In Part I of this article I discussed what an ulcer was and the primary cause of stomach and duodenal (upper small intestine) ulcers. If you haven't read Part I please do so now. Reading Part I will help you better understand this article.
Previously, I mentioned that a large number of people develop an ulcer sometime in their lives (40 million in the United States). This problem is even more common in the developing countries of the world. Many people have chronic ulcer problems that drastically affect their everyday lives. The most common cause of stomach and duodenal ulcers is a bacteria called Helicobacter pylori. This bacteria causes up to 80 percent of all ulcers in the United States.
Helicobacter pylori is acquired by the fecal-oral route of transmission. The bacteria is present in solid human waste (fecal material; dung; feces; etc.). If a person -- for instance, a restaurant cook -- does not wash properly after using the bathroom, some of the waste materials can be placed in the food, on plates, glasses or eating utensils. The next person to use the contaminated items could then be infected with Helicobacter pylori. Kind of gross, but that is why most public restaurants in the United States have signs in the restrooms telling employees to wash their hands before leaving the restroom.
After getting in the stomach Helicobacter pylori will then burrow into the mucus that protects the lining of the stomach. The bacteria will attach to the cells that line the stomach and eventually will cause damage and irritate the stomach. The irritation then leads to a sore called an ulcer. The stomach acid then makes the ulcer worse. Fortunately, this bacteria can be eliminated from your stomach with antibiotics.
However, I would NOT suggest you start gulping down leftover pills from Uncle Fred's last infection. The ulcer must be located, tests performed to see if you are infected with Helicobacter pylori, and only then if the above tests are positive will you be treated with antibiotics.
To determine if you have an ulcer, go to your physician. The physician may perform what is called an upper GI series. Basically, you have to swallow a chalky liquid called barium. Then an x-ray is taken of your esophagus, stomach, and duodenum.
Some physicians prefer an endoscopy (endo= inside; -scopy; looking) to determine if you have an ulcer. Basically, they place a very small TV camera connected to a thin tube into your mouth, down your throat, and into your stomach. Before they do this you are usually calmed down with a sedative.
If you definately have an ulcer, then the physician may do one of three things to determine if you are infected with Helicobacter pylori. They may do a blood test, a breath test, or a biopsy.
Most physicians will take some blood and send it to a laboratory to determine if you are making antibodies to the bacteria. If you are making antibodies to this bacteria, then it is highly likely that you have been infected with Helicobacter.
Another newer test is called the breath test. The nice thing about this test is that it only requires you to swallow and breath. You swallow a substance called urea. This urea is radioactive. However, you only swallow a very small amount of radioactivity, less radioactivity than what you got from the upper GI series (x-rays). If you are infected with Helicobacter pylori the bacteria will break down the urea to ammonia (very small amounts, mind you) and carbon dioxide. The carbon dioxide is the radioactive part. It is taken up in your blood stream. Your blood releases the carbon dioxide in your lungs and you exhale the carbon dioxide. You then exhale into a bag and the lab determines if any radioactive carbon dioxide is in the bag.
A third test that may be performed is a biopsy. Small portions of the stomach and/or duodenum are removed and sent to the lab to determine if infected with Helicobacter pylori. This is oftentimes done while the doctor is performing the endoscopy.
If you have an ulcer and if you are infected with Helicobacter pylori then your physician can prescribe a treatment. These treatments cure up to 90 percent of the patients with ulcers caused by Helicobacter pylori. There are several different treatment regimens. Which one your doctor uses depends on your condition and how willing you are to follow his instructions. Most treatments last about 4 to 6 weeks. The following regimens are currently approved by the food and drug administration.
- Omeprazole 40 mg (lowers stomach acid) once daily plus clarithromycin 500 mg (kills the bacteria) three times daily for two weeks, followed by omeprazole 20 mg once daily for two weeks.
- Ranitidine bismuth citrate (RBC; lowers stomach acid) 400 mg twice daily, plus clarithromycin 500 mg (kills the bacteria) three times daily for two weeks, followed by RBC 400 mg twice daily for two weeks.
- Bismuth subsalicylate 525 mg (coats the stomach, kills the bacteria) four times daily plus metronidazole 250 mg (kills the bacteria) four times daily and tetracycline 500 mg (kills the bacteria) four times daily for two weeks, plus a stomach acid lowering drug (renitidine (Zantac), cimetidine (Tagamet) etc.) as directed for four weeks.
There are some treatment failures due to the bacteria being resistant to the antibiotics used. However, for now, these are a minority of the cases. If you want more information then I suggest these sites: The Helicobacter Foundation and The National Institute's Consensus Report on Ulcers or to Medscape's article on recent testing and treatment protocols. To get the entire article you will have to become a member of Medscape. Membership is free and it is a great site! They have a search engine you can use to find the Helicobacter pylori article.
Microbiology
