Dr. MJ Bazos MD, Patient Handout
H. Pylori

What is an ulcer?

An ulcer is a break in the lining of the stomach or in the duodenum (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. Your doctor may use tests to decide if your stomach pain is caused by an ulcer.

Are ulcers serious?

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.

What causes ulcers?

Doctors used to think ulcers were caused by stress or by eating food with too much acid in it. We now know this isn't true. We now know that most stomach ulcers are caused by an infection. The infection is caused by a bacteria (germ) called Helicobacter pylori (say: "hell-ee-ko-back-ter pie-lore-ee"), or H. pylori for short. Ulcers in people who don't have an H. pylori infection are usually elated to heavy aspirin use, or heavy use of anti-inflammatory drugs like ibuprofen (some brand names: Advil, Nuprin, Motrin). Acetaminophen (brand name: Tylenol) doesn't cause stomach ulcers.

Who gets ulcers?

About half of the world's population is infected with H. pylori. In the United States, half of the people older than age 50 are infected with it. Because sanitation has improved in recent decades, younger Americans are less likely to have H. pylori infection. Only some infected people get an ulcer.

How are ulcers treated?

Since the 1970s, doctors have had several medicines that can help heal the break in the lining of the stomach or the duodenum. These medicines also make the ulcer symptoms, including the pain, get better. The problem has been that about 90% of people who used these medicines got another ulcer within a year. So for most people ulcers were a recurring problem. Finding out about H. pylori infection has changed this. Now, if you test positive for H. pylori infection, it can be treated, and you probably won't get another ulcer.

How does my doctor know if I have H. pylori infection?

H. pylori infection can be diagnosed with a blood test. Your doctor might also want you to get an x-ray or have endoscopy (an endoscope is a thin tube that carries a tiny camera) to see if you have an ulcer. A breath test is another way to find out if you have H. pylori infection.

What are the medicines used for ulcers?

There are 3 kinds of ulcer medicines. All of them do a good job of helping to heal ulcers. Your doctor will recommend the one that is right for you. You should take the medicine just the way your doctor tells you to.

The first kind reduces the amount of acid the stomach makes. This medicine heals ulcers in the duodenum in 6 to 8 weeks. Stomach ulcers take a little longer to heal. You would take these medicines for 8 to 12 weeks if you have a stomach ulcer.

A second kind of medicine blocks the stomach's ability to make acid. This medicine helps heal duodenal ulcers in 4 weeks. It helps heal stomach ulcers in 6 to 8 weeks.

A third kind of medicine coats the ulcer. It protects the sore place from stomach acid, so it can heal. It takes 8 to 12 weeks to heal an ulcer.

What if I have an ulcer and H. pylori infection?

The medicines noted above heal ulcers whether you have H. pylori infection or not. But if you have H. pylori infection too, you should also treat the infection. H. pylori is hard to get rid of. No single drug can cure this infection. The best way to cure H. pylori infection is to take several drugs at the same time.

One combination of drugs for H. pylori infection is 2 antibiotics plus bismuth (bismuth is commonly called Pepto-Bismol). This combination, called "triple therapy," means taking a large number of pills every day. Other combinations that use fewer drugs might also help. Your doctor can help decide which medicines you should take. One medicine called lansoprazole (brand name: Prevacid) is taken with an antibiotic. One medicine, called Tritec, combines bismuth and a drug to reduce acid in the stomach. It is used with an antibiotic. Helidac is another medicine that combines bismuth and 2 antibiotics.

Do the medicines cause side effects?
Because you have to take so many medicines at the same time, you may have some side effects. Minor side effects of H. pylori medicines include a black color on the tongue and black stool, diarrhea, nausea and headache. Some of the medicines leave a bad taste in your mouth. These side effects are usually minor and go away on their own.

You can only cure H. pylori infection if you take the medicines just the way your doctor tells you. If you forget to take some of your medicines or stop taking them because of side effects, the infection won't be cured. You may get another ulcer in the future. Let your doctor know right away if you have side effects with your medicines or if you have any questions about how to take them. Your doctor may suggest something to make the side effects better. He or she may give you different medicines.

What else can I do?
In the past, doctors treated ulcers by telling people to eat bland foods, drink a lot of milk and not to eat some kinds of foods. Today we know that this isn't necessary. If certain foods bother you, don't eat them. In general, however, you can eat whatever you like. You may heal faster if you don't smoke or don't use aspirin or ibuprofen. Acetaminophen will not harm your ulcer.