Joseph R. Anticaglia MD
Medical Advisory Board
For many years, peptic ulcers were considered to be caused by too much acid in the stomach, as well as, being a psychosomatic problem (a physical disease) brought on by mental stress and anxiety.
Professors in medical school taught “hyper-secretion” of stomach (gastric) acid was the fundamental cause of peptic ulcers abetted by a stressful lifestyle. Gastric acid caused its damage by eroding the lining of the stomach wall or parts of the small intestine. Doctors stocked their shelves with drugs aimed at neutralizing acids..
Steve is a 42 y/o Chicago policeman who for many weeks complained of indigestion, sensations of fullness and heartburn. These complaints gradually became more frequent and, at times, were associated with vomiting.
He noticed that about an hour after he ate, (especially meals like fried chicken and a beer) the heartburn worsened and he suffered cramp-like stomach pain. Eventually, even without eating trigger foods or alcohol, he was experiencing mid-abdominal distress. Milk and yogurt relieved the discomfort temporarily.
He took these complaints to his doctor, who told Steve he had a duodenal ulcer. He advised him to reduce stress and if possible take a week or two off from work. He recommended a bland diet with small and frequent meals; avoid coffee, tea, spicy foods and to take antacids.
On the way out of the office Steve mentioned, “I have a skin condition and when I get a flare-up, my Dermatologist puts me on an antibiotic and my stomach problems seem a lot better.”
Often, the obvious is right in front of us but we cannot connect the dots. Only when looking through the lens of a ‘retroscope’ does the answer become crystal clear
The last comment by Steve was ignored by his physician. “Stay on the diet. Cut down on the stress and anxiety. Take the antacids.” Six months later, Steve was popping antacids but felt basically the same…
Peptic Ulcer Disease and H. Pylori
PUD is an open sore in parts of the digestive tract that fails to heal. It’s an erosion of the mucous membrane that lines the internal surface of the stomach or the first part of the small intestine, the duodenum.
H. pylori Infection
H. pylori is a germ (microorganism, bacteria) that causes infection in the stomach and digestive tract. It’s found in two thirds of the world’s population and thought to spread by contaminated water, unclean food, saliva and poor sanitation conditions.
These germs find the acid environment of the stomach hospitable and may live for years before causing problems.
The outlandish concept that most peptic ulcers are caused by bacteria was received by the medical community as if someone was saying: “the sun revolves around the earth.”
This breakthrough discovery dramatically changed the treatment of peptic ulcers. And, it was the result of the brilliant and tenacious work of two men from Perth, Australia…
Dr. Barry Marshall and Dr. J. Robin Warren in 2005 were awarded the Nobel Prize in medicine for the discovery that gastritis, peptic ulcer disease and some cancers are caused by a spiral shaped bacteria Helicobacter pylori (H. pylori). Their research in the 1980’s demonstrated that H. pylori can live in an acid environment as found in the stomach. They linked H. pylori to gastritis, PUD and stomach cancers. Their research initially met blind eyes and deaf ears.
Medical journals refused to publish their findings and the pharmaceutical companies would not fund further research. Why would pharmaceutical companies support research to cure PUB when their antacids products were making billions of dollars a year?
It took years for the relentless Nobel Prize winners to debunk the entrenched stomach acid and psychosomatic theories about peptic ulcer disease.
Dr. Marshall went to the extreme to convince his skeptical colleagues. He performed a mind- boggling experiment on himself. He cultured H. pylori from one of his patients, put it in a broth and swallowed the germs! He reproduced the symptoms of gastritis and peptic ulcer disease as noted above in the case of Steve. When he told his wife what he did, she was — to use an euphemism: “outraged!”
Gastric Ulcer Endoscopy
H. pylori Electron macrograph
Tests for H. Pylori and Peptic Ulcers
Laboratory:
Your doctor may test your blood for H. pylori antibodies or a breath test to detect carbon or a stool sample to detect H. pylori proteins.
Endoscopy
This procedure involves passing a scope down the back of your throat in order to exam the linings of the esophagus, stomach and small intestine. If there is a suspicious area, a biopsy is taken and sent to the pathology lab to rule out H. pylori or cancer.
Upper G.I. Series (Gastrointestinal)
Also called a Barium swallow; with this test you’re asked to sip a white liquid containing barium which makes it easier to create X-ray images of the esophagus, stomach and small intestine.
Treatment
A two week course of an antibiotic, plus medication to reduce stomach acidity (PPI) and Pepto-Bismol is often enough to eradicate H. pylori. The treatment regimen may vary. Follow up examination and testing for H. pylori is needed to make sure that the ulcer has healed and H. pylori has been eradicated.
Patients are advised to eliminate risk factors for peptic ulcers such as aspirin, non-steroidal anti-inflammatories (NSAIDs), stop smoking or chewing of tobacco and do away with excessive alcoholic intake.
Certain individuals have the character and conviction to persist in the face of money and power. The drug companies were making billions of dollars annually for their antacid products. Surgeons were removing parts of the stomach to treat bleeding ulcers and stomach cancer. The use of antibiotics to treat H. pylori in many instances prevented the need for surgery due to the complication of bleeding ulcers and the progression of PUD to cancer.
Drs. Marshall and Warren solved a medical mystery. Pathologist Warren was steadfast in his conviction in the association of gastritis, peptic ulcer disease and H. pylori. Dr. Marshall went to the extreme to convince his skeptical colleagues. Who among us would swallow millions of germs to prove a point?
Glossary
H. pylori — Helicobacter pylori
Pepto-Bismol — bismuth subsalicylate
PPI — Proton Pump Inhibitor
References
Marshall, Barry; Warren, J. Robin; Unidentified Curved Bacilli in the Stomach of Patients with Gastritis and Peptic Ulcerations; The Lancet; June 16, 1984.
Fashner, Julia; Gitu, Alfred; Diagnosis and treatment of Peptic Ulcer Disease and H. pylori Infection; Am. Fam. Physician; Feb. 2015
Uthman, Ed; Benign gastric ulcer; Wikimedia Commons H.pylori; Wikimedia Commons
H. pilori Infectiion; June 5, 2014; Mayo Clinic
Yancey, Joseph; Cheney, Kari; Optimal Duration of Treatment Regimens for H. pylori Eradication; Am. Fam. Physician; Dec.1, 2014
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.