Peptic ulcer is a sore on the lining of the stomach or duodenum, which is the beginning of the small intestine. Peptic ulcers are common: One in 10 Americans develops an ulcer at some time in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are not caused by stress or eating spicy food. 
 
What is H. pylori?

Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers, as well as chronic gastritis (inflammation of the stomach lining) and potentially gastric cancer.

H. pylori infection is common in the United States: About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.

Researchers are not certain how people contract H. pylori, but they think it may be through food or water.

Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact, such as kissing.

How does H. pylori cause a peptic ulcer?

The H. pylori bacteria weakens the protective mucous coating of the stomach and duodenum, thus allowing acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.

H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows <I>H. pylori to make its way to the "safe" area – the protective mucous lining. Once there, the bacterium's spiral shape helps it burrow through the lining.

What are the symptoms of an ulcer?

Abdominal discomfort is the most common symptom. This discomfort usually:

* is a dull, gnawing ache. 
* comes and goes for several days or weeks. 
* occurs 2 to 3 hours after a meal. 
* occurs in the middle of the night (when the stomach is empty). 
* is relieved by eating.
* is relieved by antacid medications. 


Other symptoms include

* weight loss 
* poor appetite 
* bloating 
* burping 
* nausea 
* vomiting 


Some people experience only very mild symptoms or none at all.


Emergency Symptoms

If you have any of these symptoms, call your doctor right away:

* Sharp, sudden, persistent stomach pain. 
* Bloody or black stools. 
* bloody vomit or vomit that looks like coffee grounds. 


They could be signs of a serious problem, such as: 

* Perforation – when the ulcer burrows through the stomach or duodenal wall. 
* Bleeding – when acid or the ulcer breaks a blood vessel. 
* Obstruction – when the ulcer blocks the path of food trying to leave the stomach. 

How is an H. pylori-related ulcer diagnosed?

Diagnosing an Ulcer
To see whether symptoms are caused by an ulcer, the doctor may do an upper gastrointestinal (GI) series or an endoscopy.

Upper GI series -- An x-ray of the esophagus, stomach, and duodenum. The patient drinks a chalky liquid, called barium, to make these organs and any ulcers show up more clearly on the x-ray.

Endoscopy -- An exam that uses an endoscope, a thin, lighted tube with a tiny camera on the end. The patient is lightly sedated, and the doctor carefully eases the endoscope into the mouth and down the throat to the stomach and duodenum. This allows the doctor to see the lining of the esophagus, stomach, and duodenum. The doctor can use the endoscope to take photos of ulcers or remove a tiny piece of tissue to view under a microscope.

Diagnosing H. pylori
If an ulcer is found, the doctor will test the patient for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from that for an ulcer caused by NSAIDs.

H. pylori is diagnosed through blood, breath, stool, and tissue tests. Blood tests are most common. They detect antibodies to H. pylori bacteria. Blood is taken at the doctor's office through a finger stick.

Urea breath tests are an effective diagnostic method for H. pylori. They are also used after treatment to see whether it worked. In the doctor's office, the patient drinks a urea solution that contains a special carbon atom. If H. pylori is present, it breaks down the urea, releasing the carbon. The blood carries the carbon to the lungs, where the patient exhales it. The breath test is 96 percent to 98 percent accurate.

Stool tests may be used to detect H. pylori infection in the patient's fecal matter. Studies have shown that this test, called the Helicobacter pylori stool antigen (HpSA) test, is accurate for diagnosing H. pylori.

Tissue tests are usually done using the biopsy sample that is removed with the endoscope. There are three types:

* The rapid urease test detects the enzyme urease, which is produced by H. pylori. 
* A histology test (or biopsy) allows the doctor to find and examine the actual bacteria. 
* A culture test involves allowing H. pylori to grow in the tissue sample. 


In diagnosing H. pylori, blood, breath, and stool tests are often done before tissue tests because they are less invasive. However, blood tests are not used to detect H. pylori following treatment because a patient's blood can show positive results even after H. pylori has been eliminated.

How are H. pylori peptic ulcers treated?

Drugs Used to Treat H. pylori Peptic Ulcers
Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin
H2 blockers: cimetidine, ranitidine, famotidine, nizatidine
Proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprozole
Stomach-lining protector: bismuth subsalicylate 

H. pylori peptic ulcers are treated with drugs that kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are used to kill the bacteria. Two types of acid-suppressing drugs might be used: H2 blockers and proton pump inhibitors.

H2 blockers work by blocking histamine, which stimulates acid secretion. They help reduce ulcer pain after a few weeks. Proton pump inhibitors suppress acid production by halting the mechanism that pumps the acid into the stomach. H2 blockers and proton pump inhibitors have been prescribed alone for years as treatments for ulcers. But used alone, these drugs do not eradicate H. pylori and therefore do not cure H. pylori -related ulcers. Bismuth subsalicylate, a component of Pepto-Bismol, is used to protect the stomach lining from acid. It also kills H. pylori. 

Treatment usually involves a combination of antibiotics, acid suppressors, and stomach protectors. Antibiotic regimens recommended for patients may differ across regions of the world because different areas have begun to show resistance to particular antibiotics.
The use of only one medication to treat H. pylori is not recommended. At this time, the most proven effective treatment is a 2-week course of treatment called triple therapy. It involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shield. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in more than 90 percent of patients.

Unfortunately, patients may find triple therapy complicated because it involves taking as many as 20 pills a day. Also, the antibiotics used in triple therapy may cause mild side effects such as nausea, vomiting, diarrhea, dark stools, metallic taste in the mouth, dizziness, headache, and yeast infections in women. (Most side effects can be treated with medication withdrawal.) Nevertheless, recent studies show that 2 weeks of triple therapy is ideal.

Early results of studies in other countries suggest that 1 week of triple therapy may be as effective as the 2-week therapy, with fewer side effects.

Another option is 2 weeks of dual therapy. Dual therapy involves two drugs: an antibiotic and an acid suppressor. It is not as effective as triple therapy.

Two weeks of quadruple therapy, which uses two antibiotics, an acid suppressor, and a stomach-lining shield, looks promising in research studies. It is also called bismuth triple therapy.

Can H. pylori infection be prevented?

No one knows for sure how H. pylori spreads, so prevention is difficult. Researchers are trying to develop a vaccine to prevent infection.

Why don't all doctors automatically check for H. pylori?

Changing medical beliefs and practice takes time. For nearly 100 years, scientists and doctors thought that ulcers were caused by stress, spicy food, and alcohol. Treatment involved bed rest and a bland diet. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids.

Since H. pylori was discovered in 1982, studies conducted around the world have shown that using antibiotics to destroy H. pylori cures peptic ulcers. The prevalence of H. pylori ulcers is changing. The infection is becoming less common in people born in developed countries. The medical community, however, continues to debate H. pylori role in peptic ulcers. If you have a peptic ulcer and have not been tested for H. pylori infection, talk to your doctor.

Points to Remember

* A peptic ulcer is a sore in the lining of the stomach or duodenum. 
* The majority of peptic ulcers are caused by the H. pylori bacterium. Many of the other cases are caused by NSAIDs (a class of pain-reliever). None are caused by spicy food or stress. 
* H. pylori can be transmitted from person to person through close contact and exposure to vomit. 
* Always wash your hands after using the bathroom and before eating. 
* A combination of antibiotics and other drugs is the most effective treatment for H. pylori peptic ulcers. 


For More Information

To learn more about this topic, please visit:

Cleveland Clinic

WebMD

 
Causes
Harmful bacteria are the most common causes of foodborne illnesses. Some bacteria may be present on foods when you purchase them. Raw foods are not sterile. Raw meat and poultry may become contaminated during slaughter. Seafood may become contaminated during harvest or through processing. One in 20,000 eggs may be contaminated with Salmonella inside the egg shell. Produce such as lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7. Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of contamination are varied; however, these items are grown in the soil and therefore may become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in the restaurant or in the person's kitchen.
When food is cooked and left out for more than 2 hours at room temperature, bacteria can multiply quickly. Most bacteria grow undetected because they do not produce an "off" odor or change the color or texture of the food. Freezing food slows or stops bacteria's growth but does not destroy the bacteria. The microbes can become reactivated when the food is thawed. Refrigeration may slow the growth of some bacteria, but thorough cooking is needed to destroy the bacteria.
Symptoms
 In most cases of foodborne illness, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include
* abdominal cramps
* nausea
* vomiting
*diarrhea
* fever
* dehydration
Risk Factors
Some people are at greater risk for bacterial infections because of their age or immune status. Young children, pregnant women and their fetuses, the elderly, and people with lowered immunity are at greatest risk.
Complications 
Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious illness than vomiting or diarrhea. They can cause spontaneous abortion or death.
In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7, and can lead to kidney failure and death. HUS is a rare disorder that affects primarily young children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. The child may become infected after consuming a contaminated food, such as meat (especially undercooked ground beef), unpasteurized apple cider or apple juice, or raw sprouts.
The most common symptoms of infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 2 to 6 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Symptoms of HUS include fever, lethargy, irritability, and pallor. In about half the cases, the disease progresses until the kidneys are unable to remove waste products from the blood and excrete them into the urine (acute renal failure). A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely. 
You need to see a doctor right away if you have any of the following symptoms, with or without gastrointestinal symptoms:
* Signs of shock, such as weak or rapid pulse; shallow breathing; cold, clammy, pale skin; shaking or chills; or chest pain.
* Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urine output, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing.
* Confusion or difficulty reasoning. 
Diagnosis 
Your doctor may be able to diagnose foodborne illness from a list of what you've recently eaten and results from the proper laboratory tests. Diagnostic tests for foodborne illness should include examination of the feces. A sample of the suspected food, if available, can also be tested for bacteria and their toxins as well as for viruses and parasites.
Treatment
Most cases of foodborne illness are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. In cases with gastrointestinal or neurologic symptoms, people should seek medical attention.
In the most severe situations, such as HUS, the patient may need hospitalization in order to receive supportive nutritional and medical therapy. Maintaining adequate fluid and electrolyte balance and controlling blood pressure are important. Doctors will try to minimize the impact of reduced kidney function. Early dialysis is crucial until the kidneys can function normally again, and blood transfusions may be needed.
Prevention
Most cases of foodborne illness can be prevented through proper cooking or processing of food, which kills bacteria. In addition, because bacteria multiply rapidly between 40¡F and 140¡F, food must be kept out of this "danger zone." 
To prevent harmful bacteria from growing in food, always
* Refrigerate foods promptly. If you let prepared food stand at room temperature for more than 2 hours, it may not be safe to eat. Set your refrigerator at 40¡F or lower and your freezer at 0¡F.
*Cook food to the appropriate temperature (145¡F for roasts, steaks, and chops of beef, veal, and lamb; 160¡F for pork, ground veal, and ground beef; 165¡F for ground poultry; and 180¡F for whole poultry). Use a thermometer to be sure! Foods are properly cooked only when they are heated long enough and at a high enough temperature to kill the harmful bacteria that cause illness.
* Prevent cross-contamination. Bacteria can spread from one food product to another throughout the kitchen and can get onto cutting boards, knives, sponges, and countertops. So keep raw meat, poultry, seafood, and their juices away from other foods that are ready to eat.
* Handle food properly. Always wash your hands before touching food and after using the bathroom, changing diapers, or handling pets, as well as after handling raw meat, poultry, fish, shellfish, or eggs. Clean surfaces well before preparing food on them.
* Keep cold food cold and hot food hot.
* Maintain hot cooked food at 140¡F or higher.
* Reheat cooked food to at least 165¡F.
* Refrigerate or freeze perishables, prepared food, and leftovers within 2 hours.
* Never defrost food on the kitchen counter. Use the refrigerator, cold running water, or the microwave oven.
* Never let food marinate at room temperature; refrigerate it.
*Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.
*Remove the stuffing immediately from poultry and other meats and refrigerate it in a separate container.
* Do not pack the refrigerator. Cool air must circulate to keep food safe.
Food Irradiation
Food irradiation is the treatment of food with high energy such as gamma rays, electron beams, or x-rays as a means of cold pasteurization, which destroys living bacteria, to control foodborne disease. The United States relies exclusively on the use of gamma rays, which are similar to ultraviolet light and microwaves and pass through the food leaving no residue or "radioactivity." Food irradiation is currently approved for wheat, potatoes, spices, seasonings, pork, poultry, red meats, whole fresh fruits, and dry or dehydrated products. Although irradiation destroys many bacteria, it does not sterilize food. Even if you're using food that has been irradiated by the manufacturer, you must continue to take precautions against foodborne illness, through proper refrigeration and handling, to safeguard against any surviving organisms.
Common Sources of Foodborne Illness
Source of illness: Raw and undercooked meat and poultry.
Symptoms: Abdominal pain, diarrhea, nausea, and vomiting.
Bacteria: Campylobacter jejuni, E. coli O157:H7, L. monocytogenes, Salmonella. 
Source of illness: Raw (unpasteurized) milk and dairy products, such as soft cheeses.
Symptoms: Nausea and vomiting, fever, abdominal cramps, and diarrhea. 
Bacteria: L. monocytogenes, Salmonella, Shigella, Staphylococcus aureus, C. jejuni. 
Source of illness: Raw or undercooked eggs. Raw eggs may not be recognized in some foods such as homemade hollandaise sauce, caesar and other salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings.
Symptoms: Nausea and vomiting, fever, abdominal cramps, and diarrhea.
Bacteria: Salmonella enteriditis. 
Source of illness: Raw or undercooked shellfish.
Symptoms: Chills, fever, and collapse. 
Bacteria: Vibrio vulnificus, Vibrio parahaemolyticus.
Source of illness: Improperly canned goods, and smoked or salted fish.
Symptoms: Double vision, inability to swallow, difficulty speaking, and inability to breathe. (Seek medical help right away!)
Bacteria: C. botulinum. 
Source of illness: Fresh or minimally processed produce.
Symptoms: Diarrhea, nausea, and vomiting.
Bacteria: E. coli O157:H7, L. monocytogenes, Salmonella, Shigella, Yersinia enterocolitica, viruses, and parasites.
Points to Remember
* Foodborne illness results from eating food that is contaminated with bacteria, viruses, or parasites.
*People at greater risk for foodborne illness include young children, pregnant women and their fetuses, the elderly, and people with lowered immunity.
*Symptoms usually resemble intestinal flu. See a doctor immediately if you have more serious problems, or if you do not seem to be improving as you'd expect.
*Treatment may range from replacement of lost fluids and electrolytes for mild cases of foodborne illness, to hospitalization for severe conditions such as hemolytic uremic syndrome.
*You can prevent foodborne illness by taking the following precautions:
*Wash your hands with hot, soapy water before preparing food and after using the bathroom or changing diapers.
*Separate raw meat, poultry, or seafood from other foods to keep these foods and their juices away from ready-to-eat foods.
*Cook foods properly and at a high enough temperature to kill harmful bacteria.
*Refrigerate foods within 2 hours or less after cooking because cold temperatures will help keep harmful bacteria from growing and multiplying.
* Clean surfaces well before using them to prepare foods. 
For More Information
To find more information on this topic, visit: 
American Dietetic Association
U.S. Department of Agriculture
U.S. Department of Health and Human Services
U.S. Environmental Protection Agency (EPA)
U.S. Food and Drug Administration
Center for Food Safety & Applied Nutrition
Centers for Disease Control and Prevention
Gateway to Government Food Safety Information
Partnership for Food Safety Education