Peptic ulcer is a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). By far most instances are now known to be be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach. These ulcers can also be caused or worsened by drugs such as Aspirin.
Ulcers were once attributed to stress, tobacco smoking, blood groups, spices and a large array of strange things. Some of these factors are possibly minor contributory factors.
In Western countries the age-related prevalence of Helicobacter infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80 etc). Prevalence is higher in third world countries. Transmission is by food and human contact, sharing food utensils etc.
A minority of cases of Helicobacter infection will eventually lead to an ulcer and a larger proportion of people will get non-specific discomfort or gastritis.
Anti-acid treatments such as cimetidine, ranitidine and antacids may reduce symptoms but will not clear the infection. Bismuth compounds may actually reduce or even clear organisms. The most effective treatments are combinations of antibiotics (Erythromycin, Ampicillin, Tetracycline, Metronidazole) and proton pump inhibitors.
Treatment of Helicobacter usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required.
The diagnosis of Helicobacter can be by:
- Biopsy
- Breath tests
- Direct culture
- Direct detection of urease activity.
The possibility of other causes of ulcers, notably malignancy needs to be kept in mind.
