Think stress = ulcer? Think again.

June 27, 1997

Think stress = ulcer? Think again.

Most ulcers are caused by bacterial infections


Staff Writer

Has any stressed out person ever told you, "You're giving me an ulcer!"?

For years, ulcers incorrectly were thought to be caused by stress or diet.

"Stress can be a factor, but it does not directly cause an ulcer," says Dr. Mahmood Solaiman, a Hagerstown gastroenterologist.

Today, research shows that most ulcers are caused by bacterial infections. Researchers are not sure how people are infected. The discovery of the Helicobacter pylori bacterium's link to ulcers was made about 10 years ago. According to research studies, it causes more than 90 percent of ulcers of the duodenum, the upper part of the small intestine, and 80 to 90 percent of gastric or stomach ulcers, Solaiman says.


The second major cause of ulcers is use of nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen sodium. These nonprescription drugs, as well as medications prescribed for a variety of arthritic conditions, can reduce the stomach's ability to protect itself from the harmful effects of its digestive juices.

What is an ulcer?

An ulcer is a little crater, a small hole in the lining of the stomach or duodenum, the upper part of the small intestine, says Dr. Robert J. Trace Jr., a Hagerstown gastroenterologist. About 20 million Americans develop at least one ulcer in their lifetime.

Ulcers don't always show symptoms, but the most common symptom is a gnawing or burning pain in the abdomen between the breast bone and naval. The pain often occurs between meals. For some people, it is worse after eating. Pain is not constant, but intermittent, Solaiman says. People with ulcers also may have nausea and trouble eating.

Doctors can detect the presence of an ulcer by performing an upper GI - gastrointestinal - series which involves taking an X-ray after the patient swallows a chalky barium liquid to help make the ulcer visible.

Endoscopy is an outpatient procedure in which a small, flexible instrument with a camera on the end is inserted through the mouth, esophagus, stomach and duodenum of the sedated patient. The area can be photographed, and tissue for biopsy can be taken to detect H. pylori.

Blood and breath tests also can determine the presence of the bacterium. A problem with the blood test, according to both Trace and Solaiman, is that it can be positive for six months to a year after the person is no longer infected.

The more recently approved breath test can tell the doctor whether the person is infected now, Solaiman says. This can help in monitoring the progress of treatment.

Ulcers are treatable and should be treated aggressively - not just to minimize discomfort, but to prevent complications, including rupture, hemorrhage or blockage. Continued monitoring of stomach ulcers is important because there's a small chance that the ulcer may be cancerous, according to National Institutes of Health.

Several types of medicines are used to treat ulcers. These include drugs which modify the stomach's production of acid and others that shield the stomach's mucous lining from acid damage.

With the bacterial connection, the treatment of ulcers has changed dramatically. A combination of antibiotics and medicines that reduces the production of stomach acid is healing ulcers, eliminating H. pylori and preventing ulcers' recurrence.

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