Ulcers

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Ulcer Summary

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Ulcers

Peptic ulcers are painful open sores or lesions in either the stomach (gastric ulcers) or duodenal lining (duodenal ulcers). Ulcers affect more than four million people each year and account for approximately 40,000 surgeries and six thousand deaths. With 10 percent of the population suffering from ulcers, they are responsible for an estimated three to five million doctor's office visits and two million prescriptions each year. Until the early 1980s, ulcers were believed to be caused primarily by such factors as stress and spicy foods, but a new link was found in 1982 that has changed attitudes about the causes of this common and painful condition. With the discovery of a bacterium called Helicobacter Pylori (H. Pylori), researchers have found increasing evidence that the majority of ulcers may be caused by this bacteria, and research suggests these ulcers can be treated with antibiotics.

Duodenal ulcers occur in the first section of the intestine after the stomach. The first occurrence of these ulcers is usually between the ages of 30 and 50, and is more common in men than in women. Gastric ulcers occur in the stomach itself, and are more common in those over 60, and affect more women than men. Ulcer symptoms may be mild, severe, or nonexistent and include weight loss, heart-burn, loss of appetite, bloating, fatigue, burping, nausea, vomiting, and pain. The pain associated with ulcers is often an intermittent dull or gnawing pain, usually occurring two to three hours following a meal or when the stomach is empty, and is often relieved by food intake. While most of these symptoms require only a visit to the doctor, others require immediate medical attention. These symptoms include sharp, sudden pain; bloody or black stools; or bloody vomit sometimes resembling coffee grounds. Any or all of these symptoms could signal a perforation, bleeding, or an obstruction in the gastrointestinal tract. H. Pylori is now considered a major contributing factor in both gastric and duodenal ulcers, with the remainder of the cases caused by damage from nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.

Ulcers are diagnosed by such methods as an upper gastrointestinal (Upper GI) series or an endoscopy. Doctors who suspect an ulcer is caused by H. Pylori will often perform blood, breath, and stomach tissue tests after one of these procedures detects the presence of an ulcer. Since the discovery of H. Pylori, doctors try to determine if the ulcer is caused by this bacterium or if other factors such as the use of NSAIDs have contributed to the formation of the ulcer. Until the 1980s, medical professionals believed ulcers were caused mainly by stress, spicy foods, alcohol consumption, and excess stomach acids, and treated most ulcers with bland diets, antacids, and rest or reduced stress levels. In the early years of the twentieth century, physicians and psychologists considered overwork the cause of most ulcers. It was in the 1970s that researchers caused a stir with the idea that ulcers are caused by stress, creating a new buzzword in both the medical and business worlds. This theory led to an emphasis on stress management in the 1980s, and experts in every field from psychology to the New Age movement began to advance new theories on the causes and treatment of ulcers.

In 1982, when the H. Pylori bacterium was discovered, medical researchers began to think differently about the causes and treatment of ulcers. A pathologist in Perth, Australia, found that a significant number of ulcer patients were infected with the same unknown bacterium, later named H. Pylori. Research has found that the spiral-shaped H. Pylori bacteria are able to survive corrosive stomach acids because of their acid neutralizing properties. The bacteria work by weakening the mucous coating of the stomach or duodenum and allowing stomach acid to attack the more sensitive stomach or duodenal lining, leading to the formation of an ulcer. Possible causes of infection by H. Pylori include intake of contaminated food or water or possibly through saliva.

Many researchers in the late 1990s believe H. Pylori causes the majority of ulcers, with an estimated 80 percent of stomach ulcers and 90 percent of duodenal ulcers caused by the bacteria. Research suggests that 20 percent of Americans under 40 and 50 percent of Americans over 60 are infected with it. Further research has shown that 90 percent of ulcers traced to H. Pylori have been healed by the use of antibiotics and do not recur when treated with them.

Despite a statement by the National Institute of Health that most ulcers may be caused by H. Pylori, the issue remains a controversial one. By the final years of the 1990s, the Food and Drug Administration had not officially sanctioned the use of antibiotics to treat ulcers believed to be caused by H. Pylori. The predominant treatment of ulcers remains the use of medication such as antacids and drugs like Zantac, Tagamet, or Pepcid that inhibit the production of stomach acid, and lifestyle changes. If H. Pylori is indicated as a cause of ulcers, doctors often use a combination of drugs including antibiotics, H2 blockers such as rantidine, proton pump inhibitors such as omeprazole, and stomach lining protectors.

While research continues to examine the causes and treatment of ulcers, doctors and patients have a wider range of treatments than ever before for ulcers, as well as related conditions such as heartburn and acid-reflux disease. The last two decades of the twentieth centuryhave afforded a greater understanding of the formation of ulcers and provided a promising outlook in identifying a cure for this common and potentially dangerous disease.