A peptic ulcer is a sore in the lining of the bowel in the stomach or the upper part of the small intestine (duodenum) which becomes inflamed when digestive acid and enzymes are produced to digest food. The ulcer causes pain and can be quite debilitating. The ways in which ulcerations form are better understood all the time. This continues to be an important area of research.

What is H. pylori?

It is estimated 8 to 10 million people are infected with H. pylori. The proportion of people with this infection increases considerably with age. About 10-20% of infected adults will develop ulcers. In First Nation communities, approximately 75% of the people are infected. H. pylori infection is considered to be a carcinogen by the World Health Organization (WHO) as it is associated with the development of stomach cancer.

For many years it was thought that stress or certain foods caused ulcers. It is now known that most ulcers are caused by a bacterium called Helicobacter pylori (H. pylori) that infects the stomach and duodenum and results in inflammation, pain and the actual ulcer. The initial infection usually first occurs in childhood, although an ulcer may not develop for many years. The second most common cause of an ulcer can be aspirin or non-steroidal anti-inflammatory drugs (NSAIDs).

H. pylori Infections, Acid Reflux and Peptic Ulcers

How do I know if I have a peptic ulcer?

Symptoms are not always the same for everyone who has a peptic ulcer. Some of the various symptoms are:

• pain in the upper abdomen (which may feel worse when fasting and be relieved by eating a meal)
• vomiting which may contain blood
• black, tarry stools
• loss of weight
• loss of appetite
• lethargy or tiredness

If you are experiencing the symptoms above, you may have an ulcer and should consult with your physician.

Testing for peptic ulcers

Safe and effective tests are available to help your physician diagnose whether or not you have an ulcer. These include:

• Endoscopy: During an endoscopy, a flexible tube with a light and video camera on the end is gently inserted into your mouth and passed into the stomach and duodenum (upper portion of the intestine).Ulcers in the stomach or duodenum can be seen in real time with the camera during the procedure. Biopsies (tissue samples) can be taken during the endoscopy. This is the most accurate test for ulcers.
• Upper Gastrointestinal X-ray: This is a special type of X-ray. To prepare for it, you will be asked to drink barium or a similar substance that outlines the inside of your esophagus (the tube that connects your mouth to your stomach), stomach and duodenum. Ulcers appear as defects in the barium that coats the lining of the stomach or duodenum. This test is not always accurate in showing ulcers, especially in children.

How do I know if my ulcer is due to H. pylori infection?

There are several tests available to determine if you have H. pylori infection.

• Endoscopy and biopsy: During your endoscopy, a very small piece of the stomach lining (biopsy) is taken. The bacteria can be detected by a chemical test on this tissue sample or by looking under the microscope. In some centers the bacteria can also be cultured from the biopsy.
• Urea Breath test: During this test, you will be asked to swallow a tablet or drink a solution containing a compound called urea. If H. pylori is present in the stomach or duodenum, it will break down the urea to produce ammonia and carbon dioxide. The carbon dioxide is carried to the blood and then exhaled in the breath which can be measured.
• Antibody test: Similar to other infections, special proteins, called antibodies, are produced by the immune system following an H. pylori infection. These antibodies can be measured in the blood to diagnose exposure to the bacteria. However, they persist for years after successful treatment and therefore cannot be used to prove that the bacteria have been killed.

How are peptic ulcers treated?

Acid-suppressing drugs can heal ulcers, however, if H. pylori is still present, the pain and risks associated with ulcers will come back. Therefore, the best treatment must involve getting rid of the infection as well.

An effective vaccine to prevent H. pylori infection in humans is not available. Researchers are actively working on the development of such a vaccine.

In the past, the recommended treatment involved a combination of two antibiotics and an acid-suppressing drug, called a proton-pump inhibitor (PPI), to be taken for ten days. However, over the years, H. pylori infections have become increasingly difficult to treat. As a result, new recommendations for treatment have recently been introduced which involved changes to the strength and length of time medication is to be taken. The new recommendations include the addition of a third antibiotic along with the PPI and that these are to be taken for 14 days. If you have been diagnosed with a peptic ulcer, ask your doctor about the new recommendations.

Getting Relief from Painful Peptic Ulcers

Can H. pylori infection be prevented?

No one knows for sure how H. pylori spreads, so prevention is difficult. There are currently no human vaccines available to protect against H. pylori infections.

Do ulcers come back?

Taking an ulcer medication can heal the ulcer but if the bacteria are still present, the ulcer will most likely come back. If an ulcer is caused by medication, then stopping the medication can prevent ulcer recurrences. There is a group of patients who may have ulcers unrelated to H. Pylori or drugs and these ulcers may recur spontaneously.

I have heard that H. Pylori can cause cancer. Is this true?

H. pylori infection is considered to be a carcinogen by the World Health Organization as it is associated with the development of stomach cancer. Medications for treating H. pylori are 80 — 90% effective.

What are the complications of ulcers?

There are three main complications that can result from peptic ulcers:

1. Bleeding: Bleeding may be the first symptom and of an ulcer. Bleeding ulcers can cause vomiting of red blood or black coffee ground like material. If the blood passes out through the bowel, you may have black bowel movements. If there is a lot of bleeding both black and red stool may be passed. When an ulcer continues to bleed without treatment, you may become weak and anemic.
2. Obstruction: An ulcer can cause an obstruction or blockage of the stomach or duodenum. This may be due to acute swelling from the inflamed ulcer. With long standing ulcers, there can be healing with scarring that leads to the blockage. Patients with obstruction may have problems with filling up quickly when eating, nausea, and vomiting.
3. Perforation: Rarely ulcers may create a hole in the lining of the stomach or duodenum and result in a perforation. If this happens, you will experience sudden, severe abdominal pain.
   It is always important to contact your doctor immediately if your symptoms worsen.