For many years doctors thought ulcers were caused by excessive stomach acid, spicy foods, diet, and emotional stress. And, in the past some have described an "ulcer personality" for people who are tightly wound and who have trouble handling emotional upsets. But contrary to popular stereotype, not every person with a "Type A" personality develops ulcers.

0There are many factors that may promote the development of an ulcer including a hereditary tendency to produce too much stomach acid as well as behavioral factors such as smoking and drinking alcohol. In 1982 scientists discovered a bacterium that lives on the lining of the stomach that is responsible for ulcer disease.

Medicines that reduce stomach acid may make you feel better as your ulcer will be less irritated. But we now know that nine out of ten ulcers are caused by Helicobacter pylori. So, the good news is that with the appropriate antibiotic your ulcer and the pain it causes can be cured. If you have ever had a consistently gnawing or dull or burning pain in your abdomen between your breastbone and belly button, you may have experienced the symptoms of an ulcer. Sometimes the stomach pain is worse when you eat or drink, and sometimes it is improved with eating or drinking but then resumes an hour or two later. These differences in response to eating may be due to the location of the ulcer within the stomach or intestine. Less commonly, some people experience nausea, vomiting or loss of appetite. Sometimes ulcers bleed and if they do, this may lead to anemia, weakness and fatigue. If bleeding is very heavy this may appear in the form of dark coffee-ground-like-vomit or dark red or tarry black stool.

If you have experienced signs of ulcer bleeding, seek treatment immediately through your emergency center. If you have noticed some of the more mild symptoms described and if your symptoms do not improve, see your physician soon as there are some relatively simple tests to determine whether your ulcer is caused by H. pylori. This bacteria may be detected by a blood test, a simple breath test, or by testing small samples of the stomach lining that can be obtained at the time of endoscopy (examination of the stomach and intestine using a small tube-like scope that may be inserted through the mouth and into the stomach).

When your doctor diagnoses an ulcer, the treatment prescribed often has four goals: To decrease the amount of acid produced by your stomach, to neutralize the digestive juices, to protect the ulcer so that it may heal and, eradicate the ulcer producing infection.

If you are prone to ulcer disease you may need to change your diet and some of your habits. Heavy smokers are more likely to develop ulcers than nonsmokers and ulcers in smokers seem to take longer to heal. So, quit smoking. Avoid the use of aspirin or Ibuprofen as these may aggravate ulcers. Further, avoid caffeine, alcohol, milk, peppermint and foods that contain hot peppers or chili powder as these too may be irritating. Also, try eating smaller, more frequent meals as large meals can aggravate your stomach if you are already experiencing discomfort.

Clearly, antibiotics are increasingly the new cure for ulcers. The therapy requires one to two weeks and has a greater than 90% chance of curing your ulcer for good.

World Wide Web Resources

Helicobacter pylori and Peptic Ulcer Disease

www.cdc.gov/ncidod/dbmd/hpylori.htm

This is a very comprehensive web site from the Centers for Disease Control and Prevention that covers information for the public and for healthcare providers.

Peptic Ulcer Disease - Medical Treatment

www.pharmacy.ab.umd.edu/~umdi/hpylori.html

This site provides a summary of a consensus statement on medical treatment of peptic ulcer disease that was published in the Journal of the American Medical Association.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.