Ulcers

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ulcers

Thirty years ago, it was widely believed that stomach ulcers were caused by stress and spicy foods alone – until an Australian microbiologist named Barry Marshall drank a Petri dish of the bacteria called Helicobacter pylori to prove his theory that this painful condition could be caused by an infection.

If, like Dr. Marshall, you’ve found yourself experiencing nausea, abdominal pain, and bloating after each meal (and even if you haven’t been sampling the glassware in a science lab lately) you too may be suffering from a peptic ulcer.

About 2% of Americans (nearly four million people) suffer from peptic ulcers, which are essentially open lesions in the lining of the digestive tract. When an ulcer occurs, the same stomach acid that normally works to digest one’s food begins to work against its own body instead. Most peptic ulcers occur in the first portion of the small intestine (duodenal ulcers), and about 1/5 are found in the stomach itself (gastric ulcers).

Causes

Upwards of two-thirds of peptic ulcers are caused by Helicobacter infections. The rest are mainly attributed to the use of a class of drugs called NSAIDS (aspirin, naproxen, ibuprofen, and others) that prevent the stomach lining from making the mucus that protects it from its acidic contents.

Sometimes an ulcer that was originally caused by an infection is made worse by NSAID use, as the patient attempts to relieve pain associated with the ulcer, and instead creates a vicious cycle of increased ulcer symptoms and NSAID use. In a small number of cases, though, the root cause of an ulcer may be neither a bacterial infection nor NSAID use, but a type of stomach cancer. (Duodenal lesions are rarely malignant.)

The good news for ulcer sufferers is that the causes that were blamed for ulcers before Dr. Marshall’s experiment have largely been ruled out: so spicy foods, coffee, and caffeinated soda can still be on the menu.

Diagnosis

It may be difficult to know that you have an ulcer: stomach pain is a very common symptom of many ailments, and the burning sensation caused by an ulcer can easily be mistaken for heartburn or simple hunger.

If a doctor suspects an ulcer is causing a patient’s symptoms, the diagnosis can be confirmed by an endoscopic exam to visualize the affected area, or an X-ray exam using a barium swallow to highlight the digestive tract and search for anomalies.

A biopsy may be performed at the same time to rule out cancer as the causative agent, and non-invasive exams such as a breath test can be done to see if a Helicobacter infection is present. While cancer is not a common complication, more typical problems include gastrointestinal bleeding (often detected by the appearance of dark, tarry bowel movements) and perforation of the digestive tract lining.

Treatment

Treatment options vary based on the severity of the disease as well as the age of the patient. Younger patients and those with milder cases may be treated with antacids, and perhaps an antibiotic to end the Helicobacter infection – as was Barry Marshall at the end of his experiment. More serious cases may require surgery, especially if bleeding or perforation of the gut has occurred. If such complications go untreated, even a simple ulcer can prove fatal.

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