Thirteen years after a young Australian doctor said he had discovered the cause of most ulcers, American medicine appears to have accepted the fact that a common, curable bacterium -- not spicy foods, not stress -- causes the disease.
Now, doctors say, it's time for the American public to discard the myths about ulcer disease and reconsider the long-term need for Zantac, Pepcid, Prilosec and Tagamet -- the acid-reducing ulcer medications -- and embrace a new therapy, which involves a short course of antibiotics.
A coalition of medical experts, called the American Digestive Health Foundation, has launched a sweeping public education campaign that will feature public service announcements, shopping mall exhibits and a toll-free telephone hot line. Their message: H. pylori is the cause of the majority of peptic ulcers, and antibiotics can kill the bacteria and provide a permanent cure for ulcers in most cases.
But this change in thinking has been difficult for many people -- doctors and patients alike -- to accept, perhaps because it is so startling, says Dr. David Peura, chairman of the campaign.
Dr. Peura, of Charlottesville, Va., and other experts say that myths about ulcer disease are so pervasive it may take years to alert the estimated 25 million Americans with peptic ulcers that a simple, inexpensive cure is within grasp.
For years many doctors suspected that diet and stress weren't the only culprits, but a 1982 study by Dr. Barry J. Marshall suggesting that the bacteria were the real cause was hard to believe. Many other studies followed, but it wasn't until February 1994 that the National Institutes of Health issued new guidelines for ulcer treatment that emphasized the role of H. pylori.
"Dr. Marshall was a young physician, was not recognized as an expert in this, hadn't done any research in this area," says Dr. Peura, a gastroenterologist. "The medical establishment wasn't willing to accept one person's word on this."
H. pylori lives on or in the lining of the stomach. As many as 60 percent of older Americans have the bacterium and up to 95 percent of people with ulcers are infected by it.
Doctors aren't sure just how the bacteria cause ulcers. The bacteria may damage the barrier that protects the stomach and duodenum from acid. Nor do they understand why some people with H. pylori infection develop ulcers while others don't. The bacteria are contained in fecal material and spreads more easily where hygiene is poor.
"It is passed person to person," says Dr. Loren A. Laine, a University of Southern California physician and member of the ADHF advisory board. "There are probably some strains in which the bacteria is more likely to cause ulcers. And there are probably genetic factors among people that make you more predisposed to develop the ulcers."
H. pylori infection rates are higher among blacks and Latinos.
Ulcers can also be caused by chronic, high doses of aspirin or ibuprofen, which can irritate the stomach. In rare cases, they are caused by the overproduction of stomach acid. Peptic ulcers, PTC which are those that occur in the stomach or duodenum, are the most common kind of ulcer.
If H. pylori is thought to be the cause of the ulcer, patients usually take antibiotics for two weeks along with acid-reducing drugs for a somewhat longer period of time. And it's possible that the cure will be permanent.
"The vast majority of patients who have the bacteria will be cured," says Dr. Mel Wilcox, vice chairman of the ADHF advisory board. "Six to seven years of follow-up studies show less than 1 percent recurrence. That is really quite staggering."