The discovery that the bacterium Helicobacter pylori (H. pylori) causes peptic ulcer disease, which includes both duodenal ulcers and some stomach ulcers, was totally astounding to many doctors. If you had asked 100 gastroenterologists 30 years ago whether peptic ulcers could be an infectious disease, I think you would have received a unanimous no! Yet a couple of Australian physicians pursued an observation that many sufferers of ulcers had some peculiar bacteria growing in their stomachs, and H. pylori was discovered.
H. pylori is found in over 90 percent of people with duodenal ulcers. The number is smaller for people with stomach ulcers, since many ulcers in this location are due to the use of aspirin or nonsteroidal anti-inflammatory agents such as ibuprofen or naproxen. Many doctors also believe that the infection underlies cases of gastritis, in which the stomach lining is irritated but no clear ulcer is present, and stomach cancer.
A blood test will tell if you have been infected with H. pylori, and many doctors, including me, will treat a person based on that test alone, since the possible association with stomach cancer is so worrisome. However, the National Institutes of Health consensus statement calls for eradicating H. pylori only in cases of peptic ulcers. Recent published studies have shown that treating H. pylori in people with gastroesophageal reflux disease (GERD) does not cure the condition, and therefore many experts would restrict such treatment to people with demonstrated ulcers.
Some doctors may prefer to have more definite proof that an active infection with H. pylori is present before treating. The gold standard for diagnosis is to do an endoscopy of the stomach with a biopsy that will show H. pylori if present. There is also a newly approved test that involves no uncomfortable procedures. A small amount of radioisotope-labeled urea is given by mouth. One characteristic of H. pylori is that it digests urea, releasing the radio-labeled carbon in the form of carbon dioxide, which is exhaled in our breath, and the radioactivity can then be measured. If a certain level of radioactivity is present in the exhaled air, then H. pylori is present in the stomach.
There are now many treatments for H. pylori. Almost all involve giving an acid blocker, such as ranitidine (Zantac) or omeprazole (Prilosec), together with two antibiotics or one antibiotic and bismuth subsalicylate pills (Pepto-Bismol Regular Strength). The antibiotics that can be used include tetracycline, metronidazole, amoxicillin, and clarithromycin. It is important to take the acid blocker and the two antibiotics (or one antibiotic plus bismuth) together for the entire treatment period — which is usually two weeks — since the bacteria can become resistant to antibiotics quickly if they are give alone. These regimens all have 80 to 95 percent success rates.
In many people with peptic ulcers, which in the old days had a strong tendency to recur even when aggressively treated, eradication of H. pylori has led to permanent cure of their ulcers.