Peptic Ulcer Disease: Skip the Antacid and See Your Doctor Instead
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.
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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
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