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
