Catherine Tays wasn’t happy to learn early this year that she had an ulcer.
But her displeasure turned to surprise when doctors told her they would treat the ulcer with antibiotics.
“All my life I thought ulcers were caused by being nervous and eating spicy food. I never had any idea they were caused by bacteria,” said Tays, an elder-care worker from Winchester, Ky.
Many people still don’t know, even though it has been 14 years since Australian doctor Barry Marshall suggested that most ulcers are caused by a nasty bacterium called Helicobacter pylori that lives in the lining of the stomach.
The idea flew in the face of long-accepted medical doctrine, which held that ulcers were caused by excess stomach acid brought on by stress.
To prove his theory, Marshall gave himself an ulcer by drinking a solution loaded with H. pylori.
Now, Marshall’s discovery is finally changing the way doctors treat ulcer patients such as Catherine Tays. Not so long ago, about all doctors could tell ulcer sufferers was to take antacids–and try to reduce stress.
Today, standard therapy calls for a combination of drugs–antibiotics to kill the H. pylori and medications to control stomach acid–for up to two weeks.
“If you come in with an ulcer, you’ll be treated with antibiotics,” said Dr. Stephen Schindler, a Lexington, Ky., gastroenterologist. “That’s become common practice over the last three years or four years.”
Earlier, antacid treatments also worked. But when patients went off the drugs, their ulcers would come back, said Dr. Craig McClain, a gastroenterologist and director of the University of Kentucky’s General Clinical Research Center.
As a result, many patients had to stay on low-dose maintenance regimens of antacids. But with today’s treatments, eradicating the H. pylori usually cures the ulcer once and for all, McClain said.
As recently as three years ago, many doctors still had not picked up on the H. pylori-ulcer connection and weren’t prescribing antibiotics for their ulcer patients.
The first drug combination for treating ulcers wasn’t approved by the Food and Drug Administration until early 1996. Why did acceptance take so long?
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“Doctors tend to be conservative by nature; they take a long time to switch on anything,” McClain said. “Plus, when Marshall first came out with his work, everybody thought it was a stupid idea, including myself.”
Another reason is that early combination antibiotic therapies for ulcers were complicated, requiring patients to take several different pills daily for up to a month.
“And it was stuff that didn’t make you feel particularly good,” McClain said.
Stella Parolisi, a clinical research coordinator at the University of Virginia, where Marshall did some of his early work, said many in the general public still don’t know about H. pylori.
“My own niece developed an ulcer,” Parolisi said, “and when I told her she needed antibiotics she thought I was out of my mind.”
The medical dossier on H. pylori is growing. The bug is blamed for up to 90 percent of all ulcers–the rest are thought to be caused by taking aspirin and other similar drugs. There is evidence that H. pylori might be a factor in stomach cancer. And recent European research suggests it might increase risk for heart attack.
The other bad news is that up to a third of the U.S. population is thought to be infected with the bacteria, with many more in developing countries where sanitary conditions are poor.
H. pylori is spread through oral contact with fecal material, usually by drinking contaminated water. But McClain said that as a practical matter there’s little individuals can do to protect themselves.
The good news is that everybody who has H. pylori doesn’t get ulcers. And if you do get an ulcer, more and more new medications are becoming available. The FDA last month approved a new 10-day antibiotic treatment for ulcers. Unfortunately, McClain said, a one-day treatment probably isn’t in the offing.
But even if you have to take several drugs for several days, it’s time well spent, according to Tays. Her ulcer is gone.