WHAT IS IT?
In your stomach, gastric juices break down the food you swallow and kill bacteria that come with it. These juices consist mostly of acids and enzymes (proteins that speed up chemical reactions in the body). They don’t digest your stomach at the same time because it protects itself by making a slippery fluid, called mucus, that coats the stomach lining. If that layer of mucus is damaged, though, the juices can get through and cause a couple of problems: gastritis and ulcers.You’ll have the burning pain of gastritis if your gastric juices eat away at the mucous linings of your stomach, your esophagus (the tube that runs from your throat to your stomach), or your intestine. You get a gastric ulcer-a stomach sore-if the juices eat all the way through a section of the mucous lining and into the stomach wall. This causes pain, bleeding, and sometimes infection or other problems.
Gastritis most often goes away on its own. Sometimes, though, it can turn into an ulcer, as it does for 1 out of 10 people in the United States.
Doctors used to think that gastritis and ulcers were caused by something hard to pin down, such as stress or certain foods; patients would spend years trying to treat the symptoms with antacids or by staying away from spicy meals. Today we know that most cases come from bacteria, and almost all the rest stem from painkillers, such as aspirin, that damage the stomach’s ability to defend itself. This is good news: It means most ulcers and gastritis are now easy to treat and to cure for good.
WHAT IS HAPPENING?
Problems start when something damages the mucous lining that protects your stomach. By far the most common culprit is a bacterium called Helicobacter pylori (H. pylori). The most common way for this germ to spread seems to be through feces-when people who are infected don’t wash their hands well after going to the bathroom. It can then spread by way of food, water, eating utensils, and person-to-person contact. More than half the people in the United States are infected by the time they reach age 50.
Most of the time H. pylori causes no problems. People can have it and never know it’s there. But in some, it spurs the stomach to make too much acid and break down the mucous lining; acids and bacteria may burrow into the lining, setting the stage for gastritis or ulcers. Painkillers such as aspirin and ibuprofen open the door for gastritis and ulcers because they keep the stomach from making enough mucus to protect itself.
If gastric juices eat through the mucous lining into your stomach wall to form an ulcer, they can damage blood vessels and cause bleeding. If they eat a hole all the way through the stomach wall as well, bacteria and half-digested food can leak out, creating what is called a perforated ulcer. This condition is very painful and can be quite serious. A stomach ulcer near the part of the intestine that meets the stomach-the duodenum-may also cause swelling that sometimes blocks food from moving into the intestine.
In addition to the threat of ulcers, H. pylori infection can lead to stomach cancer. Researchers estimate that infected people are three to eight times more likely to develop this type of cancer.
WHAT CAUSES IT?
About one person in six infected with H. pylori will get an ulcer. But while doctors now know that H. pylori is most often the cause, no one is sure why some people infected with it get gastritis or ulcers and others don’t. Nor does anyone know why some people who take painkillers end up with stomach problems while others don’t. Many things can increase your chances of being exposed to the bacteria, though. And experts have found many other factors that can raise your risk of stomach problems once you have been exposed to H. pylori. Some are outside your control. Others you can do something about.
THINGS YOU CAN’T CHANGE
Age
The older you are, the greater your chance of having been exposed to H. pylori bacteria sometime in your life and the greater your chance of having gastritis or an ulcer.
Gender
More men than women get ulcers. No one knows why.
THINGS YOU CAN CHANGE
Living conditions
Doctors think you can get H. pylori by eating food or drinking water that contains it. The germ may also spread directly from one person to another, but exactly how is not clear. People living in crowded housing with poor sanitation are more likely than others to have H. pylori.
Smoking
Cigarette smoking seems to increase the chances of getting an ulcer. Smoking also slows the healing process once you have one and appears to make it more likely an ulcer will return.
Caffeine
Coffee, tea, cola, and other foods with caffeine make the stomach release extra acid. If you already have a stomach problem, this acid can make things worse. On the other hand, caffeine doesn’t seem to cause gastritis or ulcers. And decaffeinated coffee also appears to make the stomach release more acid-a hint that caffeine isn’t the only problem with these drinks. Experts aren’t sure what else is.
Stress
Stress-a person’s response to demanding or high-pressure events-was once thought to be a major cause of gastritis and ulcers. Experts now know that stress alone doesn’t cause these stomach problems. But if you’re infected with H. pylori, lots of stress can weaken your immune system. This makes it harder for your body to fight the bacteria and raises your risk of getting gastritis or an ulcer. Also, many people who already have a stomach problem say stress makes the symptoms worse.
Injury
Sometimes an injury, or even surgery, can damage the mucous lining of your stomach. Such damage may increase your chances of getting an ulcer.
WHAT YOU CAN DO FOR YOURSELF
Doctors used to tell patients with ulcers or gastritis to avoid fatty, spicy, and acidic foods. They also advised drinking a lot of milk to coat and protect the stomach. And they told patients to cut down on the stress in their lives. Now that doctors know about H. pylori, their advice has changed.
Today the most useful thing you can do for yourself is to tell your doctor about your symptoms and to be sure you’re tested for H. pylori. If you have the germ in your stomach, killing it cures the disease nine times out of 10.
Because H. pylori is so widespread, it’s hard to avoid. Still, there is much you can do to cut your risk of being infected. If you already have H. pylori in your system, you can do a lot to keep the bacteria from causing gastritis or ulcers, or to relieve their symptoms if the problems do occur.
Keep clean
Good hygiene can help you keep H. pylori from getting into your stomach or keep it from coming back after treatment for an ulcer. Wash your hands well before eating, and keep eating utensils, drinking glasses, and the bathroom clean. If you travel abroad, stick to bottled water, and avoid raw vegetables or fruits with the skin on.
Eat the right stuff
Some studies suggest that eating a lot of fiber-above all from fruits and vegetables-can lower your risk of gastritis and ulcers. Vitamin A also appears to help. Two foods that provide plenty of both are broccoli and sweet potatoes.
If you have stomach pain from gastritis or an ulcer, try eating small meals four to six times a day. Rest after each meal, if you can.
Despite what we used to think, bland diets don’t seem to ease symptoms in most people with gastritis or ulcers. Still, some people do find that staying away from certain foods-spicy ones, for instance-seems to help. If you find some foods do bother you, don’t eat them.
Keep a food diary
If you think some foods cause your symptoms or make them worse, but you’re not sure which, keep a food diary for a week or two. List all the things you eat and when you eat them. Also note any symptoms you have, what time they come on, and how strong they are. After a while you may begin to spot patterns: Symptoms might always occur after you’ve eaten a certain food. If so, avoid that food for 10 days to a month and see if your symptoms quiet down. If they don’t, stop eating the next food you suspect. After things improve, try adding the last food you avoided back to your diet, a little at a time. If your symptoms come back, you’ll know what’s to blame.
Be careful with pain relievers
If you must take painkillers often, stay away from those known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium. NSAIDs can cause or worsen gastritis and ulcers, even if you’re not infected with H. pylori. Try acetaminophen (Tylenol) instead. If you do take aspirin, get an enteric-coated type that delays release of the drug until after it has passed through your stomach.
Take the lowest possible dose of any painkiller, and take the drug with food. That way it will be less likely to cause stomach problems.
Also, talk to your doctor about other stomach-friendly drug options. If you’re taking pain relievers to treat arthritis pain, your doctor may recommend a type of drug called a COX-2 inhibitor. COX-2 inhibitors are a new class of painkillers. They seem to ease pain as well as NSAIDs do, but without the same risk of stomach problems. However, it’s still too soon to know about the side effects of long-term use of COX-2s, and some questions have already been raised about safety.
Cut down on alcohol
There’s no proven link between ulcers and alcohol, but if you have stomach problems, alcohol may make symptoms worse. Also, cirrhosis of the liver-often caused by heavy drinking-raises the risk of ulcers.
Don’t smoke
If you smoke, quit. If you don’t smoke, don’t start-smoking is one of the worst things you can do to your body. Not only can it raise your risk of getting stomach problems or make them worse, it also increases your risk of heart attack, stroke, and of course lung cancer.
Go easy with antacids and acid blockers
Over-the-counter antacids and acid blockers help ease the symptoms of ulcers and gastritis. But they don’t kill the bacteria causing the problem. Without antibiotics to get rid of the bacteria, the symptoms often return.
Antacids: These take the sting out of stomach acid to prevent or ease pain. But antacids cause side effects in some people-for instance, diarrhea or problems with the way the body uses calcium and magnesium, two important minerals-particularly when taken for a long time. Before using antacids for more than three weeks, call your doctor.
Antacids can also make some health problems worse and interfere with the way certain medications work. Check with your doctor before taking an antacid every day if you’re taking drugs for another problem or if you have high blood pressure, an uneven heartbeat, kidney disease, intestinal problems, chronic heartburn, or any symptoms of appendicitis.
Acid blockers: These over-the-counter drugs, also called H2-blockers, limit the amount of acid your stomach makes. Like antacids, acid blockers ease symptoms but don’t treat the cause. They may have side effects, too, including constipation, blurred vision, dizziness, drowsiness, skin rash, and dry mouth or skin. If you have kidney or liver disease, check with your doctor before using acid blockers. And be aware that smoking decreases the effect of the drug.
Don’t stress out
Brief bouts of stress aren’t harmful, but a lot of stress day after day can take a toll on your health. We now know that stress doesn’t cause gastritis or ulcers-but it can make symptoms worse. Built-up stress can also raise your risk of a lot of other problems such as high blood pressure and heart and artery disease.
Your natural response to stress-from any problem or high-pressure situation-causes changes in your body: Your blood pressure goes up, your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy.
Here are some tips for keeping on an even keel, even in stressful times:
Exercise. People who exercise often tend to feel less anxious and more relaxed.
Laugh more. Use humor to ease tense moments. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and ask yourself whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is no, take a few deep breaths and tell yourself to calm down. If any answer is yes, don’t seethe silently; do something to change the situation.
Take breaks to calm down. Aim for at least 20 minutes twice a day.
Keep a pet. Animals may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, stretching exercises, or meditation.
WHAT YOUR DOCTOR CAN DO FOR YOU
Because doctors know more than they used to about ulcers and gastritis, they can now do more than ever before to treat these problems.
Drug combinations
No single drug can cure ulcers caused by H. pylori. But doctors have found that two or three drugs used together can work. This is called combination therapy.
The most common treatment uses three drugs: two antibiotics, such as tetracycline and metronidazole, to kill the H. pylori bacteria, and bismuth subsalicylate-found in Pepto-Bismol-to boost your stomach’s mucus production. Sometimes a doctor will also prescribe an acid blocker to relieve pain and promote healing.
The triple-drug treatment kills the bacteria and reduces the risk of an ulcer returning in about 90 percent of cases, but it has drawbacks. You must take the drugs on a strict schedule several times a day for two weeks. And the combination has side effects. These include upset stomach, diarrhea, mouth sores, and general discomfort.
An alternative is a dual-therapy approach. Dual therapy might include one antibiotic, such as amoxicillin or clarithromycin, and an acid blocker, such as omeprazole. Dual therapy works in about 80 percent of cases. Many patients find this approach is easier to stick with and has fewer side effects than triple therapy.
Endoscopy
Your doctor can use an endoscope not only to examine your stomach but also to treat an ulcer that is bleeding. Using special attachments on the endoscope, the doctor can seal off blood vessels by burning them or inject the ulcer with drugs to stop the bleeding.
Surgery
Since antibiotics most often kill the germs that cause gastritis and ulcers, surgery is rarely needed. Sometimes, though, the drugs don’t work. In that case, you can try:
Vagotomy. The surgeon cuts the vagus nerve, which carries messages from the brain to the stomach. This keeps the brain from telling the stomach to make too much acid.
Antrectomy. The surgeon removes the lower part of the stomach-the antrum-to keep it from making a hormone that helps produce digestive juices.
Pyloroplasty. If the opening between the stomach and the intestine is blocked, a surgeon can enlarge it. Then the contents can flow more easily.
