We used to think that spicy food, alcohol and a stressful lifestyle could turn on the acid switch in the stomach and that excess acid caused ulcers. These sores -- also referred to as peptic ulcer disease -- occur most commonly in the first part of your small intestine, or duodenum, but can also develop in the lining of the stomach. But in 1982, doctors (who recently won a Nobel Prize for their work) discovered that a common bacteria known as Helicobacter pylori (H. pylori) is the real culprit behind most ulcers. Since then, our focus has shifted from ulcers as a lifestyle issue to ulcers as a treatable -- and curable -- disease.

Here's what you need to know about ulcers.

Not everyone infected with H. pylori gets ulcers.
Although about 20 per cent of North Americans under the age of 40 (and about half of those over the age of 60) become contaminated with H. pylori through environmental exposure, only about 10 per cent develop an ulcer at some point in their life.

Why doesn't everyone infected with H. pylori bacteria end up with an ulcer? Partly because the H. pylori bacteria are not all the same and their ability to cause damage varies, says Dr. David Armstrong, an associate professor of medicine at McMaster University in Hamilton. Also, some people tolerate infection better than others and don't develop symptoms.

Yet another explanation is that while lifestyle factors such as smoking and being under stress don't actually cause ulcers, they may influence why you get an ulcer while your neighbour doesn't. Finally, if you're infected with H. pylori, you're more likely to develop an ulcer -- especially in the stomach -- if you take either acetylsalicylic acid (ASA) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Family and general practitioners manage most ulcers without the need for extensive testing. Your physician will need to know the nature of your symptoms. "If it's predominantly heartburn," says Armstrong, "this suggests reflux disease (acid backing up into the esophagus)." If, on the other hand, you experience pain or discomfort in the upper abdomen that comes on either with meals or two to three hours afterward, you're more likely to have an ulcer. If you're not taking ASA or NSAIDs (both can cause ulcers), the most likely explanation for this pain is an ulcer.


Page 1 of 2 -- On page 2, learn what you can do to cope with and cure ulcers.

Treatment consists of a triple-drug regimen.
If you have an ulcer you'll be given two (maybe more) antibiotics to help eradicate the infection. And since damage caused by the infection is exacerbated by acidic digestive juices, you'll also take a proton pump inhibitor (PPI), a potent acid-suppressing medication, to help heal the ulcer and increase the effect of the antibiotics. Most people do well with this regimen. "Antibiotics can cause the occasional tummy upset or nausea, but, in general, treatment is pretty well tolerated," says Armstrong. If possible, you should stop taking ASA or NSAID therapy to make sure the ulcer heals and doesn't recur. If you can't stop these drugs, you may have to take the PPI indefinitely.

In some cases, ulcerlike symptoms such as abdominal pain turn out to be something other than an ulcer.
Between 30 and 50 per cent of people who develop symptoms of an ulcer actually have nonulcer dyspepsia, a disorder that is not unlike irritable bowel syndrome, says Armstrong.

"People with both disorders may have problems moving food through their digestive systems, although they do not have any obvious underlying disease," he says. Acid-suppressing drugs help treat symptoms in about half of those with dyspepsia. Drugs that speed the transit of food through the digestive tract (prokinetics, such as domperidone) may also improve dyspepsia symptoms. "Sometimes lifestyle changes play a role, too, so counselling and occasionally low-dose antidepressants may help reduce symptoms," adds Armstrong.

R-E-L-I-E-F!
Antacids and other mild acid-suppressing agents available in drugstores may provide adequate short-term relief if your symptoms occur fewer than twice a week. If they occur more often, you should see your doctor.

Alarming symptoms that require immediate medical attention include:
• sudden sharp persistent stomach pain;
• difficulty swallowing;
• bloody vomit or vomit that looks like coffee grounds; and/or
• bloody or black stools.

Page 2 of 2 -- Doctors disprove the myth that ulcers are caused by lifestyle; learn what the real cause is on page 1.