrument (endoscope), or by a barium x-ray of the
stomach. With endoscopy, a biopsy is usually obtained of a gastric ulcer
to determine if it is malignant and requires surgery.
Peptic Ulcer Treatment
Therapy of PUD has undergone profound changes. The first has been the development
of drugs which suppress stomach acid (Pepcid, Tagamet, Zantac, Axid) or
even stop it altogether (Prilosec). These acid-suppressing drugs have been
dramatically effective in relieving symptoms and allowing ulcers to heal.
If an ulcer has been caused by aspirin or an arthritis drug, then no subsequent
treatment is usually needed. Avoiding these drugs should prevent ulcer
recurrence.
The second major change in PUD treatment has been the discovery
of the H. pylori infection. When this infection is cleared
by antibiotics, the infection and the ulcer do not come back.
So, increasingly, physicians are not just suppressing the
ulcer with the acid-reducing drugs listed above, but they
are also curing the underlying ulcer problem by getting rid
of the bacterial infection. If not, the ulcers invariably
recur.
There are a number of antibiotic programs available now
to treat H. pylori. For example, Pepto-Bismol is an active
antibiotic against H. pylori but must be used in conjunction
with other drugs. The physician will select the best treatment
program for the patient.
