Ulcers and H. pylori Infection 

What is an ulcer?
An ulcer is a sore on  the lining of your digestive tract, which consists of  the esophagus, stomach, duodenum (the first part of the intestines)  and intestines. Ulcers cause a gnawing or burning pain in your stomach. However, most people who have stomach pains do not have an ulcer. Your doctor may suggest certain diagnostic studies to decide if your stomach pain is caused by an ulcer. 

Are ulcers serious? 
Most people with ulcers just have stomach pain. Some people don't have any symptoms at all. But ulcers may cause other health problems. Sometimes they bleed. If the ulcers become too deep, they can break through the stomach. Ulcers can block food from going through the intestines. This cause’s nausea, vomiting and weight loss. 

What causes ulcers?
Doctors used to think ulcers were caused by stress or by eating food with too much acid in it. We now know this isn't true. Most stomach ulcers are caused by an infection. The infection is caused by a bacteria (germ) called Helicobacter pylori (say: "hell-ee-ko-back-ter pie-lore-ee"), or H. pylori for short. Ulcers in people who don't have an H. pylori infection are usually related to heavy aspirin use, or heavy use of anti-inflammatory drugs like ibuprofen (some brand names: Advil, Nuprin, Motrin). Acetaminophen (brand name: Tylenol) doesn't cause stomach ulcers. 

Who gets ulcers? 
About half of the world's population is infected with H. pylori. In the United States, half of the people older than age 50 have H. pylori in their gastrointestinal tract. Because sanitation has improved in recent decades, younger Americans are less likely to have H. pylori infection. Only some infected people get an ulcer. 

How are ulcers treated? 
Since the 1970s, doctors have had several medicines that can help heal the break in the lining of the stomach or the duodenum. These medicines also make the ulcer symptoms, including the pain, get better. The problem has been that about 90% of people who used these medicines developed a recurrent ulcer within a year.  Now, if you test positive for H. pylori infection, it can be treated, and you probably won't get another ulcer. 

How does my doctor know if I have  H. pylori infection?
H. pylori infection can be diagnosed with a blood test. Your doctor might also want you to get an x-ray or have endoscopy (an endoscope  is a thin tube  that carries a tiny camera) to see if you have an ulcer. A breath test is another way to find out if you have H. pylori infection.  

What are  the medicines  used for ulcers? 
There are 3 kinds of ulcer medicines. All of them do a good job of helping  to heal ulcers. Your doctor will recommend the one  that is right for you. You should take the medicine just the way your doctor tells you to. 

• H2-blockers (one brand name: Tagamet) reduce the amount of acid the stomach makes. This medicine heals ulcers in the duodenum in 6 to 8 weeks. Stomach ulcers take a little longer to heal. You would take these medicines for 8 to 12 weeks if you have a stomach ulcer. 
• Proton pump inhibitors (one brand name: Prilosec) block the stomach's ability to make acid. This medicine helps heal duodenal ulcers in 4 weeks. It helps heal stomach ulcers in 6 to 8 weeks. 
• Bismuth subsalicylate (brand name: Pepto-Bismol) coats the ulcer. It protects the sore place from stomach  acid, so it can heal. It takes 8 to 12 weeks to heal an ulcer. 

What if I have an ulcer  and H. pylori infection? 
The medicines noted above heal ulcers whether you have H. pylori infection or not. But if you have H. pylori infection too, you should also treat  the infection. H. pylori is hard to get rid of. No single drug can cure this infection. The best way to cure H. pylori infection is to take several drugs at the same time. 

A combination  of drugs called "triple therapy," means taking 2 antibiotics (to kill the H. pylori) and an H2-blocker, proton pump inhibitor and/or bismuth. Other combinations  that use fewer drugs might also help. Your doctor can help decide which medicines you should take. 

Do the medicines cause side effects? 
Because you have to take so many medicines at the same time, you may have some side effects. Minor side effects  of H. pylori medicines include a black color on the tongue and black stool, diarrhea, nausea and headache. Some of the medicines leave a bad taste in your mouth. These side effects  are usually minor and go away on their own.

You can only cure  H. pylori infection if  you take the medicines just the way  your doctor tells you. If you forget to take some of your medicines or stop taking them because of side effects, the infection won't be cured. You may get another  ulcer in the future. Let your doctor know right away if you have side effects with your medicines or if you have any questions about how to take them. Your doctor  may suggest something to reduce the severity of side effects. He or she may give you different medicines. 

What else can I do? 
In the past, doctors treated  ulcers by telling people to eat bland foods, drink a lot of milk and not eat some kinds of foods. Today we know that  this isn't necessary. If certain foods bother you, don't eat them. In general, however, you  can eat whatever you like. You may heal faster if you don't smoke or don't use aspirin or ibuprofen. Acetaminophen will not harm your ulcer.