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What causes ulcers – stress, alcohol or bacteria?

The question: I've always thought ulcers were caused from eating too many spicy foods, being stressed, or drinking too much alcohol, but can a bacteria also cause the problem? What do you do if so?

The answer: While it's not uncommon to feel some abdominal discomfort after eating a spicy meal, drinking alcohol or dealing with a stressful situation, the truth is that they are not the root cause of ulcers.

Ulcers are holes in the lining of the stomach and small intestine that can lead to a constellation of symptoms including intermittent abdominal discomfort gets worse on an empty stomach but temporarily improves with food intake or antacid use. In more severe cases, ulcers can lead to nausea, vomiting, bloating, weight loss and blood in the stool.

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The two main causes of ulcer formation are the use of non-steroidal anti-inflammatory medications and the bacteria Helicobacter pylori (H.pylori). Anti-inflammatories cause a breakdown in the protective lining of the stomach making it vulnerable to acid. H.pylori has a similar effect but the bacteria also triggers an increase of acid production, which further causes damage to the stomach. In addition to gastritis and ulcer disease, H.pylori has been identified as a potential carcinogen – in rare but serious situations the bacteria can lead to stomach cancer.

Worldwide, 50 per cent of people are infected with H.pylori. It is thought to be spread through contaminated food and water and also seems to be passed from person to person through contact with infected saliva or stool. In Canada, it is estimated that 35 per cent of our population carries the bacteria. In countries such as Japan, Korea and Taiwan the rates are higher . Most infections occur in childhood and will last a lifetime unless treated. Fortunately, the majority of people who are infected with H.pylori do not have any symptoms . This being said, about 10-15 per cent of those with H.pylori will develop ulcers.

If you are having stomach irritation or symptoms that may indicate you have an ulcer, your doctor can test for H.pylori with blood, breath or stool tests. If you test positive, antibiotics and acid suppressive medication can help to heal the ulcer and allow the stomach lining to rebuild. It's not easy to treat, and may require three to four medications taken for seven to 14 days to ensure higher levels of success . While the body is healing, it would be prudent to limit certain foods, smoking and alcohol.

If you are without symptoms, your doctor may still consider testing for H.pylori if you have a close relative with the bacteria or you have a family history of stomach cancer. If you continue to have symptoms, your doctor may consider a different treatment, send you for further testing or refer you to a specialist for a gastroscopy to look directly at the stomach lining and take biopsies to ensure nothing more serious is the causing the symptoms.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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