A peptic ulcer is a wearing away of the lining of the stomach or the duodenum (the first part of the small intestine just below the stomach). The leading cause of peptic ulcers is a bacterium known as Helicobacter pylori (H. pylori); a secondary cause is traceable to the long-term use of nonsteroidal anti-inflammatory agents, such as aspirin and ibuprofen. Contrary to popular belief, it is now known that peptic ulcers are not caused by spicy food or stress.

ANSWERS TO COMMON QUESTIONS

What is the H. pylori bacterium, and how prevalent is it?

H. pylori is a spiral-shaped bacterium frequently found in the gastric mucous layer adherent to the epithelial lining of the stomach. The H. pylori bacterium survives in the stomach by secreting an enzyme that neutralizes stomach acid. This, in turn, enables the bacterium to make its way into the mucous layer or epithelial lining where the combined bacterium and acid often trigger an irritation that results in inflammation and/or an ulcer. The H. pylori bacterium is responsible for more than 90 percent of duodenal ulcers and more than 80 percent of gastric ulcers. It is also involved in the development of gastric adenocarcinoma and lymphoma (cancers) in some cases.

How do people become infected, and can infections be prevented?

It is unknown how the H. pylori bacterium is transmitted and why some patients become symptomatic while others do not. Generally, people are infected with a bacterium through person-to-person contact or via the ingestion of contaminated food or water.

Since the source of the H. pylori bacterium remains unknown, there are no specific recommendations to avoid infection. Generally, people should always wash their hands before eating, eat only properly prepared foods, and drink water from a safe, clean source.

What are the symptoms of an H. pylori bacterium infection?

Pain, the most common symptom, is manifested by a dull, gnawing ache; comes and goes for several days or weeks; occurs two to three hours after a meal; occurs in the middle of the night when the stomach is empty; and is relieved by the ingestion of food.

Less common symptoms include nausea, vomiting, loss of appetite, bloating, and burping.

PATHOLOGY TESTING

How is the H. pylori gastritis diagnosed?

Once your symptoms have been identified, your doctor may begin to determine their cause by evaluating your medical history, performing a physical examination, and ordering laboratory studies. Although several test methods are now available to diagnose the presence of the H. pylori bacterium, the histologic identification of the organism via the tissue biopsy procedure remains the most definitive choice. Your physician may perform an examination utilizing an endoscope -- a thin, lighted tube equipped with a tiny camera. Using a local anesthetic, the physician passes the endoscope through the mouth to view the interior linings of the esophagus, stomach, and duodenum. The endoscope permits the photographing of suspicious areas as well as the actual removal of tissue samples (biopsies) for subsequent laboratory evaluation. The tissue samples are then sent to a diagnostic laboratory for evaluation by a pathologist -- a physician who specializes in the diagnosis of disease via microscopic examination of tissue samples.

If the H. pylori bacterium or another gastric condition is discovered, the pathologist can then assist your physician in determining the existence of dysplasia (precancerous change) or cancer (including adenocarcinoma and lymphoma).

Additional tests that determine if the H. pylori bacterium is present include:

• Serological (blood) tests, which are especially useful for past infections
• Breath tests, which are useful in monitoring treatment progress
• Biopsy urease tests
• Bacterial culture of biopsy specimens

TREATMENT OPTIONS

Do I have a choice of treatment?

Peptic ulcers are treated with a combination of drugs, including antibiotics to kill the bacteria and acid suppressors to reduce stomach acid and protect the stomach lining.

Your physician will determine the most appropriate treatment plan based upon a number of factors, such as age, the size and location of the ulcer, the stage of disease, your general health, and any special concerns you may have regarding the treatment process and potential side effects. Therefore, it is essential that you discuss with your doctor all options regarding an effective treatment plan specifically tailored to your medical condition.

Resource Support

For additional information about the H. pylori bacterium, gastric disorders and gastric cancer, the following resources are available:

American Gastroenterological Association, Digestive Health Foundation
301.654.2055 www.gastro.org
Access to expert panels, support groups and detailed diagnostic and treatment information.

Center for Disease Control
1.888.MY.ULCER
(1.888.698.5237)

www.cdc.gov/ulcer

AmeriPath, Incorporated
800.330.6565

AmeriPath is the nation’s leading provider of cancer diagnostics, genomics and related information. Our AmeriPath team consists of more than 400 board-certified anatomic pathologists (many with subspecialty expertise) and our Institute of Gastrointestinal Pathology and Digestive Disease. Our specialists are able to pool their expertise through multiple modes of communication and respond quickly when consulting on unique or difficult cases.

Although AmeriPath’s board-certified pathologists do not treat patients directly, they render invaluable assistance to attending physicians (and indirectly to you) through the provision of definitive diagnoses based upon their interpretation of biopsy and cytology specimens. AmeriPath’s pathologists also serve as vital consulting links to attending physicians regarding effective treatment options.

This report is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option. Provided to you as a service by AmeriPath, Inc.