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Gastroenterology and Health
Helicobacter pylori, stomach ulcers
Does Bacteria cause Peptic Ulcers?
By Dr. W. Gifford Jones
Is there nothing sacred anymore, even at Christmas? Or have doctors been leading us astray for years on the cause of stomach ulcers? The ones who've told us too much tension, spicy foods, martini's and the good life are responsible for the gnawing pain in the pit of the stomach. Well, there's a good chance these physicians will have to eat their words. Peptic ulcers may be caused by a spiral-shaped bacterium called Helicobacter pylori. Just as you can catch a cold, you may be able to "catch" an ulcer.
A Canadian study supports this theory. Researchers discovered that children in the same household tend to infect one another with Helicobacter pylori.
DR. Peter Klein, Director of the Stable Isotope Laboratory at the Children's Nutrition Research Centre in Houston agrees. He claims that 30 per cent of 30 year olds and 80 per cent of 80 year olds are infected with this germ.
Klein also reports that in Houston 70 per cent of blacks by the age of 50 carry Helicobacter pylori. And in third world countries nearly everyone is infected by 25 years of age.
The $64.00 question is whether the high incidence of Helicobacter pylori in the population is responsible for the one in 10 people who develops a stomach ulcer during his or her lifetime. And possibly for triggering stomach cancer in less developed regions of the world.
The evidence is not complete. But it has been demonstrated that patients with persisitent recurring ulcers tend to heal permanently when H. pylori is eradicated.
But why doesn't everyone infected with H. pylori develop a peptic ulcer? It may be that some people are resistent to the bacterium. Or that some strains of the germ are stronger than others.
Does this mean that during this festive season you can throw caution to the wind and live it up? Sorry, but I doubt that scientists will ever suggest that extreme self-indulgence is desirable.
I like one particular aspect of this research. I've suspected for years that doctors tend to blame stress for diseases it doesn't cause. We all know people who live with a lot of stress but never get an ulcer, hypertension or ulcerative colitis.
Besides, it's impossible to accurately measure stress. It's also tough to detect stomach infections. Few people relish the thought of doctors trying to obtain a sample from their stomachs. But now there's a unique way of testing for the presence of H. pylori without having to pass an instrument into the stomach.
Dr. David Graham, Chief of Gastroenterology at Baylor College of Medicine, along with Dr. Klein, has invented a new breath test to detect H. pylori. What set the stage for this discovery was an intriguing question. How did Heliobacter pylori survive in the "acid rain" of the stomach?
Experiments revealed that the bacterium has a unique protective mechanism. An enzyme, called urease, is present on its surface which breaks down urea, a molecule present in all body fluids. The breakdown of urea produces one molecule of carbon dioxide and two of ammonia.
It's the alkaline ammonia molecule that protects H. pylori from the stomach's hydrochloric acid. And the breath test detects the carbon dioxide exhaled by the lungs. This test, however, is still not available at most hospitals.
Some unanswered questions remain. For instance, scientists do not know how H. pylori is spread. But it's believed that once it's contacted it remains for life unless treated.
It can also be difficult to eradicate. Bismuth salts, such as those found in Peptobismol, and such antibiotics as amoxicillin and tetracycline have been used to eliminate H. pylori.
Will wiping out this bacterium send traditional methods of treating peptic ulcers to the Smithsonian Institution? That's the hope of doctors. But the use of bismuth and antibiotics is still in the experimental stages.
So far none of this research has convinced me that genetics isn't important in deciding who gets an ulcer. Or that it's still prudent at Christmas, and any other time of the year, to treat your stomach with care. As has been aptly said, "Many dishes, many diseases".
This it the 17th year I've had the pleasure of wishing readers a merry Christmas. And special thanks to those who have helped the W. Gifford-Jones Foundation purchase computerized pumps to ease the pain of terminal cancer patients.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at letters@canadafreepress.com
