Beat the Ulcer Bug

If you think stress causes peptic ulcers, you aren't alone. But you are wrong.

Peptic ulcers are sores on the lining of the stomach or the duodenum, which is the beginning of the small intestine.

"The average person is still not aware that Helicobacter pylori, a bacteria, causes most [peptic] ulcers," says David A. Peura, M.D., an internal medicine specialist in Charlottesville, Va. In most cases, two weeks of antibiotic treatment can end the gnawing, burning pain and upset stomach that may have lasted for years.

Who's most at risk?

About 20 percent of Americans younger than 40 and about half of those older than 60 have H. pylori. But most people infected with the bacteria don't get ulcers, says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Researchers aren't sure why H. pylori doesn't cause ulcers in everyone who has it. They suspect that other factors play a role.

The NIDDK says researchers aren't certain how people contract H. pylori, but it may be through food or water. People born before 1950 are more likely to be infected, probably because of lower hygiene standards years ago. H. pylori can linger for decades and never cause trouble.

Older adults also are more likely to suffer ulcers from overusing aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs).

Experts say H. pylori accounts for 85 to 90 percent of ulcers, while about 10 percent result from taking NSAIDs. "Over-the-counter medicines can be harmful," warns Cleveland gastroenterologist Gary W. Falk, M.D. Many people use these medications too frequently and take too high a dose, he adds.

Both H. pylori and NSAIDs weaken the mucous coat that protects your stomach and duodenum from acid. The weakened coat allows the acid to get through the lining beneath it, the NIDDK says. The acid and H. pylori irritate the lining and cause a sore, or ulcer. Both H. pylori and NSAIDs stimulate acid production. Acid is important in the stomach to break down food, but too much acid can cause problems.

How is H. pylori diagnosed?

Doctors usually confirm the suspected diagnose of peptic ulcers with an endoscope, a lighted fiber-optic tube passed down the throat into the stomach. If doctors see an ulcer, they take tissue samples. Taking a tissue sample is important because treatment for an ulcer caused by H. pylori is different from treatment for an ulcer caused by NSAIDs, the NIDDK says. Other tests often precede the tissue test: tests to check your blood, breath, or stool for H. pylori.

In diagnosing H. pylori, blood, breath, or stool tests are often done before tissue tests because they are less invasive. A finger stick blood test that looks for antibodies for H. pylori bacteria is a common test. Antibodies to H. pylori will remain in the blood after treatment. So the blood test cannot be used to determine if there is a new infection of H. pylori in someone who has been treated for H. pylori.  

The NIDDK says a urea breath test is 96 to 98 percent accurate in diagnosing a new infection or testing to see if treatment was effective. To do this test, 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 that is carried to the lungs, where it is exhaled. Stool tests of a person’s fecal matter can detect an H. pylori infection.

Treatment for peptic ulcers

If you have an H. pylori peptic ulcer, your doctor will prescribe treatment to kill the bacteria, reduce stomach acid, and protect the stomach lining, the NIDDK says. Antibiotics kill the bacteria; two antibiotics are usually prescribed. H2 blockers and proton pump inhibitors reduce stomach acid. Bismuth subsalicylate is frequently given to prevent H. pylori from attaching to the lining of the stomach and intestines. Treatment involves a combination of these medications and can involve taking as many as 20 pills a day.

If NSAIDs are causing your ulcer, your health care provider will ask you to stop using them. Your provider may suggest alternative painkillers such as acetaminophen, and prescribe medication to slow acid production.

Although stress does not cause ulcers, it does play a role. "Stress can aggravate any medical problem," says Dr. Peura. The stomach secretes more acid under stress, and those under stress often smoke more, drink more alcohol, and skip more meals—all behaviors that can aggravate an ulcer.