While it used to be thought that ulcers were caused by acid indigestion or stress, close to two-thirds of all ulcers actually get their start with a bacterium called Helicobacter pylori. The good news is that a course of antibiotics can remove H. pylori, as it’s commonly called, from your stomach, enabling existing ulcers to heal and preventing others from forming.
Treating H. pylori with antibiotics has benefits beyond ulcer prevention — it may also reduce your risk of stomach cancer.
Ulcer: A Bacterial Cause
H. pylori may spread through contact with people who have it, or contact with their feces. This infection is more common in the developing world — up to 80 percent of the population is infected at an early age in some areas — than in the United States, where about one in five people under age 40 have H. pylori and about half those over age 60 are infected. People with H. pylori have about a 10 to 20 percent chance of developing an ulcer over their lifetime.
Over the past 25 years, since the discovery of H. pylori in the 1980s, the incidence of peptic ulcers has gone down because of successful treatment with antibiotics. Also, improved standards of living have likely reduced its spread.
The exact way in which H. pylori causes peptic ulcers is not yet known. We also don’t know why some people with the bacteria get ulcers while others don’t. Scientists think there is an interaction between H. pylori and the body’s immune system, causing problems for the stomach lining in certain people. The infection swells and irritates the stomach lining, weakening both the stomach lining and that of the duodenum — the beginning of the small intestine — and allowing ulcers to form.
Ulcer: Testing for Infection
There are four ways that your doctor can find out whether you have the infection:
- Antibody blood test. This will show whether you have ever been infected — a positive result does not necessarily mean you are actively infected.
- Urea breath test. This test, which checks for a substance called urea in exhaled breath, is only positive if you are currently infected.
- Stool sample test
- Biopsy of stomach lining during an endoscopy. This is the most reliable test, but also the most invasive, so most doctors prefer to use one of the other tests first.
Ulcer: Using Antibiotics to Treat Ulcers
If your doctor finds that H. pylori is the cause of your ulcer, she will prescribe antibiotics to treat your infection as well as your ulcer. This infection is difficult to treat because it lives in the lining of your stomach, a hard target for antibiotics to reach. You probably will have to take more than one antibiotic at the same time to treat it successfully.
You may also be given another medication to reduce the acid in your stomach so your ulcer can heal. It may take up to two weeks to complete this combined ulcer treatment approach.
About half of the people who have H. pylori infections and ulcers will get another ulcer within one year if the infection is not treated, so it is important to take your antibiotics as prescribed and follow up with your doctor to make sure the treatment has worked.