By Judy Rupp, Commentary

Eric grew up thinking of ulcers as a lifelong disorder brought on by emotional stress and treated by eating bland food and drinking warm milk. As Eric learned when he developed ulcers himself, he was wrong on all counts.

An ulcer is an open sore in the lining of the stomach, esophagus or the first 12 inches of the small intestine. While stress may occasionally be a contributing factor, the primary cause usually is either an infection with Helicobacter pylori bacteria or chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen or ketoprofen.

Eric’s ulcer presented itself as a gnawing or burning sensation in his upper abdomen that seemed worse when his stomach was empty and improved for awhile after he had eaten. When the symptoms got worse and started lasting longer, 30 minutes or more at a time, he made an appointment with his doctor.

Some patients feel nauseous after even a small meal or lose their appetites. Others vomit blood (which may appear as either red or black) or have dark, tarry bowel movements indicating the presence of blood. Eventually an ulcer is likely to lead to unexplained weight loss.

Since Eric doesn’t care for milk, he was delighted to find out that this beverage is no longer considered good for ulcers but should rather be avoided since it stimulates the production of stomach acids that can aggravate the ulcer.

In the past, before the bacterial cause of ulcers was identified, doctors often advised patients to avoid stress and spicy or acidic foods. Limiting these might still be advised during the early stages of treatment, when the ulcer still is healing, but over the long term, diet and lifestyle are not all that important as long as you avoid smoking and excessive drinking, either of which can irritate the stomach lining.

Drs. Barry Marshall and Robin Warren isolated Helicobacter pylori in 1982 and implicated these bacteria as a principal cause of ulcers — a discovery now recognized as a major breakthrough.

Helicobacter pylori are prevalent throughout the world, spread primarily through food, water and close personal contact, particularly by kissing. Living and multiplying in the mucus layer that covers the lining of the gastrointestinal tract, H. pylori usually cause no problem. Doctors are not sure why only some infected individuals get ulcers, but they believe it’s because these persons, for some reason, secrete more stomach acid.

With a certain level of stomach acid, bacteria weaken the protective coating of the gastrointestinal system, allowing the acid to break through this barrier and directly irritate the sensitive lining.

Smoking and excessive drinking can also contribute to this process. And some individuals apparently have a genetic susceptibility.

The other major cause of ulcers is use of NSAIDs, including aspirin. Despite the anti-inflammatory and pain-killing benefits of these drugs, NSAIDs significantly increase the risk of gastrointestinal bleeding.

In the absence of a bacterial infection, NSAIDs are the major cause of gastric ulcers. And the combination of H. pylori and NSAID use is particularly potent.

The first step in treatment is to check for H. pylori infection. When an infection is confirmed, treatment then is two-pronged, aimed at 1) killing the bacteria and 2) reducing the acid level in the gastrointestinal system to protect the lining while the ulcer is healing.

First-line treatment typically includes two antibiotics — usually clarithromycin and amoxicillin or metronidazole — taken for one to two weeks. To reduce acids, your doctor may choose a proton pump inhibitor (Prilosec, Prevacid, Aciphex, Protonix or Nexium) or an acid blocker (H-2 blocker) such as Zantac, Pepcid, Tagamet or Axid. An antacid may also be included to neutralize existing acids and give quick pain relief.

If H. pylori isn’t identified, then NSAID use should be discontinued, if this is possible given the patient’s medical condition. Acid level must then be lowered through an acid blocker, antacid or proton pump inhibitor. A cytoprotective agent such as Carafate, Cytotec or Pepto-Bismol also may be prescribed to help protect the tissues of the gastrointestinal lining.

With better knowledge and treatments, the prevalence and incidence of both Helicobacter pylori and gastric ulcers are declining in most developed countries. Ulcers, nevertheless, still affect 1 of 10 Americans, with a particularly high risk among older Americans.

A bleeding or perforated ulcer can pose significant risk and require emergency treatment. In most cases, however, an ulcer can be treated relatively quickly and decisively.

Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.