Mike, a regional representative for anexpanding software company, has had bouts of stomach discomfort and pain foreight months. His busy schedule has kept him from going to the doctor, and hefigures he will eventually lower his stress level and wean himself off favoritespicy foods. Besides, a friend has introduced him to an over-the-counter (OTC)acid-reducing drug that treats his heartburn. Mike believes that he may havecured his problem.

Mike is typical of the many people in theUnited States who suffer from heartburn, which can be a symptom of an ulcer.Too busy to seek treatment, people instead self-prescribe an antacid. Thetrouble is, many of these individuals actually have peptic ulcer disease (PUD),and by self-medicating, are not getting proper treatment for their condition.According to the American Gastroenterological Foundation (AGA), 25 millionAmericans currently suffer PUD, which is caused by the bacteriumHelicobacter pylori (H. pylori). However, studies show thatpublic perception of ulcers -- that they are caused by stress -- continues,despite evidence to the contrary.

In a survey conducted by the AGA, nearly 90percent of Americans reported that they still believe stress causes ulcers."Most of the public doesn't know about the association (between ulcers andbacteria), and the reason that's a concern is that many people will just takeover-the-counter antacids and histamine blockers -- and just take them foryears without a physician's care," says David Swerdlow, an epidemiologistat the Centers for Disease Control and Prevention (CDC) and co-author of arecent study published in the journal Infectious Diseases in ClinicalPractice. In fact, the lack of awareness on the part of both the public andthe medical community led Congress to recommend to the CDC that it mount aneffort to educate people.

In the study, Dr. Mark Dworkin and colleaguesstate that many studies show that when H. pylori is treated properly --with a regimen of antibiotics -- people are cured, even if they've had an ulcerfor years. By contrast, "treating" ulcers with an antacid does not getrid of the bacterium that causes it and carries with it an 80 percentrecurrence rate.

How Is PUD Diagnosed?

A variety of tests are available for H. pylori infection. Theyinclude a stool test, a breath test and a test that involves placing a flexibletube called an endoscope into the stomach or upper intestine, which is used toobtain a sample from the stomach lining that can be tested for the bacteria.The AGA reports that there are more than one million ulcer-relatedhospitalizations each year. H. pylori has also been implicated as thecause of some gastric cancers and may play a role in other diseases, so adiagnosis at the first sign of symptoms is important.

Not All Doctors Treat PUD the Same

A report in the July 26, 1999 issue of the Archives of InternalMedicine found that treatment designed to kill H. pylori tends tovary widely from doctor to doctor. The study found that some patients get twodrugs, while others get three, writes author Dr. M. Brian Fennerty of OregonHealth Sciences University in Portland and colleagues at the Veterans AffairsMedical Center in Portland and at Wisconsin Medical School. The most effectivecombination was a three-drug regimen containing a proton pump inhibitor, amedication that suppresses stomach acid. Ask your doctor for thistreatment.