From time to time everybody suffers the misery of an upset stomach. I have never had a peptic ulcer but I can imagine how much worse that would be. There is now very good news for people with peptic ulcers: a cure is available for most cases and the treatment is simple.
The food that we eat must be broken down in the digestive tract, principally in the stomach and small intestine, before it can be absorbed into our system. Digestive conditions in the stomach are harsh.
Strong hydrochloric acid and pepsin, an enzyme which breaks down protein, are secreted. Food leaves the stomach into the start of the small intestine, the duodenum, where digestion continues and from where food
????sorbed. Ulcers in the stomach or the duodenum are called peptic ulcers. An ulcer is a lesion (sore) in the lining of the stomach or duodenum. The immediate cause is an inability to defend against acid and pepsin. The traditionally ascribed causes of peptic ulcers were diet (e.g. too much spicy food) and emotional stress. However, it is now known that most ulcers are caused by the bacterium Helicobacter pylori, although lifestyle, acid and pepsin also play a role.
Lifestyle factors include smoking, caffeine, alcohol and stress. Smoking increases the risk of developing an ulcer, and slows the healing of an ulcer. Caffeine drinks (coffee, tea, cola) aggravate the pain of an ulcer. Heavy drinking increases the risk of getting an ulcer. Emotional stress increases the pain of an ulcer but may not be a major cause of initiating one.
The commonest symptom of a peptic ulcer is a burning or gnawing abdominal pain between the navel and the breastbone. This may be relieved by eating or taking antacids.
The healthy stomach has several mechanisms to protect itself against the corrosive digestive juices. The stomach lining is covered by a protective layer of mucous. The stomach secretes bicarbonate which helps to neutralise the acid and protect the tissue. Strong blood circulation to the stomach, and renewal and repair of cells also protect the tissue.
Non-steroidal, anti-inflammatory drugs (NSAID) make the stomach vulnerable to acid and pepsin. Several non-prescription NSAIDS such as aspirin are widely taken for minor ailments. Prescription NSAIDs are used to treat arthritis. They interfere with the stomach's production of mucus and bicarbonate, and affect blood flow and cell repair, thereby increasing the risk of stomach ulcers. Usually such ulcers disappear once NSAID ingestion is stopped.
Since the immediate cause of discomfort with peptic ulcers is overproduction of acid, medical treatment has focused on suppression of acid production. The commonest acid-suppressing drugs are called H2-blockers, e.g. cimetidine (Tagamet). However, ulcers treated solely by this method recur in 50 to 80 per cent of cases and many people must continue maintenance therapy for years. Medications are also prescribed which protect the mucous lining from acid. Also, many antacids are available without prescription.
In the early 1980s two Australian researchers, Barry Marshall and Robin Warren, discovered the spiral-shaped H. Pylori bacterium in the stomach. It was present in all cases of duodenal ulcers and 80 per cent of stomach ulcers. The other 20 per cent were caused by NSAIDs. They proposed that these bacteria were the primary cause of gastritis (inflammation of stomach lining) and peptic ulcers. They proved their point dramatically. They infected themselves with the bacteria (they drank broths of H. Pylori), developed acute gastritis with nausea and vomiting, and cured themselves by taking antibiotics, which kill the bacteria.
The Australian report initiated worldwide research into the effects of H. pylori. It was shown that ulcers healed by antibiotic treatment of H. pylori did not recur in 90 per cent of cases. It is now widely accepted that H. pylori plays a major role in causing ulcers and that antibiotic treatment cures peptic ulcers. The most effective treatment is a two-week tripleantibiotic therapy.
H. pylori can live in the stomach because it secretes an enzyme (urease) which neutralises acid. The bacterium can tunnel through the mucous layer. It produces chemicals which weaken mucus and make the stomach susceptible to damage from acid and pepsin. H. pylori can attach to stomach cells, cause inflammation, and stimulate the stomach to produce extra acid. Excess acid can also cause inflammation of the end of the duodenum that may develop into an ulcer.
It is essential to have a suspected ulcer accurately diagnosed before treatment is commenced. Diagnosis can be performed by X-ray examination or endoscopy, and by testing for H. pylori. Sometimes a suspected ulcer will turn out to be dyspepsia - persistent discomfort in the upper abdomen, including burning, nausea and bloating. Also, if diagnosis reveals an NSAID-induced ulcer, the treatment indicated is completely different from that appropriate to an H. pylori-related ulcer.
Infection with H. pylori spreads by the faecaloral route, usually in childhood, and lasts a lifetime. However, only a small number develop symptoms/problems related to the infection.
The recent discovery regarding H. pylori is a dramatic breakthrough. However, there are reports that many doctors continue to rely exclusively on acid-suppression when treating peptic ulcers. If you suspect you have an ulcer you can insist on an H. pylori test, and the antibiotic treatment if the test is positive, unless there are compelling medical reasons why this treatment is inappropriate in your case.
William Reville is a senior lecturer in biochemistry at UCC