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Not caused by stress but bacteria
The Latest Treatment for Peptic Ulcer
By Dr. W. Gifford Jones
What's the best way to cure the gnawing pain of a peptic ulcer? This week I met the doctor who has the answer. Dr Barry Marshall stunned the scientific world by claiming that peptic ulcers were not caused by stress. Rather, he claimed stomach and duodenal ulcers were triggered by a spiral-shaped bacterium called Helicobacter pylori. And that just as you can catch a cold you can catch an ulcer!
Dr. Marshall is currently Professor of Research in Internal Medicine at The University of Virginia in Charlottesville. His research began in 1981 when he was studying gastritis, an inflammation of the stomach's lining. His colleague, Dr. Robert Warren, a pathologist, noted the curved bacterium present in some biopsies taken from the stomach.
But there was a problem. Medical texts all stated that bacteria could not live in the stomach's acid environment. This fact prodded the doctor's curiosity to study the matter further.
In the next two years Dr. Marshall discovered that nearly all his ulcer patients had Helicobacter pylori in their stomachs. But his colleagues scoffed at his theory of infection.
However, Dr. Marshall had one important ace up his sleeve. Unlike so many theories, he proposed an hypothesis which was much more "testable".
For instance, the suggestion that undue stress or type A personalities were related to the incidence of ulcers is not easily "testable". After all, how can you remove all the stress from someone's life? Nor is it possible to alter genetic patterns.
But in Marshall's case if a peptic ulcer was due to bacterial infection it should be easy to cure by antibiotics. Further research proved this was the case.
Dr. Marshall claims that about 30 percent of people with H. pylori develop a peptic ulcer during their lifetime. Another 60 percent suffer from minimal symptoms.
It was initially believed that racial differences determined who develops a peptic ulcer from H. pylori. But it turned out socio-economic variations were the culprits.
Dr. Marshall reports that H. pylori is caught during childhood. This is most likely when surroundings are unclean or where vomiting and diarrhea spread the germ to other members of a family.
Genetics, Marshall claims, does play a role in who is susceptible to H. pylori infection. For instance, people of certain blood groups such as group O are more prone to peptic ulcers.
He also found that some types of Helicobacter pylori are worse than others. The worst ones produce a toxin which increases the risk of peptic ulcer.
Does Helicobacter pylori cause stomach cancer, the third most common malignancy in the world? Every year one million people develop this disease. But so far there's no specific evidence that Helicobacter pylori is responsible for this cancer.
But Dr. Marshall points out that the Japanese have a high incidence of this malignancy. And that 70 percent of the population are also infected with this bacterial infection!
So what should doctors do if they suspect a patient has a peptic ulcer? Should they submit the patient to an upper GI series to discover an ulcer by X-ray? Or perform a gastroscopy where an optical instrument is passed down the throat and into the stomach to detect an ulcer?
Dr. Marshall says many doctors are saying, "Why not do a blood test to see if Helicobacter pylori is present?" Like any other infection H. pylori causes the body to create an immune response. This generates antibodies which can be detected by a blood sample. If they are found the doctor can prescribe antibiotics.
If the patient's symptoms subside then there's no need to do anything further. But if this doesn't happen gastroscopy must be done.
Dr Marshall reports that within a year there will be several tests available. They will merely require a finger prick to detect the presence of Helicobacter pylori.
So how do you get rid of that gnawing pain and cure a peptic ulcer in 1997? Dr Marshall says that one of the most popular treatments in the world is to use a combination of three drugs Prevacid, Biaxin and Amoxicillin for one week.
Prevacid (30 milligrams twice a day) helps to decrease the amount of acid in the stomach. This is taken along with two antibiotics, Biaxin (500 mg. twice a day) and Amoxicillin (one gram twice a day) helps to "debugg" the stomach of Helicobacter pylori.
How long it takes for the ulcer to heal depends on its size. But about 90 percent are gone within one month. Moreover the recurrence rate for the infection once the ulcer is cured is less than one percent. These drugs also help our healthcare system. Marshall says the lifetime cost of treating an ulcer used to be $10,000.00. Now these three drugs cost about $100.00.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at letters@canadafreepress.com
