Revolution in Ulcer Treatment : Medicine: Sure, you’re a Type-A, but that doesn’t mean <i> you’re</i> the cause of your aching stomach. The culprit just might be a common bacterium that antibiotics can zap. But convincing patients--and doctors--has been difficult.
Thirteen years after a young Australian doctor said he had discovered the cause of most ulcers, American medicine appears to have accepted the fact that a common, curable bacterium--not spicy foods, not stress--causes the disease.
Now, doctors say, it’s time for the American public to discard the myths about ulcer disease and reconsider the long-term need for Zantac, Pepcid, Prilosec and Tagamet--the acid-reducing ulcer medications--and embrace a new therapy, which involves a short course of antibiotics.
A coalition of medical experts, called the American Digestive Health Foundation (ADHF), has launched a sweeping public education campaign that will feature public service announcements, shopping mall exhibits and a toll-free telephone hot line. Their message: H. pylori is the cause of the majority of peptic ulcers, and antibiotics can kill the bacteria and provide a permanent cure for ulcers in most cases.
But this change in thinking has been difficult for many people--doctors and patients alike--to accept, perhaps because it is so startling, says Dr. David Peura, chairman of the ADHF ulcer campaign. The treatment for H. pylori represents the first cure of a major disease entity since the polio vaccine was developed four decades ago.
“It’s so totally revolutionary. It’s like taking a dictum that has been held sacred for many years and saying that it’s no longer true,” says Peura, of Charlottesville, Va.
Peura and other experts say that myths about ulcer disease are so pervasive it may take years to alert the estimated 25 million Americans with peptic ulcers that a simple, inexpensive cure is within grasp.
To launch the public education campaign, the ADHF summoned the media on a hot, muggy morning earlier this month to Grand Central Station in New York City, where, they noted: “You may get stressed, but you won’t get an ulcer.”
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For years many doctors suspected that diet and stress weren’t the only culprits causing peptic ulcers, but a 1982 study by Dr. Barry J. Marshall suggesting that the bacteria were the real cause was hard to believe. Many other studies followed, but it wasn’t until February, 1994, that the National Institutes of Health issued new guidelines for ulcer treatment that emphasized the role of H. pylori.
“Normally, science involves putting together a puzzle from the outside in to create the whole picture. Here, we had a picture--clinical observation and treatment--and were trying to put the puzzle together to support it,” says Peura, a gastroenterologist. “Dr. Marshall was a young physician, was not recognized as an expert in this, hadn’t done any research in this area. The medical establishment wasn’t willing to accept one person’s word on this.”
H. pylori lives on or in the lining of the stomach. As many as 60% of older Americans have the bacterium and up to 95% of people with ulcers are infected by it.
Doctors aren’t sure just how the bacteria cause ulcers. The bacteria may damage the barrier that protects the stomach and duodenum from acid. Nor do they understand why some people with H. pylori infection develop ulcers while others don’t. The bacteria are contained in fecal material and spreads more easily where hygiene is poor.
“It is passed person to person,” says Dr. Loren A. Laine, a University of Southern California physician and member of the ADHF advisory board. “There are probably some strains in which the bacteria is more likely to cause ulcers. And there are probably genetic factors among people that make you more predisposed to develop the ulcers.”
H. pylori infection rates are higher among African Americans and Latinos.
Ulcers can also be caused by chronic, high doses of aspirin or ibuprofen, which can irritate the stomach. In rare cases, they are caused by the overproduction of stomach acid. Peptic ulcers, which are those that occur in the stomach or duodenum, are the most common kind of ulcer.
Although ulcer disease is rarely fatal, the disease has been costly and painful for many people. Marlena Wood, 49, a hard-driving real estate broker in Manhattan, is typical of ulcer patients who suffered for years and blamed themselves for the disease.
At 32, Wood was in the fashion business, under stress and dieting on cherries when she had her first ulcer attack. She landed in the hospital with a bleeding ulcer and needed blood transfusions.
She began taking acid-reducing medication, but suffered three more life-threatening bouts with bleeding ulcers over the next 13 years. Each bout seemed to occur during a period of high stress.
“I had doctors say to me, ‘Well, it’s because you’re a Type-A personality. Why don’t you quit the business world?’ ” Wood recalls. “You really think you’re to blame.”
After her last hospitalization, in 1991, a top New York gastroenterologist prescribed a new acid-reducing drug.
“He told me I owned this disease, and that, forever and a day, I would have to take drugs,” she says.
But last winter, Wood read a newspaper article about H. pylori and asked a different doctor about it. Within days, she underwent a simple blood test to determine if she had the bacteria. “It was positive in spades,” Wood says.
In January, she began a regimen of antibiotics, acid-reducing drugs and medications to protect the ulcer from stomach acid. Despite a stressful spring, her doctor has told Wood she is probably cured.
“I am so excited that doctors can now tell people who suffer from this that it’s not their personality or their diet,” Wood says. “Every person in the world who has ulcers should somehow be notified about this.”
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It will take some time to reach everyone with the good news, but, for now, the American Digestive Health Foundation is concentrating on three groups of people, who, it says, should consult with their doctors immediately. They are:
* Anyone currently undergoing ulcer treatment who has not been tested for H. pylori or taken an antibiotic therapy.
* People who take acid-reducing medications on a regular basis to avoid stomach pain.
* People who have suffered from a bleeding ulcer or a hard-to-treat ulcer in the past.
And, says Laine: “Even if you have had an ulcer in the past and seem fine, you should still probably go back.”
Doctors have several methods to test for H. pylori ; among them are a blood test and an experimental breath test that is still awaiting approval by the U.S. Food and Drug Administration. Some doctors also prefer that their patients undergo endoscopy--in which a tube is inserted through the mouth into the stomach--to diagnose the ulcer before beginning treatment.
Others believe that, because the new antibiotic therapy is so inexpensive and safe, that anyone with symptoms of ulcer disease and a positive blood test for H. pylori should begin treatment.
According to a new study in the Annals of Internal Medicine, the cost of treating the H. pylori- induced ulcer without endoscopy is about $850 compared to about $1,400 with endoscopy.
If H. pylori is thought to be the cause of the ulcer, patients usually take antibiotics for two weeks along with acid-reducing drugs for a somewhat longer period of time. And it’s quite possible that the cure will be permanent.
“The vast majority of patients who have the bacteria will be cured,” says Dr. Mel Wilcox, vice chairman of the ADHF advisory board. “Six to seven years of follow-up studies show less than 1% recurrence. That is really quite staggering.”
While the ADHF has spent the past year educating doctors about the new ulcer guidelines, Peura says that Americans have to make sure they are benefiting from the new guidelines.
“I think most doctors have heard about the guidelines and have had a chance to read them or had material presented to them. But I think there are still physicians who do not know about the role of H. pylori in ulcer disease,” Peura says.
“We want people to query their physicians about this. There is no greater impetus for a physician to get on board with this than to have patients ask them about it.”
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The Myths About Ulcers
A poll taken last month by the American Digestive Health Foundation found that Americans still don’t know about a revolutionary discovery in ulcer treatment.
Of 409 adults polled:
* 69% had never heard that a bacterium can play a role in peptic ulcer disease.
* 79% had never heard about the bacterium H. pylori.
* 89% thought ulcers could be caused by stress or worry.
* 59% thought ulcers could be caused by poor diet or certain foods.
* 26% thought ulcers are inherited.
