Ulcers and the germ connection

In the stomach, there are protective substances that guard the stomach lining against damage. There are also aggressive substances, like stomach acid, that help to digest food. An ulcer forms because of an imbalance between the protective and aggressive factors in the stomach. The term peptic ulcer can mean an ulcer in the stomach or an ulcer in the duodenum (the first part of the intestine below the stomach).

Helicobacter pylori, or H. pylori, bacterial infection is another important factor in either causing ulcers or making ulcers harder to heal. About 80% to 90% of ulcers may be associated with H. pylori infection in the stomach. The H. pylori bacteria may lead to increased acid production in the stomach and may decrease the protective factors in the duodenum leading to peptic ulcers. H. pylori infection may also increase the risk of stomach cancer. For these reasons, many people are tested for H. pylori and prescribed a special combination of medications to get rid of H. pylori infection.

Where does H. pylori come from? How do you get it?

How helicobacter pylori infects a person is still unknown. It may be passed from person to person by direct contact with saliva, vomit, or fecal material. For example, if you touch a surface contaminated with fecal material and then touch your mouth you can unknowingly swallow fecal matter.

How do I know if I've got it, and if I've got it, how do I get rid of it?

Your doctor can order a simple breath test to determine if you have H. pylori or not. Other methods of detection include stool samples, blood tests, and biopsies (where a sample of tissue is taken).

Treatment to rid a person of H. pylori involves using a combination of medications – often a proton pump inhibitor (PPI) and three antibiotics or two antibiotics with bismuth subsalicylate (Pepto Bismol®). It is important to take the medication exactly as directed to increase the chances that the treatment will work.

What role do NSAIDs and ASA play in ulcers?

Nonsteroidal anti-inflammatory drugs (NSAIDs), often taken for arthritis pain, are an important cause of ulcers. NSAIDs prevent the production of a substance that protects the stomach. NSAIDs also directly irritate the lining of the stomach. People who take NSAIDs regularly are at increased risk of developing an ulcer. Peptic ulcers caused by NSAIDs may sometimes lead to complications such as gastrointestinal bleeding.

People taking NSAIDs every day are more likely to develop a peptic ulcer compared to others who take NSAIDS occasionally.

ASA (also known as acetylsalicylic acid; e.g., Aspirin® and generics) is often prescribed in low doses to reduce the risk of stroke or heart attack (for people who have already had a stroke or heart attack). It helps to keep the blood from clotting where it shouldn't. Because ASA used in this way is important for your heart, do not stop taking it because you are afraid it will give you an ulcer. Instead, speak to your doctor for more information.

Not everyone who takes ASA or NSAIDs will get an ulcer. Things that increase the risk are a past history of an ulcer, advanced age, taking higher doses, taking ASA together with an NSAID, taking 2 or more NSAIDs, regularly consuming alcohol while also taking ASA or NSAIDs, and infection with H. pylori.

If you are at greater risk of developing an ulcer from ASA or NSAIDs, your doctor may prescribe a medication to help prevent an ulcer from forming or to treat an infection with H. pylori. If you'll be taking ASA or NSAIDs for the long term, your doctor may recommend that you take a proton pump inhibitor (PPI) or misoprostol to reduce your risk of an ulcer.

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