By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ANTIBIOTICS ARE NOW PART OF STANDARD TREATMENT FOR MOST ULCERS

Question: My husband just got back from the doctor's office. He says he has an ulcer and that he needs to take antibiotics for it. This doesn't make any sense to me. Is he right or do I need to speak with the doctor to find out what is really going on?

Answer: While it is always appropriate to call the doctor's office when you have questions, your husband's report makes perfect sense. Let me tell you about ulcers and how we treat them now.

Historically it was thought that ulcers were caused by over-wrought emotions, spicy food and a stressful lifestyle. An ulcer is a sore, what we doctors call an erosion, that develops in the lining of the stomach or the first part of the small intestines (duodenum). Ulcer symptoms -- burning and gnawing types of pain in the stomach region -- were traditionally treated with medications that would either decrease the production of stomach acid or neutralize what was already present. While these medications helped relieve the symptoms and even healed some of the ulcers, they would return.

In 1982, a bacterium, Helicobacter pylori (H. pylori), which is able to survive in an acidic stomach environment, was identified as the cause of ulcers. Up to 80 percent of gastric (stomach) ulcers and 90 percent of duodenal ulcers are caused by H. pylori. Now we treat ulcers with antibiotics in addition to medications to suppress acid production in the stomach. In most cases, this combined therapy is very effective at not only curing the ulcer but also at preventing a recurrence.

The exact mode of transmission is not clearly known yet, but person to person contact is quite likely.
H. pylori can be diagnosed by a blood test, a breath test or a biopsy that's taken when you have an "upper GI scope." In this latter procedure -- called an EGD -- your doctor visually examines the lining of your esophagus, stomach and upper duodenum with a small camera (flexible fiberoptic endoscope) which is inserted down the throat. EGD is the "gold standard" test for determining whether or not you have an ulcer and, if so, for finding out if it is caused by H. pylori.

Since the discovery of H. pylori as the cause of most ulcers is relatively new, there are still many things we don't know about the presence of H. pylori in the stomach. Over 60 percent of the world's population is infected with H. pylori in the lining of their stomachs, but most of these individuals don't have an ulcer. At the present time, we only treat people who have ulcer symptoms. We really don't know conclusively what we should do for people with H. pylori and no symptoms.

So be sure your husband takes all of his medications and follows up with his physician as directed to increase the chances of being cured of the ulcer. Also, even if you never come down with ulcer symptoms yourself, it would be a good idea to ask your physician occasionally if there is any new information about H. pylori. It may be that at some future point the evidence will indicate that everyone with H. pylori in his or her stomach lining should be treated even in the absence of symptoms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.