Learning About H Pylori and Peptic Ulcers

What is a peptic ulcer?

H. pylori bacteria can cause peptic ulcers-sores on the lining of the stomach or duodenum.

A sore on the lining of the stomach or small intestine is called a peptic ulcer. Less commonly, a ulcer may develop just above the stomach in the esophagus, the tube that connects the mouth to the stomach.

In the stomach its called a gastric ulcer. If it occurs in the small intestine, it is a duodenal ulcer. People can have both gastric and duodenal ulcers at the same time. They also can develop peptic ulcers more than once in their lifetime.

Peptic ulcers are not rare. Each year in the United States, about half a million people develop the ulcer.11Ramakrishnan K, Salinas RC. Peptic ulcer disease. American Family Physician. 2007;76(7):1005-1012.

What are the causes?

A bacterium called Helicobacter pylori (H. pylori) is a major cause of peptic ulcers. Aspirin and ibuprofen also cause ulcers. Rarely, cancerous or noncancerous tumors in the stomach, duodenum, or pancreas cause ulcers.

Ulcers are not caused by stress or eating spicy food, but both can make ulcer symptoms worse. Drinking and smoking can cause ulcers, too.

What is H. pylori?

H. pylori is a type of bacteria-a germ that may cause infection. H. pylori infection is common, particularly in developing countries, and often begins in childhood. Usually, symptoms only present themselves in adulthood.

H. pylori causes more than half of peptic ulcers worldwide.2 The bacterium causes peptic ulcers by damaging the mucous coating that protects the stomach and duodenum. There is damage to the stomach lining and this allows stomach acid to get to the sensitive lining. Together, the stomach acid and H. pylori irritate the lining of the stomach or duodenum and cause an ulcer.

Yet, most people infected with H. pylori never develop ulcers. No one knows why. Most likely, development of ulcers depends on characteristics of the infected person; the type, or strain, of H. pylori present; and factors researchers have yet to discover.

2Helicobacter pylori and peptic ulcer disease; economics of peptic ulcer disease and H. pylori infection. Centers for Disease Control and Prevention Accessed February 23, 2009.

How is H. pylori spread?

Researchers are not certain how H. pylori is transmitted, although they think it may be spread through contaminated food or water. Bad food or water, not washed or purified properly, can have the bacteria.

The infection can spread from person to person. Studies suggest that having contact with the stool or vomit of an infected person can spread H. pylori infection. And H. pylori has been found in the saliva of some infected people, which means infection could be spread through direct contact with saliva.

What are the symptoms of a peptic ulcer?

The most common symptom of ulcers is abdominal pain. Felt anywhere between the navel and the breastbone, this discomfort usually

• is a dull or burning pain
• occurs when the stomach is empty-between meals or during the night
• may be briefly relieved by eating food, in the case of duodenal ulcers, or by taking antacids, in both types of peptic ulcers
• lasts for minutes to hours
• comes and goes for several days or weeks

Other symptoms include

• weight loss
• poor appetite
• bloating
• burping
• nausea
• vomiting

There are some sufferers who suffer no symptoms.

Emergency Symptoms

A person who has any of the following symptoms should call a doctor right away:

• sharp, sudden, persistent, and severe stomach pain
• bloody or black stools
• bloody vomit or vomit that looks like coffee grounds

These symptoms might be a sign of a serious problem:

• bleeding-when acid or the peptic ulcer breaks a blood vessel
• perforation-when the peptic ulcer burrows completely through the stomach or duodenal wall
• obstruction-when the peptic ulcer blocks the path of food trying to leave the stomach

How is an H. pylori-induced ulcer diagnosed?

Noninvasive Techniques

If you have an ulcer, your doctor will first ask you about over-the-counter drugs you are taking. Patients who are taking an NSAID are asked to stop, reduce the dose, or switch to another medication.

Then the doctor tests to see if H. pylori is present. Getting tested is important because H. pylori-induced ulcers are treated differently than ulcers caused by NSAIDs.

Doctors use one of three simple, noninvasive tests to detect H. pylori in a patient's blood, breath, or stool. Because the breath test and stool test more accurately detect H. pylori than the blood test, some doctors prefer to use one of these two tests. The following tests are usually outpatient tests:

Blood test. A blood sample is taken from the patient's vein and tested for H. pylori antibodies. Antibodies are substances the body produces to fight invading harmful substances-called antigens-such as the H. pylori bacterium.

Urea breath test. A patient takes something labeled with a special atom of carbon. After a few minutes, the patient breathes into a container, exhaling carbon dioxide. If the carbon atom is found in the exhaled breath, H. pylori is present, as this bacterium contains large amounts of urease, a chemical that breaks urea down into carbon dioxide and ammonia.

Stool antigen test. A stool sample is tested for H. pylori antigens.

Can H. pylori infection be prevented?

No one knows for sure how H. pylori spreads, so prevention is difficult. Doctors are trying to find a vaccine to cure H. pylori infection. To help prevent infection, doctors advise people to

• wash their hands with soap and water after using the bathroom and before eating
• eat food that has been washed well and cooked properly
• drink water from a clean, safe source

By Kshamica Nimalasuriya MD, MPH

Bleeding Ulcer, or What can Happen if You Don't Treat a Simple Ulcer

Ulcer is a disease that unfortunately makes more and more victims each year, because modern lifestyle helps this disease to appear and advance. Ulcer is caused by a bacteria called Heliobacter Pylori, which billions of people are carrying. If a person that carries this bacteria lives a stressful life and eats a lot of spicy food (factors that help the bacteria quickly evolve) then he/she will most likely suffer from one of the many forms of ulcer. Ulcer occurs because this bacteria slowly eats the protective membrane around the lining of the stomach and exposes the sensitive tissue beneath it to the dangerous gastric acids inside the stomach. Therefore, ulcer causes an open wound in the stomach, esophagus or duodenum.
If someone has discovered that he or she is suffering from ulcer then the treatment must start as soon as possible because if the disease is left untreated severe complications can appear. The treatment is simple, the patient is prescribed a series of medication depending on the type of ulcer and how advanced it is.
But what happens if a person is not aware that ulcer is affecting him/her or if he/she simply leaves the disease untreated? Well an untreated ulcer can turn into a much worse form of ulcer - bleeding ulcer. It's called bleeding ulcer because loss of blood occurs due to the fact that H pylori keeps eating the tissue until it reaches the blood vessels and blood starts to enter the digestive track.
Someone that has bleeding ulcer will start vomiting blood, have black, loose stools, will start to experience pain in the abdominal area and indigestions will often follow a meal. In extreme cases, if nothing is done about the ulcer it will eventually lead to death, so bleeding ulcer must be treated immediately after it's discovered or its consequences will be felt in the entire body. Bleeding ulcer is treated through surgery in most cases, but surgery is not required if the illness is detected early. It is hoped that in the near future ulcer and bleeding ulcer treatment will be much easier because new medical tehniquies are researched intensively every day, since this disease affects more and more people and the situation is becoming alarming.
In conclusion, if you suspect that you have ulcer or bleeding ulcer pay a visit to the local doctor and ask for his advice as soon as you can, because in the early stages both ulcer and bleeding ulcer are treated with just a few pills, which is of course much better that going through surgery and suffering life-threatening complications.

By Groshan Fabiola

It Sounds Crazy But Ulcers Can Cause Back Pain

In cases of chronic back pain one might think, "Do Ulcers Cause back Pain?" A simple answer to this anxious question is 'yes', a peptic ulcer is a probable cause of back pain.

What is an ulcer? An ulcer is a specific term that signifies any open sore, lesion or break in the skin or in a mucous membrane. A thin tissue that lines the inner surface of body openings such as a lining of the stomach and intestines is a mucous membrane. However as a generalized concept or as a most commonly referred to concept, people speak of ulcers that occur in the upper digestive system such as peptic ulcers. The digestive system comprises of esophagus, stomach, duodenum and intestines. Ulcers in the stomach are called gastric ulcers, and likewise there are duodenal ulcers and esophageal ulcers. Duodenal ulcers account for 80% cases of peptic ulcers.

There are many symptoms of ulcers. The most common sign of ulcers is an intermittent and irritating pain in the stomach this pain also transfers to other areas such as the shoulder blades, back, indigestion, heartburn, gas, bloating, appetite loss and nausea. A few well known symptoms of ulcers are back pain, headache, itching and choking sensation.

A few years back it was widely considered by physicians that lots of excessive stress was a major cause of ulcers in people. Their theory was that lots of stress increases the production of hydrochloric acid in the body. This acid is strong enough to eat away the proactive mucous lining of the stomach causing an ulcer. Although still widely accepted by many, there is a newer theory that bacterial infection is responsible for ulcers in more that 70 to 80% of the cases.

Bacteria 'Helicobacter Pylori' is the most common bacteria known to cause gastric ulceration. These bacteria can burrow into the mucous layer of stomach and produce inflammation. Excessive acidic juices generated by stomach due to spicy foods are capable of burning the lining of digestive tract and thereby damaging the digestive system. Extreme physical and emotional stress is likely to aggravate an existing ulcer, though it is normally not considered as a root cause for ulcer.

Apart form the infection, use of non steroidal anti-inflammatory drugs or NSAIDs can also trigger ulcers. NSAIDs are commonly used by people as pain killers for headaches, sore muscles, menstrual cramps and other similar situations. Belonging to this family of NSAIDs is aspirin, ibuprofen and acetaminophen, excessive use of such type of drugs may prove to be detrimental to the stomach lining and cause ulcers. Mucosal protection is further damaged by over consumption of Alcoholic beverages and heavy smoking.

As a first step towards ulcer diagnosis, any physician would inquire about the symptoms. Besides the symptoms, the physician would look for factors from a patient's such as any cases of family history of ulcers or stomach cancers, frequency of alcohol consumption, smoking habits, patient's age, recent weight loss, repeated nausea or vomiting incidences, back pain, history of using anti-inflammatory drugs or other NSAIDs. Apart from the symptoms and patient's history, endoscopy is a modern approach to minimally invasive diagnostic medical procedure. Endoscopy is also well accepted as one of the best methods of diagnosing ulcers. An endoscope is a narrow tube which contains a light and tiny camera at its end to study the patient's digestive system. When this tube is inserted down the patient's throat the physician can examine the interior walls of the stomach and duodenum. Endoscope can also carry a small scissor to cut off small sample of mucous membrane for further examination of potential stomach cancer.

Imaging techniques are not as reliable as endoscopy but are also used frequently as patients are becoming more comfortable with this technique. Using the imaging technique, the patient is made to drink a fluid containing barium. Barium is a substance which is opaque and transparent to x-rays. An x-ray image of the patient's digestive system can show any abnormalities like ulcers that may be present wherein the opaque substance appears as a white patch on the x-ray image. Most of the symptoms of ulcers can be treated with over the counters medications which can relieve the pain, nausea or other general discomfort created by ulcers.

Ulcers and especially Peptic Ulcers do cause severe back pain. Such pain is likely to happen immediately after eating when some one is suffering from ulcers.

Zoe Beartoes