Drug Combination Found Effective on Peptic Ulcers : Medicine: A bacterium linked to the malady can be killed by antibiotics and acid-suppressing compounds, a federal advisory panel says.
Peptic ulcers can be treated effectively with a recently discovered combination of antibiotics and traditional acid-suppressing drugs, a federal advisory panel concluded Wednesday, giving new hope to the estimated 25 million Americans afflicted by the disease.
The combination drug treatment can eradicate the bacterium Helicobacter pylori , reducing the rate of recurrence of peptic ulcers in up to 90% of patients, a panel of medical experts convened by the National Institutes of Health found. H. pylori was discovered in 1982 and researchers have since established a strong association between its presence and the development of one kind of peptic ulcer.
Peptic ulcer disease is a chronic inflammation of the stomach and duodenum, the place where the stomach joins the small intestine. Typically, it is not life-threatening but can result in substantial suffering and economic burden. It affects as much as 10% of the U.S. population at any given time.
Historically, such ulcers were thought to be related to stress and diet. Treatment focused on bland foods, bed rest and--in severe cases--hospitalization. Later, as scientific speculation about the cause of ulcers centered on digestive secretions such as gastric acid, the use of acid-reducing drugs known as H2 blockers became an important element in treatment.
Twelve years ago, a 32-year-old resident in internal medicine sought to turn those beliefs upside down with his discovery of a link between H. pylori and ulcers.
But instead of hailing Australian doctor Barry J. Marshall’s findings as a breakthrough, the medical Establishment challenged them at nearly every turn because they overturned deeply held medical beliefs about the cause of ulcers. The medical panel’s conclusions Wednesday serve as a final validation of Marshall’s discovery.
Peptic ulcers are those that strike the gastrointestinal tract. Not everyone infected with the organism develops ulcers, and individuals can develop peptic ulcers without harboring the bacterium, scientists believe. The committee stressed that the therapy should be used only in those patients who test positive for the organism and who suffer from ulcer symptoms.
Although traditional therapy has been effective in reducing or eliminating individual ulcers, the problem has tended to recur because, scientists long believed, ulcer-prone individuals were particularly vulnerable to the stress and other factors in which the malady was thought to be rooted.
Nevertheless, recent research has shown that dual and triple combinations of bismuth, an acid-reducing compound; antibiotics, and antimicrobial drugs can successfully cure the H . pylori infection and reduce the rate of ulcer recurrence, the panel said.
The most effective triple-drug therapies include bismuth and the antibiotics tetracycline and metronidazole, the group said. In some cases, resistance to metronidazole could require a substitution of amoxicillin, the panel said. The committee recommended that the drugs be administered for two weeks.
“While mild side effects occur in each drug combination, they do not normally prevent patients from completing their therapy,” said Dr. Tadataka Yamada, chairman of the panel. Tadataka heads the department of internal medicine at the University of Michigan Medical Center.
The panel also found a strong link between the bacterium and other upper gastrointestinal diseases, including gastritis, an inflammation of the stomach lining that also can be cured by eliminating the organism.
Finally, the panel said infection with the bacterium should be considered a risk factor for gastric cancer. But the committee found no evidence that treating the infection reduces the risk.
Gastric cancer is rare in the United States but extremely common in many parts of the world.
There are several tests for the bacterium, including blood tests and a breath test that measures levels of the enzyme urease. Elevated levels usually indicate the presence of H. pylori.
