Ulcers-What Really Causes Them?
If you scored 10 or higher or if you are taking any stomach medications, feel fuller sooner, stay fuller longer than you used to or if you burp within 30-60 minutes of eating, you certainly have stomach issues.
One often overlooked cause of stomach problems, one that is often the root cause of other problems such as hypochlorhydria (low stomach acid) and GERD, is an infection with the bacteria Helicobacter pylori. The discovery of this organism and that it is the major causative agent of stomach ulcers, serves as a typical example of how the medical profession works.
In the late 1800’s researchers from Italy and Germany separately found bacteria in the stomachs of dogs. Later, Robin Warren, an Australian pathologist, noted small curved bacteria colonizing the lower part of the stomach in about 50% of patients from which biopsies had been taken. He made the crucial observation that signs of inflammation were always present in the gastric mucosa close to where the bacteria were seen. Barry Marshall, MD became interested in Warren’s findings and together they initiated a study of biopsies from 100 patients. They were able to cultivate a previously unknown bacterial species. They found the bacteria present in almost all patients with gastric inflammation, duodenal ulcer or gastric ulcer. They proposed that Helicobacter pylori was involved in the cause of these diseases.
Of course, at the time, all MD’s knew that the cause of ulcers was stress and the resultant excess of stomach acid. They treated accordingly. Even though reducing or eliminating gastric acid production does help heal ulcers, they have a nasty habit of recurring, since H. Pylori bacteria and stomach inflammation remain. Of course, Marshall was virtually ostracized for his heretical beliefs. Instead of giving up he did the unthinkable- he drank a vial of H. Pylori! (A bad way of committing suicide). In a few days he developed nausea and vomiting. An endoscopic biopsy showed gastritis! He treated himself with antibiotics and the infection promptly resolved. Marshall, Warren and others subsequently showed that patients could be cured from their peptic ulcer disease only when the bacteria were eradicated from the stomach. It is now known that H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. It is found in the stomach in about 50% of all humans. It has been traced back at least 58,000 years to the birthplace of humans in Africa. In countries with high socio-economic standards infection is less common than in developing countries where almost everyone is infected.
H. pylori is a highly infectious disease. It can be contracted in early childhood, by transmission from mother to child. It may remain in the stomach for the rest of the person’s life unless treated. Kissing may transmit the disease. If a family member has an ulcer, there is a higher incidence of H. pylori among family members. The severity of inflammation and its exact location is important for the resultant disease. In most individuals infection is asymptomatic, but 10-15% of infected individuals will experience peptic ulcer disease. Such ulcers are more common in the duodenum than in the stomach itself.
If H. pylori infects the corpus region of the stomach, it causes widespread inflammation that predisposes one to stomach cancer, which still ranks as number two in the world in terms of cancer deaths! Another form of cancer, MALT Lymphoma is present at higher rates in infected people. Eradicating H. pylori causes regression of the tumor. Current research indicates that other inflammatory diseases of the GI system may be linked to H. pylori and other bacteria found in the GI tract.
So after being virtually laughed out of the profession for his ridiculous ideas, Marshall was awarded the Nobel Prize for Medicine in 2005. The moral of the story is- don’t always believe everything your doctor tells you or does.
Unfortunately, 25 years after Marshall’s discovery, very few physicians seem to be testing for H. pylori. They continue giving Prevacid and other acid blockers out like candy. You can even get it over the counter! Tummy meds are still the biggest seller around. You can’t go a night without hearing a TV ad for one, which extols their virtues, but fails to tell of the dire consequences of prolonged use. Long-term use carries with it a risk of osteoporosis. Failure to eradicate the underlying cause can increase rates of MALT Lymphoma. Loss of stomach acid has major consequences for the entire GI tract, some of which were discussed in two other articles, Disorders of the Stomach and Understanding the Digestive Tract.
If you are on the acid blocker Merry-Go-Round perhaps it is time to get off. How can you tell if you have H. pylori? If you score high on the above test, have had gastritis, GERD or an ulcer or have a family member who has; it would be a good idea to be tested. There are a number of methods of testing. You can have an endoscopic biopsy, but if the area biopsied isn’t infected, it could be missed. You can have a breath test done (H. pylori produces urea which can be exhaled and measured), but if the infection isn’t currently active it can also be missed. A stool sample also has its drawbacks. An immunoassay for Immunoglobulin (Ig) A, G and M will detect past and present infection and may be the best method, but is expensive. Simple, inexpensive tests that check for IgG antibodies to H. pylori are available.