Ulcers and Helicobacter Pylori Infection

By Alan Peterson, M.D.

What is an ulcer?

An ulcer is an opening in lining of the stomach or in the first part of the small intestine called the duodenum.  They can cause a gnawing or burning pain in the stomach. Most people, however, that complain of stomach pain do not have an ulcer. Your doctor can do tests to determine if your stomach pain is caused by an ulcer.

Are ulcers serious?

Most people with ulcers just have stomach pain. Some people do not have any symptoms at all. But ulcers may cause other health problems. Sometimes they can bleed; if they become too deep they can break through the stomach wall or perforate. They can also block food from going to the intestines.

What causes ulcers?

Some people think ulcers are caused by stress or eating food that has too much acid in it, but this is not true. Most stomach ulcers are caused by infection with a bacteria called Helicobacter pylori, or H. pylori for short. Ulcers that occur in those that do not have H. pylori infection are related usually to aspirin use or use of anti-inflammatory drugs such as ibuprofen (some brand names: Advilâ, Nuprinâ, Motrinâ, Mediprinâ), Naprosynâ, Celebrexâ, or Vioxxâ. Acetaminophen (brand name: Tylenolâ) does not cause stomach ulcers.

How does my doctor know if I have an H. pylori infection?

This can be diagnosed with a blood test. Other tests such as x-ray or having a tube passed down into the stomach (upper endoscopy) might also be helpful. A breast test is another way to find out about H. pylori infection.

How are ulcers treated?

Three medications can be utilized. Your doctor will decide which is best for you. One kind reduces the amount of acid that your stomach makes. The second kind blocks the stomach’s ability to make acid. A third kind coats the ulcer.

What if I have an ulcer and H. pylori Infection?

The medicines described earlier heal ulcers whether you have H. pylori infection or not. But, if you have H. pylori infection too, your doctor will also treat the infection. It is hard to get rid of. No single medicine can cure this infection. The best way to cure H. pylori infection is to take several medicines at the same time.  These include one or two antibiotics plus bismuth, or medicine to block stomach acid production. There are combination medications of the above drugs such that one does not have to take so many pills.

Do the medicines cause side effects?

Because you have to take so many medications for this problem, you may have some side effects. They are usually minor, including a black color on your tongue, black stools, diarrhea, nausea, and headaches.  Some can leave a bad taste in your mouth.

You can cure H. pylori infection only if you take the medications just the way your doctor tells you. If you forget to take some of your medicines or stop taking them because of side effects, the infection will not be cured. The ulcer could recur. Let your doctor know right away if you have side effects with your medications or if you have any questions about how to take them. Sometimes alternatives can be prescribed or other medications given to offset the side effects that you might be experiencing.

What else can I do?