Departments
Health Matters
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Week of 7 November 1997 |
Vol. I, No. 11 |
Health Matters
Ulcers: triple therapy for a one-two punch
Will antibiotics help to cure my ulcer?
Ulcers, painful lesions inside the lining of the gut (equivalent to canker sores in the mouth), most commonly arise from two interacting factors: the Helicobacter pylori (H. pylori) bacterium and excessive acid secretion. Contrary to popular belief, stress or food almost never play a role in inducing ulcers.
Curing an ulcer requires addressing both the infection and the oversecretion of acid, says Michael Wolfe, M.D., chief of the Section of Gastroenterology at Boston Medical Center and associate professor of medicine at the Boston University School of Medicine. "H. pylori and excess acid function like a one-two punch, and curing an ulcer involves blocking both punches with a combination of antibiotics and drugs, such as H2 blockers or proton-pump inhibitors, also known as PPIs. The drugs prevent the secretion of excess acid, and antibiotics treat the bacteria."
While the lining of the stomach walls is designed to withstand the acidic environment, H. pylori weakens the lining and can eventually produce an ulcer. Since most people infected with the bacteria never suffer from ulcers, a second factor probably must come into play -- high nighttime acid secretion. "The majority of ulcer patients produce more acid at night," says Wolfe. "The excess acid eats away at the stomach lining, which is weakened by the H. pylori, and the result is the ulcer."
Once patients are diagnosed with an ulcer (either by X ray or endos-copy), they should be tested for the presence of the bacterium. If H. pylori infection is diagnosed, patients normally take a combination of antibiotics, such as "triple therapy," which consists of bismuth (the active ingredient in Pepto-Bismol), metronidazole, and amoxicillin or tetracycline. Triple therapy and other regimens are designed to eradicate the infection caused by the bacteria and do not halt the excess acid secretion.
Taking H2 blockers (such as Pepcid and Zantac) or PPIs (such as Prevacid and Prilosec) in conjunction with antibiotics enhances their effectiveness in eliminating the infection by as much as 15 percent. Moreover, these drugs alleviate the uncomfortable symptoms of the ulcer.
Triple therapy is effective and inexpensive. A typical two-week supply costs less than $40, and when used in combination with H2 blockers or PPIs, the chance of developing another ulcer is only 1 to 2 percent. One major drawback to triple therapy is that patients are required to take roughly 16 to 18 pills every day and must avoid drinking alcohol. Additionally, diarrhea, nausea, vomiting, skin rash, and constipation are possible side effects.
Wolfe cautions that while complicated ulcers (ulcers that produce bloody or black stools) may also arise from H. pylori infection, they are most commonly caused by the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Alleve, or Alka-Seltzer. Patients who suffer from ulcers of any kind should inform their doctors of any over-the-counter medicine they use regularly.
"It's become clear that the best method to prevent recurrent ulcers is to eradicate H. pylori infection with antibiotics, and the best way to relieve the immediate symptoms of an ulcer is to stop excess acid secretion with H2 blockers or PPIs," Wolfe concludes.
Keep in mind:
- The majority of noncomplicated ulcers are associated
with H. pylori infection.
- Antibiotics eradicate the bacteria; H2 blockers and
PPIs stop excess acid secretion.
- If in conjunction with stomach pains, you have bloody or black stools or dizzy spells or you look pale, you may have a bleeding ulcer. You should seek immediate medical attention.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on ulcers or other health matters, call 638-6767.