- Peptic Ulcers, Gastritis & Helicobacter Pylori
- Diagnosis of Peptic Ulcers, Gastritis & Helicobacter Pylori
- H. pylori: Causes, symptoms, and stomach ulcers
- Possible complications of stomach ulcers
- Key points about H. pylori
- Helicobacter pylori
- Signs and Symptoms
- When to Call the Doctor
- Ulcer and Gastritis
- Helicobacter Pylori Testing
- What Happens During the Test?
- After The Test
- Test Results
- How To Schedule A Test
- How Do I Get Rid of an H. Pylori Infection?
Peptic Ulcers, Gastritis & Helicobacter Pylori
Most ulcers are caused by bacteria called Helicobacter pylori (H. pylori), which are believed to be transmitted from person to person through close contact and exposure to fecal matter or vomit.
The bacteria cause an infection that weakens the protective mucus in the stomach and duodenum, allowing acid to get through to the sensitive lining beneath.
Both the acid and bacteria irritate the lining and cause an ulcer to form.
If left untreated, a H. pylori infection can cause gastritis (inflammation of the lining of the stomach). Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). An untreated H.
pylori infection may also progress into peptic ulcer disease or stomach cancer later in life. Another common cause of gastritis is long-term use of aspirin, ibuprofen and other anti-inflammatory drugs.
In the past, children with peptic ulcers lived with the chronic condition for several years or even a lifetime. Today, we have a better understanding of what causes peptic ulcers and how to treat them, meaning most children can be cured.
Symptoms of peptic ulcers, gastritis and H. pylori infection can be very mild in some children.
Abdominal discomfort is the most common symptom of peptic ulcers and usually feels a dull, gnawing ache.
The pain often occurs two or three hours after a meal or in the middle of the night when the stomach is empty. The pain may come and go for several days or weeks.
Eating and taking antacid medicine helps relieve the discomfort. It is not clear if H. pylori infection without ulcers causes abdominal pain.
Other symptoms include:
- Dark stool (with gastritis or an ulcer)
- Poor appetite
- Weight loss
Diagnosis of Peptic Ulcers, Gastritis & Helicobacter Pylori
If your child experiences symptoms of peptic ulcers, gastritis or H. pylori infection, a pediatric gastroenterologist can perform the following exams and tests to make a diagnosis:
- Physical exam. A physician will examine the abdomen for signs of bloating and can track your child's weight loss.
- Complete medical history. Your child’s physician will review your child’s health records and family health history.
- Upper gastrointestinal (GI) endoscopy. Your child's doctor can perform an upper gastrointestinal (GI) endoscopy to examine the esophagus, stomach and duodenum.
- Biopsy. A pediatric gastroenterologist may take a stomach tissue sample to study the cells for signs of damage or infection.
- Blood tests. A variety of blood tests can indicate the presence of other reasons for abdominal pain.
- Breath tests. Breath tests measure the amount of gases, such as hydrogen, in the breath which can be a sign of bacterial overgrowth in the intestines or lactose intolerance.
- Stool tests. By studying the contents of your child’s stool, the physician can get information about infections that may be upsetting the digestive tract.
H. pylori: Causes, symptoms, and stomach ulcers
Helicobacter pylori, commonly called H. pylori, is a type of bacteria that infects the stomach and small bowel. It was discovered in 1982 by two Australian researchers who also found that it causes peptic ulcer disease.
Peptic ulcers are open sores in the lining of the stomach or the upper part of the small intestine. Peptic ulcers are often simply called “ulcers” or “stomach ulcers.” H. pylori also increase the risk of developing stomach cancer and gastritis.
In this article, we will explain what H. pylori is, how it makes you sick, and how it causes stomach ulcers.
For years, medical experts believed that peptic ulcers were caused by stress or certain foods.
After the discovery of H. pylori, however, this theory was argued extensively. A study in Digestive and Liver Disease suggests that 60 to nearly 100 percent of peptic ulcers are associated with H. pylori.
Ulcers aren’t the only problems associated with H. pylori; researchers discovered that H. pylori cause gastritis, a condition that involves inflammation of the stomach’s lining. H. pylori infection is also linked to stomach cancer; however, the American Cancer Society states that most people with H. pylori in their stomach never develop stomach cancer.
The stomach has a layer of mucus that is designed to protect it from stomach acid. H. pylori attack this mucus lining and leave part of the stomach exposed to acid. Together, the bacteria and the acid can irritate the stomach, causing ulcers, gastritis, or stomach cancer.
However, many people have H. pylori in their stomachs but do not have ulcers or any other related problems. In fact, two-thirds of the world’s population have H. pylori, according to the Centers for Disease Control and Prevention (CDC). But, for reasons not yet understood, some people get ulcers, gastritis, or stomach cancer from an H. pylori infection.
It is worth noting that peptic ulcers may also be caused by long-term use of certain medicines, including pain relievers such as ibuprofen, aspirin, and naproxen. These medicines are called NSAIDs, or non-steroidal anti-inflammatory drugs.
A study published in The Lancet found that ulcers are rare in people who don’t take NSAIDs and who don’t have H. pylori in their stomachs.
No one knows for sure how people catch H. pylori. In some cases, contaminated food or water may be to blame. It has been found in human saliva, so experts think it may be able to spread from person to person.
There is no known way to prevent H. pylori infection, but experts recommend:
- Washing hands before eating and after using the restroom.
- Eating food that has been handled and prepared safely.
- Drinking only clean, safe drinking water.
H. pylori infections are more common in developing countries where people may not have access to clean, safe food and water.
Share on PinterestSymptoms of an H.pylori infection may include stomach pain and swelling, nausea, and dizziness.
Many people with H. pylori don’t have any signs or symptoms. If people get an illness caused by H. pylori, however, they may have various symptoms.
Symptoms of a stomach ulcer might include a dull or burning pain in the upper belly area. The pain is sometimes worse at night or when the stomach is empty. There may be temporary relief from taking an antacid, but the pain comes back.
Symptoms of gastritis often include upper belly pain, nausea, and vomiting.
A study in Alimentary Pharmacology & Therapeutics states that people with H. pylori infection may be up to six times more ly to get stomach cancer. Quick treatment of H. pylori can help reduce the damage that H. pylori can cause. This, in turn, may help reduce the risk of stomach cancer and other problems.
Possible symptoms of stomach cancer include:
- belly pain or swelling
- loss of appetite
- nausea or indigestion
- feeling full without eating very much
People with any of these symptoms should talk with their doctor. These symptoms may be caused by other conditions, so proper medical care is needed to diagnose the issue.
Possible complications of stomach ulcers
An ulcer can lead to serious complications if left untreated, including:
- Internal bleeding that can become life-threatening.
- A hole in the stomach that can lead to infection.
- Scar tissue that can block the stomach or intestine, preventing it from emptying food.
These complications require immediate medical attention. Possible warning signs include:
- severe stomach pain
- black or tarry stool
- stool with bright red blood
- vomit with bright red blood
- vomit that looks coffee grounds
- feeling weak or short of breath
- feeling dizzy or faint
- chills or fever
Share on PinterestAn endoscopy may be used to help diagnose stomach issues caused by H. pylori, such as peptic ulcers.
People who have symptoms of an ulcer, gastritis, or another stomach issue may be tested for H. pylori or other problems.
H. pylori can be detected with blood, breath, or stool tests.
Ulcers, gastritis, and stomach cancer are often diagnosed with a combination of the following tests:
- Medical history: past medical problems and symptoms are discussed.
- Physical exam: examining and listening to the belly.
- Special X-rays that show the inside of the stomach.
- Endoscopy: doctors view the inside of the stomach with a special instrument while the patient is sedated or put to sleep.
If an ulcer is found, patients may be treated with a variety of medications, including some or all of the following:
- Antibiotics to kill H. pylori.
- Medicines that reduce stomach acid called proton pump inhibitors (PPIs) or histamine receptor blockers.
- Medicines that coat the ulcer and help it heal.
Sometimes, a peptic ulcer can come back after treatment. To help avoid this, experts recommend:
- Stop NSAIDs or take a much smaller dose.
- Only take NSAIDs with special medicines that protect the stomach.
- Avoid alcohol.
- Do not smoke.
Most H. pylori infections can still be successfully treated with antibiotics. However, research suggests that some H. pylori infections are becoming resistant to certain antibiotics. This means H. pylori is able to survive antibiotic treatment and the patient may need another drug to kill the bacteria.
A study in the journal Clinical Gastroenterology and Hepatology found some patients in the U.S. had H. pylori infections that were resistant to two different antibiotics. The American Journal of Gastroenterology reported a high number of resistant H. pylori bacteria in Latin American countries.
Antibiotic resistance is a growing problem across the globe. The CDC say that more than 23,000 people die each year as a result of an antibiotic-resistant infection. Many people may have heard of methicillin-resistant Staphylococcus aureus (MRSA), but there are many other types of bacteria that have become resistant to antibiotics.
Everyone can do their part to help fight the problem of antibiotic resistance. The CDC say that people should:
- Use antibiotics only when prescribed by a doctor.
- Never use antibiotics for colds or the flu – these are viruses and antibiotics won’t work against these illnesses.
- Take the entire course of antibiotics if they have been prescribed.
- Never share antibiotics with others.
- Never use old or leftover antibiotics.
Fortunately, H. pylori is still treatable with several different antibiotics. Quick treatment will help prevent damage to the stomach and the possible problems of ulcers, gastritis, and stomach cancer.
ABOUT CAUSES DIAGNOSIS TREATMENT
Helicobacter pylori (H. pylori) is a type of bacteria that infects your stomach. It can damage the tissue in your stomach and the first part of your small intestine (the duodenum). This can cause pain and inflammation . In some cases, it can also cause painful sores called peptic ulcers in your upper digestive tract.
H. pylori is common. Many people have it. Most people who have it won’t get ulcers or show any symptoms. But it is a main cause of ulcers.
H. pylori attacks the lining that protects your stomach. The bacteria makes an enzyme called urease. This enzyme makes your stomach acids less acidic. This weakens your stomach’s lining. Your stomach cells then have greater risk of being hurt by acid and pepsin, strong digestive fluids. That can lead to sores or ulcers in your stomach or duodenum.
The H. pylori bacteria can also stick to stomach cells. Your stomach can’t protect itself very well. The area gets red and swollen (inflamed).
H. pylori can also get the stomach to make more acid. Health experts don’t fully understand how.
H pylori can also cause stomach cancer.
Health experts don’t know for sure how H. pylori infection is spread. They believe the germs can be passed from person to person by mouth, such as by kissing.
It may also be passed by having contact with vomit or stool. This may happen if you:
- Eat food that was not cleaned or cooked in a safe way
- Drink water that is infected with the bacteria
You may be at greater risk for H. pylori infection because of:
- Your age. Over half the people in the U.S. with the bacteria are over age 50.
- Your race or ethnicity. Almost half of all African Americans have the bacteria. the people who come to the U.S. from developing countries, at least 50% of Latinos and 50% of people from Eastern Europe have H. pylori.
Most people first get the bacteria when they are children, but adults can get it too.
Most people have the bacteria for years without knowing it because they don’t have any symptoms. Experts don’t know why.
You may have redness and swelling (inflammation) in your stomach lining. This is called gastritis.
You may get sores or peptic ulcers in your stomach or the first part of your small intestine (duodenum). Ulcer symptoms may include belly or abdominal pain, which can:
- Be a dull pain that doesn’t go away
- Happen 2 to 3 hours after you eat
- Come and go for several days or weeks
- Happen in the middle of the night when your stomach is empty
- Go away when you eat or take medicines that reduce your stomach acid level (antacids)
- May cause anemia because of bleeding
Other symptoms of an ulcer may include:
- Weight loss
- Not feeling hungry
- Swelling or bloating
- Having an upset stomach or nausea
The symptoms of ulcers may look other health problems. Always see your healthcare provider to be sure.
Your healthcare provider will look at your past health and give you a physical exam. You may also need to have tests, including:
- Blood tests. These check for infection-fighting cells (antibodies) that mean you have the bacteria.
- Stool culture. This looks for any abnormal bacteria in your digestive tract that may cause diarrhea and other problems. A small stool sample is collected and sent to a lab. In 2 or 3 days, the test will show if you have any abnormal bacteria.
- Stool antigen test. This takes a stool sample to check for the H pylori bacteria.
- Breath tests. These can check if there is any carbon after you swallow a urea pill that has carbon molecules. If carbon is found that means that H. pylori has made the enzyme urease. This enzyme makes your stomach acids less acidic. It weakens your stomach’s mucous lining.
- Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the lining of your food pipe (esophagus), stomach, and duodenum (the first part of your small intestine). It uses a thin, lighted tube or endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes down into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. A small tissue sample (biopsy) is taken if needed. The tissue sample can show if you have the enzyme urease. It can also check the bacteria that is there.
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Your healthcare provider may have you take medicine that kills bacteria (antibiotics).
Other medicines may include:
- H-2 blockers. These are used to reduce the amount of acid in your stomach by blocking the hormone histamine. Histamine helps to make acid.
- Proton pump inhibitors. These help to keep your stomach from making acid. They do this by stopping the stomach's acid pump from working.
- Stomach-lining protectors.These medicines protect your stomach lining from acid and help kill bacteria.
- You may have to take multiple medicines at the same time to get rid of the H pylori. Sometimes the medicine plan can be complicated, but it is important to follow instructions to get rid of the bacteria.
If you are infected with the bacteria you can get a painful sore called a peptic ulcer. These sores form in your upper digestive tract.
A very bad ulcer can wear away your stomach lining. It can also cause problems such as:
- Bleeding when a blood vessel is worn away
- A hole or perforation in your stomach wall
- Blockage when the ulcer is in a spot that blocks food from leaving your stomach
H. pylori can also lead to stomach cancer.
Health experts don’t know for sure how the bacteria passes from person to person. But having good health habits (hygiene) can help keep you safe. These habits include:
- Washing your hands with soap and water. It is very important to do this after using the bathroom and before eating.
- Making sure all food you eat has been cleaned and cooked safely.
- Making sure that your drinking water is safe and clean.
Once you know for sure that you have H. pylori, follow up with your healthcare provider. They will do some tests to make sure the bacteria has been removed.
Call your healthcare provider if your symptoms get worse or you have new symptoms. Call right away if you have symptoms such as bloody vomit, blood in your stools, or black, tarry-looking stools. Call your healthcare provider if you are losing weight without trying.
Key points about H. pylori
- H. pylori is a type of bacteria that infects your stomach.
- It attacks your stomach and the first part of your small intestine (duodenum). This can cause redness and swelling (inflammation).
- Many people with the bacteria won’t have any symptoms.
- It can cause open sores called peptic ulcers in your upper digestive tract.
- It can cause stomach cancer.
- It may be passed or spread from person to person by mouth, such as by kissing. It may also be passed by direct contact with vomit or stool.
- Having good health habits (hygiene) can help protect you.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Helicobacter pylori (H. pylori) bacteria are a common cause of digestive illnesses, including gastritis (the irritation and inflammation of the stomach lining), peptic ulcers (sores in the lining of the stomach, small intestine, or esophagus), and even stomach cancer later in life.
These bacteria are found worldwide, but especially in developing countries, where up to 10% of children and 80% of adults are ly to have had an H. pylori infection — usually without any symptoms.
Signs and Symptoms
Anyone can have an H. pylori infection without knowing it — most H. pylori infections are “silent” and cause no symptoms. When the bacteria do cause symptoms, they're usually either symptoms of gastritis or peptic ulcer disease.
In kids, symptoms of gastritis may include nausea, vomiting, and abdominal pain, although these symptoms are seen in many childhood illnesses.
H. pylori, which used to be called Campylobacter pylori, also can cause peptic ulcers (commonly known as stomach ulcers).
In older kids and adults, the most common symptom of peptic ulcer disease is a gnawing or burning pain in the abdomen, usually in the area below the ribs and above the navel.
This pain often gets worse on an empty stomach and improves as soon as the person eats food, drinks milk, or takes antacid medicine.
Kids who have peptic ulcer disease can have ulcers that bleed, causing hematemesis (bloody vomit or vomit that looks coffee grounds) or melena (stool that's black, bloody, or looks tar). Younger children with peptic ulcers may not have such clear symptoms, so their illness may be harder to diagnose.
Scientists suspect that H. pylori infection may be contagious because the infection seems to run in families and is more common where people live in crowded or unsanitary conditions. Although research suggests that infection is passed from person to person, exactly how this happens isn't really known.
Doctors can make the diagnosis of an H. pylori infection by using many different types of tests. A doctor may:
- look at the stomach lining directly. The patient will be under sedation during this procedure, which involves inserting an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctor may then take samples of the lining to be checked in the laboratory for microscopic signs of infection and for H. pylori bacteria.
- do blood tests, which can detect the presence of H. pylori antibodies. Blood tests are easy to do, although a positive test may indicate exposure to H. pylori in the past, not an active infection.
- do breath tests, which can detect carbon broken down by H. pylori after the patient drinks a solution. Breath tests are time-consuming, provide no information about the infection's severity, and can be difficult to perform in young children.
- do stool tests, which can detect the presence of H. pylori proteins in the stool (poop). breath testing, stool tests indicate the presence of H. pylori but give no information about an infection's severity.
Doctors treat H. pylori infections using antibiotics. Because a single antibiotic may not kill the bacteria, your child will normally be given a combination of antibiotics. Usually, the doctor will also give antacids or acid-suppressing drugs to neutralize or block production of stomach acids.
If your child has symptoms of bleeding from the stomach or small intestine, these symptoms will be treated in a hospital.
Because H. pylori infection can be cured with antibiotics, the most important home treatment is to give your child any prescribed antibiotic medicine on schedule for as long as the doctor has directed.
One way to help soothe the abdominal pain is by following a regular meal schedule. This means planning meals so that your child's stomach doesn't remain empty for long periods. Eating five or six smaller meals each day may be best, and your child should take some time to rest after each meal.
It's also important to avoid giving your child aspirin, aspirin-containing medicines, ibuprofen, or anti-inflammatory drugs because these may irritate the stomach or cause stomach bleeding.
With prolonged antibiotic therapy, H. pylori gastritis and peptic ulcer disease (especially ulcers in the duodenum, a portion of the small intestine) often can be cured.
Right now, there's no vaccine against H. pylori. And because transmission isn't clearly understood, prevention guidelines aren't available. However, it's always important to make sure you and your family:
When to Call the Doctor
Call your doctor immediately if your child has any of these symptoms:
- severe abdominal pain
- vomit that's bloody or looks coffee grounds
- stool that's bloody, black, or looks tar
- lasting gnawing or burning pain in the area below the ribs that improves after eating, drinking milk, or taking antacids
However, it's important to remember kids can get stomachaches for many reasons — indigestion, viruses, tension and worry, and appendicitis. Most stomachaches are not caused by H. pylori bacteria.
Ulcer and Gastritis
Gastritis and an ulcer are conditions that affect the stomach and small intestine, and they share many symptoms, such as abdominal pain, nausea, vomiting, loss of appetite and weight loss. There are many differences, though.
Gastritis and an ulcer both inflame the stomach lining, but gastritis is a general inflammation, and an ulcer is a patch of eroded stomach lining. Though gastritis and an ulcer share symptoms, an intense, localized pain is much more common with an ulcer, and an ulcer also carries the risk of bleeding, cancer and eventual stomach perforation.
Doctors use a variety of techniques to diagnose each specific ailment, and the methods of treatment vary as well.
Gastritis can be caused by a variety of reasons irritation due to chronic vomiting, excessive alcohol use, chronic vomiting, stress, or the use of certain medications or other anti-inflammatory drugs. It may also be caused by any of the following bacteria's and infections:
- Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the liver and gallbladder).
- Helicobacter pylori (H. pylori): A bacteria that lives in the mucous lining of the stomach.
- Infections caused by bacteria and viruses
- Pernicious anemia: A form of anemia that occurs when the stomach lacks a naturally occurring substance needed to properly absorb and digest
If gastritis is left untreated, it can lead to a severe loss in blood, or in some cases increase the risk of developing stomach cancer.
- A bacterium. A common cause of ulcers is the bacterium Helicobacter pylori. H. pylori bacteria commonly live and multiply within the mucous layer that covers and protects tissues that line the stomach and small intestine.
- Regular use of pain relievers. Certain over-the-counter and prescription pain medications can irritate or inflame the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox), ketoprofen and others. Peptic ulcers are more common in older adults who take pain medications frequently, such as might be common in people with osteoarthritis.
- Other medications. Other prescription medications that can also lead to ulcers include medications used to treat osteoporosis called bisphosphonates (Actonel, Fosamax, others).
Helicobacter Pylori Testing
Torrance Memorial Physician Network provides breath test for Helicobacter Pylori. Helicobacter Pylori (H. pylori) is the bacterium (germ) responsible for most ulcers and many cases of stomach inflammation (chronic gastritis).
What Happens During the Test?
During the test, you will be asked to exhale into a balloon- bag. The air you breathe into this bag is tested to provide a basis for comparison (called a baseline sample).
You will then be asked to drink a small amount of a pleasant lemon-flavored solution. Fifteen minutes after drinking the solution, a second breath sample will be taken.
The air you breathe into this bag is tested for an increase in carbon dioxide.
After The Test
- Your breath samples are sent to the laboratory where they are tested.
- You may resume your normal activities.
- You may resume your normal diet and medicines unless you have other tests that require dietary restrictions.
- Your doctor will notify you as soon as your laboratory test results are available.
- If the test indicates that you do have a H. pylori infection, it can be treated with antibiotics.
- One month after antibiotic treatment your doctor might order a repeat breath test to make sure the infection has been cured.
How To Schedule A Test
Please consult with your physician to schedule a testing.
All procedures are directed by the guidance of your Torrance Memorial Physician Network primary care physician.
How Do I Get Rid of an H. Pylori Infection?
Helicobacter pylori (H.
pylori) is a corkscrew-shaped bacteria that was identified in 1982 as a principal cause of stomach ulcers and chronic gastritis, conditions which were formerly believed to be caused by stress and poor diet. Symptoms of H.
pylori may include stomach pain, bloating, nausea, and tarry stools. Blood, stool, and breath tests can be used to confirm the infection and may be followed by an endoscopic exam to look directly inside the stomach.
H. pylori is believed to be present in the upper gastrointestinal tract of around 50 percent of the world’s population. Of these, over 80 percent of cases are entirely without symptoms. Of those who are symptomatic, an H. pylori infection is associated with an increased risk of stomach cancer.
While an H. pylori infection typically requires combination antibiotic therapy, growing rates of antibiotic resistance have made eradication of the bacteria all the more difficult.
The presence of H. pylori in the upper gastrointestinal tract is not inherently associated with disease. According to epidemiologic research from the University of Bologna that was published in 2014, as many as 85 percent of affected individuals will never experience symptoms of any sort.
Those who do will typically develop acute gastritis, an inflammatory condition characterized by bouts of abdominal pain and nausea. Over time, this may progress into chronic gastritis in which the symptoms are persistent. Common signs and symptoms include:
- Stomach pain
- Loss of appetite
The pain is most often experienced when the stomach is empty, between meals, or the early morning hours. Many describe the pain as “gnawing” or “biting.”
People with an H. pylori infection have between a 10 percent and 20 percent lifetime risk of a stomach ulcer. This most often occurs in the stomach itself, resulting in a gastric ulcer, or the pyloric antrum connecting the stomach to the duodenum, resulting in a duodenal ulcer.
You can often tell which ulcer is which by the timing of symptoms. A gastric ulcer (also known as a peptic ulcer) will usually cause pain shortly after eating, while the pain tends to develop two to three hours after eating if the ulcer is duodenal.
The severity of symptoms can vary and will typically overlap with those of gastritis. Severe ulcers may trigger a cascade of symptoms, some of which are directly related to gastric bleeding and the development of anemia. Common signs and symptoms include:
- Black stool (a characteristic sign of bleeding)
- Blood in stool (usually if the bleeding is profuse)
- Shortness of breath
- Difficulty breathing
- Lightheadedness or fainting
- Vomiting of blood
Emergency medical attention should be sought if symptoms these develop.
The most common risk factor associated with stomach cancer is H. pylori infection.
The main contributing factor is the persistent inflammation associated with chronic gastritis, which can trigger pre-cancerous changes in the lining of the stomach. An H.
pylori infection will not generally be the sole cause but rather a contributing factor alongside family history, obesity, smoking, and a diet rich in salted, smoked, or pickled foods.
Stomach cancer is often entirely without symptoms in the early stages. Indigestion, heartburn, and a loss of appetite are not uncommon. As the malignancy progresses, symptoms may include:
- Persistent weakness and fatigue
- Bloating after meals
- Nausea and vomiting
- Difficulty swallowing
- Diarrhea or constipation
- Blood in stools or tarry stools
- Unexplained weight loss
- Vomiting of blood
It is important to recognize these symptoms so that you can seek treatment as soon as possible. Because 80 percent of these malignancies are symptom-free in the early stages, most cases are only discovered after the cancer has already spread (metastasized) to the lymph nodes or beyond.
H. pylori is a microaerophilic bacteria, meaning that it requires little oxygen to survive. While the bacteria is contagious, it is still not entirely clear how it is spread.
Most evidence suggests that it is transmitted via an oral-oral route (through the direct or indirect exchange of saliva) or a fecal-oral route (through contact with unsanitized hands or surfaces, or the drinking of contaminated water).
The rates of infection are far lower in North America and western Europe, where around a third of the population is believed to be affected. By contrast, the prevalence in eastern Europe, South America, and Asia is well in excess of 50 percent.
The age at which someone is infected appears to influence the risk of disease. People infected at a younger age are at a greater risk of atrophic gastritis in which the lining of the stomach develops scarring (fibrosis). This, in turn, increases the risk of gastric ulcers and cancer. By contrast, H. pylori infections acquired at an older age will more ly lead to a duodenal ulcer.
In the U.S. and other developed countries, H. pylori infection tends to occur at an older age. Due to strict public sanitary measures, only around 10 percent of infections in the U.S. occur in people under 30. The remainder is seen in older people, particularly those over 60, who account for around half of all infections.
Having H. pylori is not a disease unto itself and, as such, routine screening is not recommended. It is only when symptoms develop that your doctor will want to confirm the presence of the bacteria and investigate any abnormal changes in the stomach.
H. pylori can usually be diagnosed with one of three minimally invasive tests:
- Blood antibody tests can detect whether specific defensive proteins, known as antibodies, have been produced by the immune system in response to the bacteria.
- Stool antigen tests look for direct evidence of the infection in a stool sample by detecting a specific protein, known as an antigen, on the surface of the bacteria.
- Carbon urea breath tests are performed by breathing into a prepared packet 10 to 30 minutes after swallowing a tablet containing urea (a chemical comprised of nitrogen and a minimally radioactive carbon). H.
pylori produces an enzyme that breaks down urea into ammonia and carbon dioxide (CO2). Excessive levels of CO2 will trigger a positive reaction, confirming the presence of the bacteria.
If these tests are inconclusive and your symptoms persist, your doctor may order an endoscopy to view your stomach and obtain tissue samples. Endoscopy is an outpatient procedure performed under sedation in which a flexible, lighted scope is inserted down the throat and into your stomach.
Once there, a tiny fibreoptic camera can capture digital images of the gastric lining. A special attachment at the end of the scope can pinch off tissue samples (known as a pinch biopsy) for analysis in the lab.
Common side effects of endoscopy include sore throat, upset stomach, heartburn, and prolonged drowsiness. In rare cases, gastric perforation, bleeding, and infection may occur. Call your doctor or seek emergency care if you experience fever, shortness of breath, tarry stools, vomiting, or severe or persistent abdominal pain following the procedure.
Stomach ulcers can be positively diagnosed by direct visualizing the ulcerated tissue.
If cancer is suspected, the tissue sample will be sent to a pathologist to either confirm or rule out the presence of cancer cells.
If cancer is found, other blood tests (referred to as tumor markers) and imaging tests (such as a PET/CT scan) will be ordered to stage the disease and direct the course of treatment.
Low-level H. pylori infections are often missed by current diagnostic tools. To this end, efforts will often be made to exclude other possible causes if H. pylori cannot be confirmed. These may include:
Typically speaking, H. pylori is not treated if it does not cause symptoms. In fact, research suggests that H. pylori may be beneficial to some people by suppressing the “hunger hormone” ghrelin and normalizing the excessive secretion of stomach acids.
According to a 2014 study from the University of Queensland, the eradication of H. pylori was associated with an increased risk of obesity. Other studies have suggested an inverse relationship between H. pylori and GERD in which the bacterial infection may very well reduce the severity of acid reflux.
If an H. pylori infection causes symptomatic disease, the treatment would be focused, firstly, on the eradication of the infection and, secondly, on the repair of any injury to the stomach.
Eradication of H. pylori has proven difficult as increasing rates of antibiotic resistance have rendered many traditional therapies useless.
Because of this, doctors today will take a more aggressive approach by combining two or more antibiotics with an acid-reducing drug known as a proton pump inhibitor (PPI).
If a first-line therapy fails, additional combinations will be tried until all signs of the infection have been erased.
While drug selection can vary known patterns of drug resistance in a region, the therapeutic approach in the U.S. is typically described as follows:
- First-line therapy involves a 14-day course of the antibiotics clarithromycin and amoxicillin used in combination with an oral PPI.
- Second-line therapy would involve a 14-day course of the antibiotics tetracycline and metronidazole, an oral PPI, and bismuth subsalicylate tablets (such as chewable Pepto-Bismol) which help protect the stomach lining.
Tinidazole is sometimes substituted for metronidazole.
- Sequential therapy involves two separate courses of therapy. The first is conducted over five days with amoxicillin and an oral PPI.
This is followed by a second five-day course comprised of clarithromycin, amoxicillin, and an oral PPI. Outside of the U.S. where the drug is approved, the antibiotic nitroimidazole is often added.
A number of other combinations may be explored involving different classes of antibiotics and durations of treatment. Some doctors will also incorporate oral probiotics, such as Lactobacillus- and Bifidobacterium-containing yogurt, into therapy, which may help suppress bacterial activity.
Ultimately, the success of any treatment depends on strict adherence to the prescribed therapy. Stopping short “when you feel better” only allows drug-resistant bacteria to escape and re-establish an even harder-to-treat infection. It is only by completely eradicating all traces of H. pylori that a sustained cure can be achieved.
Ulcers can often be treated at the time of the endoscopic diagnosis.
When spotted, various instruments can be fed through the endoscope to either seal off a blood vessel with a laser or electrocautery (in which tissue is burned with an electrical current), or to inject epinephrine into the vessel to stop bleeding. A clamp attachment can also be used to hold the wound shut until the bleeding stops.
If these procedures are unable to stop the bleeding, surgery may be required. This is generally only pursued if there is a high risk of a gastric perforation. An active perforation is considered a medical emergency requiring immediate surgery.
Surgery may include a partial gastrectomy in which part of the stomach is removed, often through laparoscopic (keyhole) surgery. Fortunately, advances in pharmaceutical and endoscopic treatments have made ulcer surgery an increasingly rare procedure in the U.S.
Even after H. pylori has been positively identified, it may take time—and several trial-and-error attempts—the cure you of the infection. During this time, you will want to take steps to avoid anything that can cause stomach upset or trigger the excessive production of acid.
Among some of the tips to consider:
- Avoid aspirin and other NSAIDs that can cause stomach irritation and promote gastric bleeding.
- Speak with your doctor if you are taking a blood thinner warfarin. If appropriate, the drug may need to be stopped until the treatment has been successfully completed.
- Do not overdose on iron supplements.
While they can help treat anemia caused by gastric bleeding, overconsumption may trigger stomach upset.
- Avoid caffeine, acidic foods, spicy foods, and carbonated beverages. Instead, focus on high-fiber fruits and vegetables, plain chicken and fish, and probiotic foods yogurt and kombucha.
- Explore stress reduction techniques that may help temper the production of stomach acid. These include mindfulness meditation, guided imagery, Tai chi, and progressive muscle relaxation (PMR).
- Stay well hydrated, drinking around eight 8-ounce glasses of water per day. This may help dilute stomach acid.
- Exercise can improve your energy levels and sense of well-being. But avoid overexerting yourself or performing exercises that either jostle or compress the stomach. Moderation is key.
It is often difficult to avoid H. pylori given that the bacteria is so widespread and our understanding about the routes of infection remains limited.
As a general rule, it is always wise to wash your hands regularly, to eat food that has been properly prepared, and to drink water from a safe, clean source.
Beyond that, there are no official recommendations on how to avoid H. pylori infection.
If you're experiencing symptoms of gastritis that either recur or fail to go away, ask your doctor to investigate H. pylori as a possible cause. The tests are quick and minimally invasive and may help direct you to effective and lasting treatment.