Stomach Ulcer Disease & H. Pylori Infection
An ulcer is a breakdown of the stomach mucosa (the mucosa is the inner lining of the stomach that contains glands).
The stomach contains several layers including the mucosa, the sub-mucosa, muscle, and serosa. An ulcer by definition is when gastric mucosa breaks down and penetrates down to the muscle.
Ulcers are very common and the incidence increases with age. Persons infected with H. Pylori bacteria have a 10 fold increase in incidence. H. Pylori is a helical shaped bacteria that colonizes in the gastric mucosa. H. Pylori is a major cause of ulcer formation worldwide. The infection is usually acquired in the childhood through the oral route. To survive living in the acidic condition of the stomach, H. Pylori generates ammonia that neutralizes acid and provides a comfortable environment to live. It also produces molecules that break down the mucosa and allows them to move around in the mucosa layer. H. pylori also manipulate the stomach cell which leads to increased acid production.
There are several ways to test for the bacteria, including stool testing, blood testing, breath testing, and finally biopsy of the stomach during an endoscopy procedure. The blood test may be a good initial screening test, but will always remain positive despite completion of antibiotic therapy and H. Pylori eradication. Therefore, it is not a good test to check to confirm eradication. The stool antigen test is a good test to check for eradication 4-6 weeks after completion of therapy. This test is non-invasive and relatively inexpensive to perform. The Urea breath test is also a good test to perform 4-6 weeks after the completion of therapy.
Another major cause of peptic ulcer disease is the use of Non-Steroidal Anti-inflammatory drugs (NSAID’s) such as Ibuprofen and Naproxen. Another cause is Aspirin which is commonly used for cardiovascular protection and treatment of heart disease. In the United States, millions of people take NSAID’s daily, and thousands of them will have serious side-effects including gastrointestinal bleeding and die due to complications. Aspirin and non-steroidal medications disrupt the production of molecules called prostaglandins that normally protect the stomach; therefore with inhibition of these molecules, the stomach is defenseless. Individuals with H. Pylori infection, who take NSAID’s or Aspirin, have a higher likelihood of developing ulcers.
Additional risk factors for ulcer formation include smoking, alcohol, corticosteroid medications, Sirolimus used after kidney transplantation, and Bisphosphonates used for osteoporosis.
The treatment of ulcers includes removing the causative agent such as Aspirin or NSAID’s and using medications to reduce the acid, and allow the mucosa to properly heal.