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Digestive Health Special Report

Focus on Peptic Ulcers

Ulcers are often blamed on stress and spicy food, but the reality is that bacteria called Helicobacter pylori (H. pylori) cause most of these painful erosions in the stomach and small intestine. The goal of ulcer treatment is to prevent stomach acid from continuing to erode the lesion and to eradicate H. pylori. Research shows ways to fight even the most recalcitrant H. pylori infection.

What is peptic ulcer disease?
Peptic ulcers are deep, non-healing sores or holes in the lining of the stomach (gastric ulcers) and in the first part of the small intestine, called the duodenum (duodenal ulcers). Between 70% and 80% of gastric ulcers and nearly all duodenal ulcers result from H. pylori bacteria that infect the lining of the stomach and cause inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen, can erode the stomach lining and are the second most common cause of ulcers. H. pylori may also be present in people who develop ulcers from NSAIDs.

People with gastric ulcers usually feel pain in their upper abdomen 15-30 minutes after eating. A duodenal ulcer, on the other hand, hurts when the stomach is empty; eating often relieves pain. Ulcers don't always cause pain, though, and painless ulcers are more common in people over 55 and in people taking NSAIDs. Painless ulcers may not be found until they cause bleeding. Symptoms such as anemia or blood in the stool may suggest bleeding due to a blood vessel ruptured by an ulcer. An upper endoscopy is often needed to check for ulcers. During endoscopy, a biopsy sample can be taken to be tested for H. pylori.

Eradicating stubborn bacteria.
Medications called H2-blockers and proton pump inhibitors suppress the production of stomach acid and let ulcers heal. Antibiotics are taken simultaneously to treat the H. pylori infection. To ensure that H. pylori are eliminated, doctors typically prescribe 10- to 14- day "triple therapy," which includes a proton pump inhibitor plus two antibiotics. Bismuth subsalicylate (Pepto-Bismol and other brands) may also be recommended.

A study in the Annals of Internal Medicine offered another solution to H. pylori: sequential therapy, which starts patients on a proton pump inhibitor and five days of a mild antibiotic -- then two stronger antibiotics added to the proton pump inhibitor for five days. The study compared triple therapy with sequential therapy in 300 people. Patients received the proton pump inhibitor pantoprazole (Protonix) plus the antibiotics clarithromycin and amoxicillin or a sequential treatment of five days of pantoprazole, amoxicillin, and placebo followed by five days of pantoprazole, clarithromycin, and the antibiotic tinidazole (Tindamax).

Eight weeks later, tests revealed that H. pylori were eradicated in 93% of the sequential-therapy patients vs. 79% of triple-therapy patients. Sequential therapy may help combat H. pylori that have become resistant to frequently used antibiotics. The first stage of sequential therapy might eradicate enough H. pylori to make mutations against the second wave of antibiotics more difficult.

Antibiotics may not cure ulcers that are caused by NSAIDs, and continued use of NSAIDs lowers the chances that ulcers will heal. However, people who take NSAIDs and then develop ulcers should still be tested and treated for H. pylori infection. Proton pump inhibitors might help reduce the risk of subsequent ulcers in patients who must continue taking NSAIDs to treat other medical conditions.

Posted in Digestive Health on March 22, 2010

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