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 (ADHF), 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: \o7 H. pylori \f7 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 ADHF ulcer campaign. The treatment for \o7 H. pylori \f7 represents the first cure of a major disease entity since the polio vaccine was developed four decades ago.
"It's so totally revolutionary. It's like taking a dictum that has been held sacred for many years and saying that it's no longer true," says Peura, of Charlottesville, Va.
Peura 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.
To launch the public education campaign, the ADHF summoned the media on a hot, muggy morning earlier this month to Grand Central Station in New York City, where, they noted: "You may get stressed, but you won't get an ulcer."
For years many doctors suspected that diet and stress weren't the only culprits causing peptic ulcers, 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 \o7 H. pylori.\f7
"Normally, science involves putting together a puzzle from the outside in to create the whole picture. Here, we had a picture--clinical observation and treatment--and were trying to put the puzzle together to support it," says Peura, a gastroenterologist. "Dr. Marshall was a young physician, was not recognized as an expert in this, hadn't done any research in this area. The medical establishment wasn't willing to accept one person's word on this."
\o7 H. pylori \f7 lives on or in the lining of the stomach. As many as 60% of older Americans have the bacterium and up to 95% 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 \o7 H. pylori \f7 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."
\o7 H. pylori \f7 infection rates are higher among African Americans 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, which are those that occur in the stomach or duodenum, are the most common kind of ulcer.
Although ulcer disease is rarely fatal, the disease has been costly and painful for many people. Marlena Wood, 49, a hard-driving real estate broker in Manhattan, is typical of ulcer patients who suffered for years and blamed themselves for the disease.
At 32, Wood was in the fashion business, under stress and dieting on cherries when she had her first ulcer attack. She landed in the hospital with a bleeding ulcer and needed blood transfusions.
She began taking acid-reducing medication, but suffered three more life-threatening bouts with bleeding ulcers over the next 13 years. Each bout seemed to occur during a period of high stress.
"I had doctors say to me, 'Well, it's because you're a Type-A personality. Why don't you quit the business world?' " Wood recalls. "You really think you're to blame."
After her last hospitalization, in 1991, a top New York gastroenterologist prescribed a new acid-reducing drug.
"He told me I owned this disease, and that, forever and a day, I would have to take drugs," she says.