Facts of LifeUlcers: The myth of stress and spicy food [Archives:2005/855/Health]

June 30 2005

By Dr. Khaled alNsour
For the Yemen Times

An ulcer is a sore or hole in the lining of the stomach. Similar to other sores, the top layer of tissue is gone, exposing more sensitive tissues underneath. An ulcer is a break in the lining of the stomach or in the duodenum (the first part of the small intestine). The most common type of ulcers are peptic ulcers ) those found in the stomach and the first part of the small intestine. Ulcers cause a gnawing or burning pain in your stomach. However, most people who have stomach pain don't have an ulcer.

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 causes nausea, vomiting and weight loss.

Causes and treatment

Doctors used to think ulcers were caused by stress or by eating food with too much acid in it. But this is not true, in fact most stomach ulcers are caused by an infection. The infection is caused by a bacteria (germ) called Helicobacter pylori. 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 aspirin, ibuprofen, or naproxen (some brand names: Advil, Nuprin, Motrin). About half of the world's population is infected with H. pylori. Especially because some ulcers are attributed to smoking, excess stomach acid, and certain foods and beverages.

A layer of mucus normally protects the stomach from the acid the body releases to digest food. But that layer can be eroded by bacteria or by certain medications. Without its protective layer, the stomach is vulnerable to the acid, and an ulcer may result. About 80 percent of ulcers are caused by the bacteria Helicobacter (H.) pylori, according to Dr. Freston. H. pylori usually enters the body in childhood. It is carried in stool and can be transmitted through food, water or unwashed hands. H. pylori may live in the body for a long time before the bacteria erodes enough of the mucus lining to allow an ulcer to form.

Most anti-inflammatory drugs (NSAIDs) can cause ulcers because they lower the amount of a chemical called prostaglandin, which essentially ensures there's enough mucus to protect the stomach lining from the acid. By decreasing prostaglandin, traditional NSAIDs allow acid to penetrate the stomach lining, and the long-term use of these medications may lead to an ulcer.

About 80 percent of patients with ulcers have pain that is centered in the upper part of the abdomen, usually right below the breastbone. However, some ulcer patients don't feel any pain and often don't know they have an ulcer unless they start vomiting blood (from a bleeding ulcer), or passing blood from their rectum or in their stool. (Bloody stool looks black, not red.)

Older people are the least likely to feel pain from an ulcer because as we age we tend to lose sensitivity in our abdomen. And patients on NSAIDs may not feel pain because the drugs decrease all pain, not just pain caused by arthritis, for example.

While patients whose ulcers are caused by H. pylori are generally fully healed with medication, it's not yet known whether the bacterial infection can return. For this reason, patients who've been treated for H. pylori-related ulcers should see their doctor if their symptoms return.

Ulcers are often easy to diagnose and treat, but that isn't always the case. If H. pylori isn't found in a patient with an ulcer, and acid-reducing drugs aren't effective after two to three weeks, surgery may be necessary to cut out the ulcerated part of the stomach or duodenum and reduce acid secretion, says Dr. Ponsky. While surgery generally takes care of the ulcer that wouldn't heal, patients whose ulcers are caused by NSAIDs will have to try alternative pain relievers and get a gastroenterologist's advice on medications to help reduce the acid that accumulates.

Doctors say that smoking does aggravate peptic ulcer disease, regardless of what caused the ulcer, although we don't know why. Relapse rates for both NSAID-related ulcers and those caused by H. pylori bacteria are both higher in smokers. And, while stress has never been scientifically linked to peptic ulcers, patients claim their ulcer symptoms often get worse when they are under stress.