Mike, a regional representative for an expanding software company, has had bouts of stomach discomfort and pain for eight months. His busy schedule has kept him from going to the doctor, and he figures he will eventually lower his stress level and wean himself off favorite spicy foods. Besides, a friend has introduced him to an over-the-counter (OTC) acid-reducing drug that treats his heartburn. Mike believes that he may have cured his problem.
Mike is typical of the many people in the United States who suffer from heartburn, which can be a symptom of an ulcer. Too busy to seek treatment, people instead self-prescribe an antacid. The trouble is, many of these individuals actually have peptic ulcer disease (PUD), and by self-medicating, are not getting proper treatment for their condition. According to the American Gastroenterological Foundation (AGA), 25 million Americans currently suffer PUD, which is caused by the bacterium Helicobacter pylori (H. pylori). However, studies show that public perception of ulcers -- that they are caused by stress -- continues, despite evidence to the contrary.
In a survey conducted by the AGA, nearly 90 percent of Americans reported that they still believe stress causes ulcers. "Most of the public doesn't know about the association (between ulcers and bacteria), and the reason that's a concern is that many people will just take over-the-counter antacids and histamine blockers -- and just take them for years without a physician's care," says David Swerdlow, an epidemiologist at the Centers for Disease Control and Prevention (CDC) and co-author of a recent study published in the journal Infectious Diseases in Clinical Practice. In fact, the lack of awareness on the part of both the public and the medical community led Congress to recommend to the CDC that it mount an effort to educate people.
In the study, Dr. Mark Dworkin and colleagues state that many studies show that when H. pylori is treated properly -- with a regimen of antibiotics -- people are cured, even if they've had an ulcer for years. By contrast, "treating" ulcers with an antacid does not get rid of the bacterium that causes it and carries with it an 80 percent recurrence rate.
How Is PUD Diagnosed?
A variety of tests are available for H. pylori infection. They include a stool test, a breath test and a test that involves placing a flexible tube called an endoscope into the stomach or upper intestine, which is used to obtain a sample from the stomach lining that can be tested for the bacteria. The AGA reports that there are more than one million ulcer-related hospitalizations each year. H. pylori has also been implicated as the cause of some gastric cancers and may play a role in other diseases, so a diagnosis at the first sign of symptoms is important.
Not All Doctors Treat PUD the Same
A report in the July 26, 1999 issue of the Archives of Internal Medicine found that treatment designed to kill H. pylori tends to vary widely from doctor to doctor. The study found that some patients get two drugs, while others get three, writes author Dr. M. Brian Fennerty of Oregon Health Sciences University in Portland and colleagues at the Veterans Affairs Medical Center in Portland and at Wisconsin Medical School. The most effective combination was a three-drug regimen containing a proton pump inhibitor, a medication that suppresses stomach acid. Ask your doctor for this treatment.