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A peptic ulcer is a sore on the lining of the stomach
or duodenum, which is the beginning of the small intestine. Peptic
ulcers are common: One in 10 Americans develops an ulcer at some
time in his or her life. One cause of peptic ulcer is bacterial
infection, but some ulcers are caused by long-term use of
nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and
ibuprofen. In a few cases, cancerous tumors in the stomach or
pancreas can cause ulcers. Peptic ulcers are not caused by stress or
eating spicy food, but these can make ulcers worse.
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Helicobacter pylori (H. pylori) is a type
of bacteria. Researchers believe that H. pylori is
responsible for the majority of peptic ulcers.
H. pylori infection is common in the United
States: About 20 percent of people under 40 years old and half of
those over 60 years have it. Most infected people, however, do not
develop ulcers. Why H. pylori does not cause ulcers in every
infected person is not known. Most likely, infection depends on
characteristics of the infected person, the type of H.
pylori, and other factors yet to be discovered.
Researchers are not certain how people contract H.
pylori, but they think it may be through food or water.
Researchers have found H. pylori in the saliva
of some infected people, so the bacteria may also spread through
mouth-to-mouth contact such as kissing.
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H. pylori weakens the protective mucous coating
of the stomach and duodenum, which allows acid to get through to the
sensitive lining beneath. Both the acid and the bacteria irritate
the lining and cause a sore, or ulcer.
H. pylori is able to survive in stomach acid
because it secretes enzymes that neutralize the acid. This mechanism
allows H. pylori to make its way to the "safe" area-the
protective mucous lining. Once there, the bacterium's spiral shape
helps it burrow through the lining.
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Abdominal discomfort is the most common symptom. This
discomfort usually
Other symptoms include:
Some people experience only very mild symptoms, or none
at all.
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To see whether symptoms are caused by an ulcer, the
doctor may do an upper gastrointestinal (GI) series or an endoscopy.
An upper GI series is an x ray of the esophagus, stomach, and
duodenum. The patient drinks a chalky liquid called barium to make
these organs and any ulcers show up more clearly on the x
ray.
An endoscopy is an exam that uses an endoscope, a thin,
lighted tube with a tiny camera on the end. The patient is lightly
sedated, and the doctor carefully eases the endoscope into the mouth
and down the throat to the stomach and duodenum. This allows the
doctor to see the lining of the esophagus, stomach, and duodenum.
The doctor can use the endoscope to take photos of ulcers or remove
a tiny piece of tissue to view under a microscope. This procedure is
called a biopsy. If an ulcer is bleeding, the doctor can use the
endoscope to inject drugs that promote clotting or to guide a heat
probe that cauterizes the ulcer.
If an ulcer is found, the doctor will test the patient
for H. pylori. This test is important because treatment for
an ulcer caused by H. pylori is different from that for an
ulcer caused by NSAIDs.
H. pylori is diagnosed through blood, breath,
stool, and tissue tests. Blood tests are most common. They detect
antibodies to H. pylori bacteria. Blood is taken at the
doctor's office through a finger stick.
Urea breath tests are an effective diagnostic method
for H. pylori. They are also used after treatment to see
whether it worked. In the doctor's office, the patient drinks a urea
solution that contains a special carbon atom. If H. pylori is
present, it breaks down the urea, releasing the carbon. The blood
carries the carbon to the lungs, where the patient exhales it. The
breath test is 96 percent to 98 percent accurate.
Stool tests may be used to detect H. pylori
infection in the patient's fecal matter. Studies have shown that
this test, called the Helicobacter pylori stool antigen
(HpSA) test, is accurate for diagnosing H. pylori.
Tissue tests are usually done using the biopsy sample
that is removed with the endoscope. There are three types:
In diagnosing H. pylori, blood, breath, and
stool tests are often done before tissue tests because they are less
invasive. However, blood tests are not used to detect H.
pylori following treatment because a patient's blood can show
positive results even after H. pylori has been
eliminated.
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Antibiotics: metronidazole, tetracycline,
clarithromycin, amoxicillin H2 blockers: cimetidine, ranitidine,
famotidine, nizatidine
Proton pump inhibitors: omeprazole,
lansoprazole, rabeprazole, esomeprazole, pantoprozole
Stomach-lining protector: bismuth
subsalicylate |
H. pylori peptic ulcers are treated with drugs
that kill the bacteria, reduce stomach acid, and protect the stomach
lining. Antibiotics are used to kill the bacteria. Two types of
acid-suppressing drugs might be used: H2
blockers and proton pump inhibitors.
H2 blockers work by blocking
histamine, which stimulates acid secretion. They help reduce ulcer
pain after a few weeks. Proton pump inhibitors suppress acid
production by halting the mechanism that pumps the acid into the
stomach. H2 blockers and proton pump
inhibitors have been prescribed alone for years as treatments for
ulcers. But used alone, these drugs do not eradicate H.
pylori and therefore do not cure H. pylori-related
ulcers. Bismuth subsalicylate, a component of Pepto-Bismol, is used
to protect the stomach lining from acid. It also kills H.
pylori.
Treatment usually involves a combination of
antibiotics, acid suppressors, and stomach protectors. Antibiotic
regimens recommended for patients may differ across regions of the
world because different areas have begun to show resistance to
particular antibiotics.
The use of only one medication to treat H.
pylori is not recommended. At this time, the most proven
effective treatment is a 2-week course of treatment called triple
therapy. It involves taking two antibiotics to kill the bacteria and
either an acid suppressor or stomach-lining shield. Two-week triple
therapy reduces ulcer symptoms, kills the bacteria, and prevents
ulcer recurrence in more than 90 percent of patients.
Unfortunately, patients may find triple therapy
complicated because it involves taking as many as 20 pills a day.
Also, the antibiotics used in triple therapy may cause mild side
effects such as nausea, vomiting, diarrhea, dark stools, metallic
taste in the mouth, dizziness, headache, and yeast infections in
women. (Most side effects can be treated with medication
withdrawal.) Nevertheless, recent studies show that 2 weeks of
triple therapy is ideal.
Early results of studies in other countries suggest
that 1 week of triple therapy may be as effective as the 2-week
therapy, with fewer side effects.
Another option is 2 weeks of dual therapy. Dual therapy
involves two drugs: an antibiotic and an acid suppressor. It is not
as effective as triple therapy.
Two weeks of quadruple therapy, which uses two
antibiotics, an acid suppressor, and a stomach-lining shield, looks
promising in research studies. It is also called bismuth triple
therapy.
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No one knows for sure how H. pylori spreads, so
prevention is difficult. Researchers are trying to develop a vaccine
to prevent infection.
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Changing medical belief and practice takes time. For
nearly 100 years, scientists and doctors thought that ulcers were
caused by stress, spicy food, and alcohol. Treatment involved bed
rest and a bland diet. Later, researchers added stomach acid to the
list of causes and began treating ulcers with antacids.
Since H. pylori was discovered in 1982, studies
conducted around the world have shown that using antibiotics to
destroy H. pylori cures peptic ulcers. The prevalence of
H. pylori ulcers is changing. The infection is becoming less
common in people born in developed countries. The medical community,
however, continues to debate H. pylori's role in peptic
ulcers. If you have a peptic ulcer and have not been tested for
H. pylori infection, talk to your doctor.
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The U.S. Government does not endorse or favor any
specific commercial product or company. Trade, proprietary, or
company names appearing in this document are used only because they
are considered necessary in the context of the information provided.
If a product is not mentioned, this does not mean or imply that the
product is unsatisfactory.
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2 Information Way
Bethesda, MD
20892-3570
Email: nddic@info.niddk.nih.gov
The National Digestive Diseases Information
Clearinghouse (NDDIC) is a service of the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is
part of the National Institutes of Health under the U.S. Department
of Health and Human Services. Established in 1980, the clearinghouse
provides information about digestive diseases to people with
digestive disorders and to their families, health care
professionals, and the public. NDDIC answers inquiries, develops and
distributes publications, and works closely with professional and
patient organizations and Government agencies to coordinate
resources about digestive diseases.
Publications produced by the clearinghouse are
carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse
encourages users of this e-pub to duplicate and distribute as many
copies as desired.
NIH Publication No. 05-4225
October 2004
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