Ulcers

What's the Problem?

An ulcer is a sore or hole in the lining of the stomach or duodenum (the first part of the intestine). The most common ulcer symptom is gnawing or burning pain in the abdomen between the breastbone and the belly button. Ulcer pain often occurs when the stomach is empty, between meals, and in the early morning hours, but it can occur at any time. Less common symptoms include nausea, vomiting, or loss of appetite. Sometimes ulcers bleed. If bleeding continues for a long time, it may lead to anemia with weakness and fatigue. If bleeding is heavy, blood may appear in vomit or bowel movements, which may appear dark red or black.

Ninety percent of ulcers are caused by an infection with the bacterium Helicobacter pylori (H. pylori) and can be cured in about two weeks with appropriate antibiotic treatment. The other 10% of ulcers are caused by non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen. People who have an ulcer should be tested for H. pylori and if infected should be treated with appropriate antibiotics. H. pylori infection can be diagnosed by a blood test, a breath test or an endoscopy. During endoscopy, a small tube with a camera is inserted through the mouth and into the stomach to look for ulcers.

Who's at Risk?

Approximately 25 million Americans will have an ulcer at some point in their lifetime. People of any age can get an ulcer and women are affected just as often as men. There are approximately 500,000 – 850,000 new cases of ulcer disease each year and more than 1 million ulcer-related hospitalizations each year. Ulcer disease has a $6 billion annual impact on national health care budget. Curing an ulcer takes less time and costs substantially less than treating ulcer symptoms over a person's lifetime.

Can It Be Prevented?

To date, a vaccine for H. pylori is not yet available; scientists are still researching how the bacterium is transmitted.

Most people still believe ulcers are caused by stress or spicy foods and are not aware that ulcers are caused by an infection that can be cured. It is possible that many chronic ulcer patients do not visit their doctors because they don't realize that their ulcers can be cured permanently with a 10-14 day course of antibiotic-based therapy. Many may, instead, continue to self-medicate with traditional ulcer treatment (H₂ receptor antagonists) which became available as over-the-counter medications in 1995. Primary care physicians still report treating more than 50% of first-time ulcer patients with acid-reducing medications and not antibiotic regimens.

Tips for Scripts

• EDUCATE viewers that nine out of ten ulcers are caused by an infection, not spicy foods and stress. Eliminating the infection with antibiotics means that there is a greater than 90% chance that the ulcer can be cured for good.
• REMIND viewers that it is extremely important to take all of the medicine until it is gone. As of July 1998, FDA had approved eight treatment options for H. pylori infection.
• INFORM viewers that the personal and economic costs of treating the ulcer with antibiotics is considerably less than the costs associated with taking over-the-counter medications over a lifetime.

Case Examples

1. A 35-year-old woman has recurrent abdominal pain. She thinks she has pelvic inflammatory disease and she'll never have children because her fallopian tubes are scarred. This causes the break-up of her marriage. She finally visits a physician who correctly diagnoses the source of her recurrent abdominal pain as peptic ulcer disease. She receives 2 weeks of antibiotics and is cured for good. Her husband comes back and begs forgiveness, but it's too late because she leaves him for the hero physician who cured her ulcer.
2. A 64-year-old widow is suffering from recurrent heartburn and upper abdominal pain. She treats herself with over-the-counter antacids and other medications (H₂ receptor antagonists/blockers) because she can't afford medical care; she's retired and has no health insurance. One day her neighbor finds the widow lying in a pool of blood and calls emergency medical services; her pulse is faint. She is rushed to the emergency room, where things are touch and go for awhile. Doctors perform emergency surgery to remove a huge ulcer crater in her duodenum, repair the damage and save her life. The pathology report reveals that she has H. pylori infection which caused her ulcer. She takes just 2 weeks of antibiotic therapy and is cured of her ulcer and pain permanently.