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Gastroenterology and Health

Bacteria

Are You Treating Your Peptic Ulcer The Wrong Way?

By Dr. W. Gifford Jones

It's been said that, "He who laughs last, laughs best". That's why Dr's Barry J. Marshall and J. Robbin Warren must be chuckling to themselves these days. In 1983 these Australian researchers reported that peptic ulcers were caused by bacteria. And all the world's gastroenterologists guffawed. Now Marshall and Graham are having the last laugh.

But it's been a tough sell. For years peptic ulcers were supposed to be due to type A personalities who produced too much hydrochloric acid which eroded the stomach wall. And the standard treatment has been to maintain the proper acid balance in the stomach.

Now numerous studies have confirmed that a spiral-shaped germ, called "Helicobacter pylori is the culprit. It has been shown to thrive in the stomach of practically everyone with duodenal ulcers and in four out of five patients with stomach ulcer.

But new ideas are always hard to sell. It wasn't until Texas researchers showed that eradicating H. pylori with antibiotics protected 90 per cent of ulcer patients from subsequent attacks that everyone took notice.

This year the National Institute of Health in the U.S.convened a panel of medical experts to evaluate the findings. They concluded that antibiotics should be used to treat peptic ulcers.

This news must have given some pharmaceutical company executives an ulcer. Zantac, an antisecretory drug that helps to block hydrochloric acid production is the largest selling prescription drug in the world. This recent research has people wondering if the millions spent on Zantac would now be relegated to the scrap heap.

How prevalent is H. pylori? Dr. Peter Klein, at the Children's Nutrition Research Centre in Houston, claims that 30 per cent of 30 year olds and 80 per cent of 80 year olds are infected with this germ.

Klein also reports that in Houston 70 per cent of Blacks carry Helicopter pylori by the age of 50. And in the Third World countries nearly everyone is infected by 25 years of age.

The $64.00 question is why doesn't everyone infected with this germ develop a peptic ulcer? It may be that some people are genetically resistant to the bacterium. Or that some strains of the germ are stronger than others.

I like one aspect of this research. I've suspected for years that doctors tend to blame stress for many diseases without just cause. We all know people who live with severe, constant stress but never get an ulcer, hypertension or ulcerative colitis. Genetics, I'm sure, plays a major role.

There are several unanswered questions. Scientists still do not know how H. pylori is spread. But it's believed that once it's contacted it remains for life unless eradicated.

Doctors have other dicey questions to solve. For instance, untold numbers of people suffer from stomach pain, heartburn, bloating, nausea and other gastric complaints. The diagnostic ability of physicians is often taxed to know whether or not these symptoms are due to a stomach or duodenal ulcer.

The only sure way to find out is to subject patients to barium X-rays or by passing an optical instrument into the stomach,. These are not pleasant procedures. And they cost a huge amount of money to discover that the majority of these patients don't have an ulcer.

Dr. Barry Marshall, who is now at the University of Virginia, recently addressed the American Gastroenterological meeting in New Orleans. He suggested that it's cheaper to test for H. pylori in dyspeptic patients rather than subject them to more expensive procedures. If H.pylori is present then antibiotics should be given to eradicate this bacterium.

But not all doctors agree with Dr. Marshall. Dr. Desmond Leddin, at Dalhousie University in Halifax, believes that treating patients who have H. pylori is overkill. He says patients without any disease will be needlessly subjected to antibiotics. Moreover increased use of antibiotics will lead to resistant strains of bacteria and other side-effects. And that some diseases such as hiatus hernia will be missed unless diagnostic studies are done.

One thing is fairly certain. The old methods of treatment often resulted in a recurrent ulcer once the therapy was stopped.

"Debugging the stomach" by the use of antibiotics often results in a permanent cure. In the largest study done so far only 15 per cent of ulcers recurred after a two year period.

Currently the best treatment appears to be the use of the antibiotics tetracycline and metronidazole along with bismuth subsalicylate (Pepto-Bismol) for two weeks. This combination eradicates H. pylori in 90 per cent of cases. Other doctors suggest using the antibiotic amoxicillin and an H2 blocker instead of bismuth.

This is a rapidly changing field. An update will be forthcoming as new developments appear.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod