Ulcers in the stomach or duodenum were attributed for years to excess stomach acid and treated with antihistamines which reduce acid secretion and antacids. In the past, milk was recommended, but dairy products can be the cause of the problem and are often contra-indicated; milk allergy may be an original cause of gastritis which leads to ulceration. A common cause of stomach ulcers is the regular use of ASA or related anti-inflammatory drugs - NSAIDs. If ulcer symptoms occur while taking these drugs, their use should be discontinued. Food causes must be considered and diet revision is an essential part of all gastrointestinal disease.
An acute duodenal ulcer will present with pain high and central in the abdomen; the pain comes on as the stomach empties 3 or 4 hours after eating and during the night. Eating food, especially bland foods, milk or antacid tends to relieve the pain. Antihistamines ( H2 blockers - examples are tagamet, pepcid and zantac) have been prescribed for years to treat ulcers and acid reflux into the esophagus and are now available as over-the counter medications.
In the past decade, evidence of bacterial infection in ulcer disease has accumulated. Now,it is reasonable to assume that recurrent or chronic duodenal ulcers are related to infection with the bacteria, Helicobacter pylori; the bacteria may also play a role in causing stomach ulcers and chronic gastritis. The puzzling aspect of H Pylori (HP)is that 90% of the people who harbor the bacteria in their stomachs do not have ulcer disease. The 10% of people who develop ulcers in the presence of H. Pylori, however, may have recurrent ulcers and benefit form treatment to eradicate the bacteria.
If you look for H. pylori in the general population, you will find that it is common. In Canada 20-40% of the population harbor the bacteria (the incidence increases with age). In developing countries 80% of the population may have the bacteria. The incidence of infection increases with poor living conditions.
Benefits of H Pylori Infection ?
Anderson et al suggested that H pylori infection causes gastric atrophy which turn reduces the complications of acid reflux into the esophagus (Barrett's esophagus and esophageal adenocarcinoma). “This is one more reason to screen for infection only when you are ready to eradicate and thereby ready to treat -- and only as deemed appropriate by consensus standards.”
There may be other benefits from HP infection. It is likely that the numerous and diverse microflora that populate the human digestive tract are beneficial. Blaser et al suggested that phylogeographic evidence from more than 58,000 years ago supports that H pylori colonized the stomach of humans. Despite the antiquity of this association, there is evidence that the prevalence of H pylori is decreasing. In the United States and other industrialized nations, the current prevalence of H pylori infection in children younger than 10 years has decreased from 70%-90% to less than 10%. There is substantial evidence now to support the inverse association between H pylori and childhood asthma, allergic rhinitis, and atopy.
The Canadian Helicobacter pylori Consensus Conference made recommendations several years ago about the diagnosis and treatment of HP. They offered a number of guidelines reviewed here:
Test for HP be done only when treatment is planned ( i.e. when symptoms are convincing and prolonged or when an ulcer has been demonstrated by X-ray examination.) The urea breath test or antibody tests are recommend for people who have chronic dyspepsia - upper abdominal pain and discomfort lasting more than three months.
No tests be done in asymptomatic people unless there is a strong family history of stomach cancer.
Urea Breath tests have "excellent sensitivity and specificity". (1) A carbon isotope (C13) can be used and is stable so that breath samples can be collected in an MDs office and mailed to a lab for analysis. A positive breath test indicates active infection and treatment is indicated.
Test for antibodies to H pylori are available but the accuracy is in doubt; these test are relatively inexpensive and easy to do and may add further conviction to start treatment when the clinical evidence is strong.
The question of who should have endoscopy - a look with a fiberoptic scope with biopsy and culture is more difficult to answer. This invasive procedure is expensive, has risk as associated and (at least in Canada) may involve delay waiting for specialist consultation and bookings in endoscopy suites. The consensus was that treatment can proceed without endoscopy, although patients over 50 and patients with alarming associations such as anemia or weight loss should be scoped to look for cancer. Testing for HP is recommended in patients taking NSAIDs who develop an ulcer. In the majority of cases, there is no need for follow-up tests after appropriate eradication therapy. Antibody tests should not be used to confirm eradication of HP.
HP Eradiation Therapy
Various schemes for treating heliobacter infection have emerged. The use of antobiotic combinations and a proton pump inhibitor is popular. For example: Clarithomycin 500 mg and metronidazole 500 mg twice a day for 7 days plus omeprazole 20 mg twice a day for 7 days followed by omeprazole 20 mg every morning for another 21 days. Antibiotic resistance is emerging and complicates the choices of drugs.
Self Treatment of Symptoms
Self-therapy of milder symptoms - dyspepsia and early ulcer-like symptoms consists of retreating to Alpha Nutrition Phase 1 foods, using brown rice instead of white rice with the option oftaking tagamet or zantac as recommended by the manufacturer. Remember that the bedtime dose is very important because your stomach will spend 8 hours or more in a near-empty condition vulnerable to the action of accumulating acid. Phase 1of the Alpha Nutrition should be sustained for 2 to 3 weeks or until symptoms are gone and then food is reintroduced using the medium track - foods from Phases 2 and 3 are slowly reintroduced.
If adequate diet revision does not resolve symptoms promptly and/or prevent recurrent gastritis or ulcers, you need medical assessment and treatment.
References: Anderson LA, Murphy SJ, Johnston BT, et al Relationship Between Helicobacter pylori Infection and Gastric Atrophy and the Stages of the Oesophageal Inflammation, Metaplasia, Adenocarcinoma Sequence: Results From the FINBAR Case-control Study. Gut. 2008;57:734-739
Blaser MJ, Chen Y, Reibman J. Does Helicobacter pylori Protect Against Asthma and Allergy? Gut. 2008;57:561-566