Myth or Fact, Stress Causes Ulcers... | Granite Peaks GI

Foryears, people have believed that stress caused ulcers. While stress does contribute to a number of gastrointestinal issues (i.e., Irritable Bowel Syndrome), it is not the cause of ulcers. There are two main causes of ulcers: (1) Medications, primarily non-steroidal anti-inflammatory drugs (NSAIDs), which includes both over-the-counter and prescription medications such as aspirin, ibuprofen, naproxen and others; and, (2) a chronic bacterial infection known as H. Pylori– which has been identified in 65-85 percent of those found to have stomach and duodenal ulcers. (Excessive alcohol use and smoking exacerbate and may promote the development of ulcers.)
Now that doctors know the two main causes of ulcers- NSAIDs and H. Pylori infection- they are able to detect them, treat them, and cure patients of their ulcer disease. Whereas in the past, a patient might have had to undergo surgery for their ulcer, now doctors can manipulate the medications or treat the H. Pylori with antibiotics. Surgery is a rare option.
H. Pylori is the most common infectious agent in the world and is especially prevalent in under-developed countries. Scientists are not sure how the H. Pylori infection is spread, but suspect it is contracted through food and water.
“There are different strains of H. Pylori,” explains Granite Peaks Gastroenterologist Kyle Barnett, MD. “You may get the bacterial infection when you are young, but it might not cause symptoms for many years. If the strain is non-aggressive, you may never even know you have the infection.” When it does present itself, it is important to treat the infection as it can lead to serious diseases. “When we see stomach cancer, this bacteria is often present,” confirms Dr. Barnett, who has been treating patients for more than 20 years.
Detecting the bacteria can be done through a variety of noninvasive tests. One of the easiest, quickest tests is the breath test method done during an office visit. A blood test identifies antibodies, signaling prior exposure to the bacteria- it doesn’t necessarily mean you are still infected. Like the blood test, a stool test can also show whether the bacteria is present.
Another method of detecting H. Pylori is to do a biopsy. “Generally, we do a biopsy if we’re performing an upper endoscopy on a patient who has exhibited ulcer symptoms,” explains Dr. Barnett. There are factors that can influence the sensitivity of all the tests (i.e., if the patient has been taking acid blockers or antibiotics).
“Providing your doctor with a detailed account of what you are taking and your symptoms will help determine what tests and steps should be taken next,” advises Dr. Barnett. He points out that it is common to see the bacteria in groups who have emigrated together or in families, since they have shared space, food, and similar habits. This means if your siblings or parents have tested positive for H. Pylori, you could carry it too.
While abdominal pain is one of the symptoms of ulcers (see sidebar), it could also be a result of a number of gastrointestinal issues, such as acid reflux, pancreatitis or gall bladder issues. Testing for H. Pylori will help determine if an ulcer may be involved in the patient’s discomfort. Immediate evaluation is necessary when gastrointestinal bleeding is the presenting symptom, such as passing black or bloody stools. When blood mixes with acid in the stomach, it turns black.
The good news about ulcers? They are very treatable. “Twenty years ago we knew very little about the role H. Pylori played in the development of ulcers. Oftentimes, ulcers were a chronic problem in people; they would require surgery, sometimes removing a portion of their stomach as their ulcer treatment,” recalls Dr. Barnett. “Now, it is a rare patient that requires surgery. We can treat them medically.”
If a patient comes in with symptoms of burning abdominal pain, nausea, vomiting, or any symptoms that suggest a more aggressive process, (i.e., bleeding, weight loss, trouble swallowing) or is elderly, they should be evaluated as soon as possible. Recognizing the symptoms and causes of ulcers can lead to earlier detection, specific non-surgical ulcer treatment, and hopefully prevention of complications of ulcers.