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. Last Updated: 07/27/2016

Ulcer Cause, Cure Surprisingly Simple

WASHINGTON -- Millions of Americans with stomach ulcers go undiagnosed and untreated because neither they nor their physicians know that most ulcers are caused by a common and easily treated bacterial infection, according to a new U.S. government survey.


The national survey, which was conducted by the U.S. Centers for Disease Control and Prevention, or CDC, found that only about a quarter of Americans understand that a bacterial infection is responsible for stomach ulcers. The remainder erroneously believe that stomach ulcers are caused by a combination of stress and eating spicy foods.


"For years, we all thought ulcers were a chronic condition ... and had to be endured for the rest of our lives,"" said Mitchell Cohen, director of the CDC's Division of Bacterial and Mycotic Diseases. ""That isn't true. Most ulcers are caused by a bacterial infection, and even if you've had an ulcer for years, you could still be cured."


Peptic ulcers strike an estimated 25 million Americans at some time in their lives, according to the CDC. The cost of ulcer complications is enormous, running to an estimated $6 billion a year for medical bills and lost days from work, according to the CDC. Yet studies show that more than 90 percent of ulcers are caused by an infection with a spiral-shaped bacterium known as Helicobacter pylori, which is easily treated with a two-week course of antibiotics.


Ulcers are small holes or sores that form in the lining of the stomach or in the first section of the intestine known as the duodenum. Left untreated, they can cause serious gastrointestinal bleeding. About 40,000 people undergo emergency surgery and 6,000 people die annually in the United States from complications of peptic ulcers. There is also growing evidence that chronic, untreated ulcers may increase the risk of stomach cancer.


Early evidence linking stomach ulcers to infection with Helicobacter pylori emerged in 1982 from work by Australian physicians Robin Warren and Barry Marshall. The idea that a simple bacterial infection caused ulcers was controversial within the medical community.


But Marshall was so convinced of the link between Helicobacter pylori and ulcers that he ingested the bacteria and documented both the formation of his own stomach ulcers and their cure following treatment with a combination of antibiotics and stomach-acid-neutralizing medicines.


The National Institutes of Health convened an expert panel to review ulcer treatment in 1994. Until that time, standard therapy relied primarily ondrugs called H-2 blockers, named because they interfere with the release of histamine in the body and thus thwart acid production in the stomach. The NIH consensus panel concluded that the link was strong enough between Helicobacter pylori and ulcers to recommend that ulcer patients infected with the bacteria undergo treatment with antibiotics.


Nonetheless, the idea has been slow to catch on, and in 1995 the CDC found that only 5 percent of ulcer patients were being treated with antibiotics.


Testing for Helicobacter pylori once was a complicated, invasive procedure. But new techniques make it possible to detect the infection by drawing a small amount of blood or by giving patients a simple breath test, said Benjamin Gold, a scientist in the Foodborne and Diarrheal Branch at the CDC and assistant professor of pediatrics at Emory University School of Medicine in Atlanta, Georgia.


How people contract an infection with Helicobacter pylori is still not understood. The microbe burrows into the stomach lining where it often remains undetected for years and even decades. Scientists believe the infection may commonly occur in childhood, but how and why it happens is still not known.


Once Helicobacter pylori infection is detected in a person with stomach ulcers, treatment with antibiotics is very effective. During the past year, the FDA has approved five different antibiotic regimens for eradicating Helicobacter pylori infection.


"All treatment regimens are given for two weeks with cure rates of 80 to 98 percent," Gold said.