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• Introduction
• Causes
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• Complications
• Risk Factors
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• Treatment for NSAID-Induced Ulcers
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• Treatment for Bleeding Ulcers
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Peptic ulcers

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of stomach and GI ulcers.

Alternative Names

Duodenal ulcers; Gastric ulcers; H. pylori

Complications

Most people with severe ulcers experience significant pain and sleeplessness, which can have a dramatic and adverse impact on the quality of life.

Complications of Peptic Ulcers

Peptic ulcers from either H. pylori or NSAIDs can be very serious if they progress to the point of hemorrhage or perforation of the stomach or duodenum. Of the people who get ulcers, up to 15% will experience some degree of bleeding, which can be life threatening in some cases. Ulcers that form where the small intestine joins the stomach can swell and scar, resulting in a narrowing or closing of the intestinal opening. In such cases, a patient will vomit the entire contents of the stomach and emergency procedures are necessary.

Complications of peptic ulcers cause an estimated 6,500 deaths each year. These figures, however, do not reflect the high number of deaths associated with NSAID use. Ulcers caused by NSAIDs are more likely to bleed than those caused by the bacteria H. pylori. NSAID-related bleeding and stomach problems may be responsible for 107,000 hospital admissions and 16,500 deaths each year.

Because there are usually no GI symptoms from NSAIDs until bleeding begins, doctors cannot predict which patients taking these drugs will develop bleeding. The risk for a poor outcome is highest in people who have had long-term bleeding from NSAIDs, blood clotting disorders, low systolic blood pressure, mental instability, or the presence of another serious, unstable medical condition. Populations at greatest risk are elderly patients and those with other serious conditions, such as heart problems.

Stomach Cancer and Other Conditions Association with H. pylori

H. pylori is specifically strongly associated certain cancers. And, although evidence is inconsistent, some studies have also linked it to a number of non-gastrointestinal illnesses as well.

Stomach Cancers. Stomach cancer, also called gastric cancer, is the second most common cause of cancer worldwide. In developing countries where the rate of H. pylori is very high, the risk of stomach cancer is six times higher than in America. An important 2001 study strongly supported previous work that found a causal link between H. pylori infection and stomach cancer. In the study, uninfected people did not develop stomach cancer. However, the stomach cancer rates for H. pylori- associated conditions were: 4.7% for nonulcer dyspepsia, 3.4% for gastric ulcers, and 2.2% of stomach polyps. Experts now suggest that H. pylor i may be as carcinogenic in the stomach as cigarette smoking is in the lungs.

The process most likely starts during childhood. Infection with H. pylori in early years promotes a precancerous condition called atrophic gastritis . This may lead to cancer through the following steps:

• With atrophic gastritis, the stomach becomes chronically inflamed and loses patches of glands that secrete protein and acid.
• Acid protects against carcinogens (substances that cause cancerous changes in cells).
• New cells replace those destroyed, but these new cells do not produce enough acid to protect against carcinogens.
• Over time, then, cancer cells in the stomach may develop and proliferate.

Onset of H. pylori infection in adulthood poses an even lower risk, since the development of atrophic gastritis takes years and the patient is likely to die of other causes first. Other factors, such as specific genetic strains and diets might also influence a higher risk for stomach cancer. For instance diets high in salt and low in fresh fruits and vegetables have been associated with a greater risk. Some but not all evidence suggests that the virulent H. pylori genetic strain called CagA may also be a particular risk factor for precancerous changes.

(Interestingly, people with duodenal ulcers caused by H. pylori appear to have a lower risk of stomach cancer, though scientists do not know why. It may be that different H. pylori strains affect the duodenum and the stomach. Or, the high levels of acid that affect the duodenum may help prevent the spread of the bacteria to critical areas of the stomach.)

Pancreatic Cancer. H. pylori has recently been linked to pancreatic cancer.

Heart Disease. Some research has reported a very high rate of H. pylori infection in men with coronary artery disease, but more recent work has found no relationship between the bacteria and heart disease. A 2001 study suggested that only relationship between the bacteria and heart disease may be that people with both tend to be in lower socioeconomic groups. Further studies are needed.

Other Diseases. H. pylori has also been weakly associated with other non-intestinal disorders including migraine, Raynaud's disease (marked by cold extremities), and some skin disorders, such as chronic hives.

• Review Date: 7/14/2006
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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