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Modern Perspectives on Stomach Ulcers

Summary & Participants

Not too long ago doctors thought stomach ulcers were caused by stress and spicy foods. In 1982 researchers discovered a bacteria that changed our understanding of peptic ulcer disease, opening a world of treatment and relief. Listen to gastroenterologists explain why stress, alcohol and spicy food are no longer blamed.

Medically Reviewed On: May 07, 2008

Webcast Transcript

ANNONCER: Peptic ulcer disease is a common gastrointestinal disorder that affects an estimated four million Americans. The problem occurs when the tissue lining the stomach or upper part of the small intestine becomes eroded.

JENNIFER CHRISTIE, MD: There is a break in the normal gastric or small intestinal mucosa. And the mucosa is the lining of the stomach. So what occurs is that there is a deep ulceration into one of the muscular layers of the stomach or small intestines.

ANNOUNCER: Doctors no longer believe what had been commonly assumed just a few years ago, that peptic ulcer disease is caused by spicy food, smoking, alcohol, or stress.

HASHEM EL-SERAG, MD, MPH: We now know that the most important risk factor for peptic ulcer disease is an infection with a bacteria called Helicobacter pylori. It's an infection that is usually acquired in the first few years of life. It results in an inflammation in the stomach, so-called gastritis. And in at least one out of six infected patients, one of out six might develop an actual breakdown of the lining or peptic ulcer disease.

ANNOUNCER: Stomach ulcers can also be caused by some medications.

HASHEM EL-SERAG, MD, MPH: What we're seeing now, especially in younger patients, more cases of peptic ulcer disease that are not related to H. Pylori or Helicobacter pylori, but rather to the second common cause of peptic ulcer disease, which is the ingestion of a category of medications called non-steroidal anti-inflammatory drugs. A typical example would be the ibuprofen, naproxen, and high doses of aspirin.

ANNOUNCER: Symptoms of peptic ulcer disease can vary.

JENNIFER CHRISTIE, MD: Some patients can present with bleeding or sudden abdominal pain. However, most patients present with sort of a gnawing pain in the upper portion of the stomach. It may be associated with nausea and some vomiting. Sometimes the pain moves, and radiates to the back. Patients may say the pain is worse when they eat. Or, it may be relieved when they eat.

HASHEM EL-SERAG, MD, MPH: In a small percent of the patients, peptic ulcer disease might develop really serious complications in the form of bleeding, in the form of perforation, which is basically burrowing a hole through the stomach wall and perforating, and in the form of repeated scarring.

ANNOUNCER: If an ulcer is suspected, a doctor will check for the presence of H. Pylori, usually with a simple blood test. Sometimes a gastroenterologist will perform an endoscopic exam, viewing the interior of the stomach or small intestine with a camera on a long cable that's threaded through the mouth and esophagus. Peptic ulcers are treated with antacids, as well as compounds that protectively coat the lining of the stomach, and drugs that suppress the production of acid in the stomach. When H. Pylori is present, antibiotics are used as well.

HASHEM EL-SERAG, MD, MPH: Typically, it's two to three antibiotics plus an acid-suppressing medication such as an H-2 blocker or a proton pump inhibitor. The combination is taken anywhere from one week to two weeks. The success rates run an average from 70 percent to 90 percent of the cases, depending on whether there is a resistance to the bacteria to antibiotics or not.

ANNOUNCER: Sometimes, surgery is required, which can be as simple as repairing a hole, or as complicated as removing a portion of stomach or small intestine.

JENNIFER CHRISTIE, MD: Surgery is indicated if a patient has a perforated peptic ulcer, or an ulcer that has eroded through the entire lining of the stomach. And also in patients that have uncontrollable bleeding from the ulcer. And in patients who have a refractory ulcer. Refractory, meaning not responding to our medical therapies.

ANNOUNCER: When relying on medical therapy, doctors have learned it is often important to use antibiotics. Acid suppressors alone won't always end the problem.

HASHEM EL-SERAG, MD, MPH: Once you stop these medicines, the ulcers come back, typically in a seasonal way. Since the discovery of Helicobacter pylori, if you have H. Pylori, and if you have peptic ulcer disease, and you get treated for Helicobacter pylori successfully, then you break that cycle of recurrence.

ANNOUNCER: An estimated one in ten Americans will develop a peptic ulcer at some point in their lives. Now that doctors understand the causes of the condition, patients can generally expect simple and effective treatment.

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