It’s Not All in Your Head : Contrary to popular belief, ulcers are thought to be caused by bacteria rather than emotions and stress. Antibiotics may hold the cure.
Talk about stigma: Ask any ulcer patient.
Sometime after saying hello, the average person asks someone with stomach pain, decreased appetite, heartburn and nausea a psychological questions: “Have you been under a lot of stress lately?” “Have you been tense?”
People often worry that their stomach problems are caused by their fast-track jobs or busy schedules, and some are embarrassed that they have not yet learned to deal with the rigors of their lives, said Dr. Gerald Green, an Encino-based gastroenterologist and chief of staff at Encino / Tarzana Regional Medical Center.
But the latest research blames bacteria--not attitude, coping skills or personality. Scientists have learned that a bacterial organism called Helicobacter pylori is almost always the cause of stomach and duodenal ulcers, said Green, who is also a clinical professor of medicine at USC.
“Evidence that stress is related to ulcers is not there,” Green said. “People under stress may develop a variety of gastrointestinal symptoms, such as dyspepsia or irritable bowel syndrome--but not ulcers.”
Researchers at a wide range of medical centers have shown that antibiotics, either given alone or in combination with a bismuth agent--such as Pepto-Bismol--can cure ulcers by eliminating the Helicobacter infection.
Green said that, before this discovery--since the 1970s--people with uncomplicated peptic ulcers were typically put on a drug such as cimetadine (Tagamet), which would resolve about 90% of the ulcers within four to eight weeks. But as many as 70% of the ulcers would recur, which would force the patients to go back to the $30-a-month drug regimen, often indefinitely.
Patients would often blame their psychological status rather than the treatment plan for their protracted illness, he said.
When antibiotics are given instead of Tagamet, ulcers return in only 10% of the cases, Green said.
Although this information has been widely published in the medical literature, many people are unaware of the new approach, said Lois Pound, a registered nurse and coordinator of the GI / Endoscopy Center at Northridge Hospital Medical Center.
“Patients have no idea; they think it’s all about stress or diet,” she said.
There are several simple ways to check for the presence of the bacteria, including a blood test and a breath test that checks for a complex chemical reaction that occurs when Helicobacter is present, said Green. The organism is found in 90% of the people with duodenal ulcers and in as many as 80% of those with stomach ulcers, according to some studies.
The presence of Helicobacter in the stomach tends to be more common as people get older, said Green. “In certain populations, more than 50% of those over age 50 have the bacteria present, yet less than 10% of children are found to have the bacteria,” he said.
The vast majority of people eventually develop the infection but no symptoms, according to Green. Those who have the bacteria and also smoke or take non-steroidal anti-inflammatory drugs--such as Motrin or aspirin--have a greater risk of developing an ulcer than do others.
Ulcers are common. In the United States, about one in 10 people at some time in their lives will develop a duodenal ulcer, and one in 30 will get a gastric ulcer, according to the American Medical Assn.
Dr. Neil Fagen, a gastroenterologist in Northridge, suggests that people with stomach symptoms first try over-the-counter remedies and then see their health practitioner if symptoms persist or if there is a family history of ulcers.
