HEALTH PROBLEMS Feeling the burn? Test for an ulcer

H. pylori is the culprit behind many ulcers.
By SHERRI L. SHAULIS
VINDICATOR CORRESPONDENT
YOUNGSTOWN -- It wakes you up in the middle of the night. That familiar burning sensation. Your mind races, trying to remember what you ate for dinner. Or was it maybe something you drank? As you head for the medicine cabinet, you wish the pain would just go away.
But that pain could be an indicator of something more serious than just heartburn.
"The main indicator of an ulcer is pain," explains Dr. Rudolph Krafft, family practice resident director at St. Elizabeth's Hospital.
"It can be above the abdomen, or sometimes even in the back, the side or below the rib cage. Some patients describe it as a gnawing, empty feeling that improves by eating or by using antacids. Other times, they say it's a sharp pain that will wake them up."
Common cause: Ulcers, the erosion of the lining of the stomach or intestinal tract, are most often caused by the bacteria called helicobacter pylori, or H. pylori.
While presence of the bacteria is common -- according to the National Digestive Diseases Information Clearinghouse, about 20 percent of people under the age of 40 and about 50 percent of people over age 60 have the bacteria -- it does not always lead to ulcers. Though many ulcers today are traced to H. pylori, the majority of people with the bacteria do not develop ulcers.
Most likely, according to NDDIC, infections depend on the person with the bacteria, the bacteria itself and other factors.
H. pylori was unknown even 10 years ago as a major cause of ulcers, and research is still being conducted on how the bacteria is transmitted. Some studies show it to be present in food or water supplies. Other research, according to NDDIC, found the bacteria in the saliva of some ulcer patients, suggesting the bacteria could be transmitted by kissing.
Symptoms: Once an ulcer is formed, there may be several symptoms, or none at all, which can make it difficult to detect.
"The symptoms can be misleading, and they are not always the same in all people," said Dr. Farid Naffah, a gastroenterologist with his own practice, Avamar, in Howland. "There can be pain, depending on the patient, and sometimes that pain is aggravated by food. Other times, a patient may feel full too quickly; they may take just a few bites and feel they can't eat any more. But the symptoms are usually whatever a patient perceives to be a symptom."
In ulcers caused by H. pylori, the bacteria wears away the mucous coating of the stomach or duodenum (small intestine), allowing acid to get to the sensitive lining underneath. Both the acid and bacteria irritate that lining, causing a sore, or ulcer.
H. pylori bacteria, however, is not the only leading cause of ulcers, especially in the elderly. Many medications can lead to irritations in the linings of the stomach and intestinal track, including aspirin or ibuprofen, drugs used to fight arthritis and steroids.
Other risks: "Alcohol and smoking also increase the risks of ulcers," said Dr. Krafft. "And stress itself, although that's somewhat controversial, is also believed to increase the risks."
No matter the cause, Dr. Naffah said, ulcers can affect any age group and either sex. If left undetected or untreated, he said, ulcers can wear away the lining of the stomach or intestine enough to cause a perforation, or hole, which creates internal bleeding. At that point, surgery is often the only way to treat the ulcer, Dr. Naffah said. Sometimes, an untreated ulcer can also lead to scarring, which could develop enough to obstruct the stomach or intestine, also requiring surgery to correct.
"Ulcers are not something that is tested for routinely," Dr. Krafft explained. Patients who may require testing include those who display some of the classic symptoms, like pain, every day or every other day; those who use antacids on a daily basis; those for whom antacids used to work but no longer do; and those who are vomiting blood.
Dr. Naffah added that patients who received treatment for ulcers previously may need to be checked to make sure the H. pylori bacteria is not still present.
Some tests, like a breath test and a barium swallow, also known as an upper GI series, can detect the presence of H. pylori or an ulcer itself, but they are not always as accurate or readily available.
"I know of no one who uses the breath test in the area," said Dr. Naffah. "Especially since there are other testing methods that are more available and cheaper to use."
Best test: The best way to detect an ulcer, both doctors agree, is an endoscopy procedure.
"With a scope, we can view and biopsy the ulcer if necessary and test for an infection," Dr. Krafft said.
Dr. Naffah, whose practice houses an endoscopy center, said the scope is a rather easy procedure in which the person is sedated but awake.
"The patient is drowsy, and they often experience an amnesic effect, where they forget the procedure even happened."
While sedated, the physician inserts a tube down the throat and into the stomach and intestine to check for ulcers. Most physicians in the area, he said, are experienced enough in the procedure that it only takes a few minutes. Some bleeding ulcers, if detected early enough, can be stopped through the endoscopic procedure, Dr. Krafft said.
Dr. Naffah said the scopes are often done on an outpatient basis, meaning the patient can leave once sedation has worn off.
"We recommend they don't drive after the procedure," he said. "But most are able to return to work or normal activity within a day or two."