In a recent interview, Dr. Gupta discussed a little known cause of ulcers, and its potential to contribute to stomach cancer. Here are his answers to some timely questions.
Could my ulcers be caused byinfection?

Stomach and duodenum ulcers can be caused by a bacterial infection called helicobector pylori. Duodenum ulcers are more likely to be caused by infection than gastric ulcers.
Can the infection be present without ulcer or ulcer symptoms?

Yes. You may not feel anything. It is believed that in the United States, as many as 10 to 20% of the adult population may be harboring an infection in the lining of the stomach. And in most patients, it may not cause any pain or symptoms other than minor stomach upsets.

Developing countries, such as Mexico and Latin America, have a much higher rate. As many as 60 to 80% of adults may be infected with this bacteria.
Could this infection be related to diet?

We believe so. Studies show that in developing countries, the bacteria is more prevalent in outlying areas than in urban areas, where diet and hygiene are better.
Then what is the significance ofhelicobector pylori in this country?

The World Health Organization considers this bacteria to be a Class 1 carcinogen. The presence of the bacteria is thought to be a pre-cancerous condition for stomach cancer.

Therefore, those 10 to 20% of people in the United States who have the infection carry the same high risk of stomach cancer as those in developing countries.
How does this cause cancer?

This bacteria is unique in that it produces an enzyme called urease. Urease breaks down the amino acids in food. This breakdown results in a gas called ammonia. The presence of ammonia can bring about changes in the DNA of the gastric lining cells.

The bacterium exists in the colon as well, but it won't cause cancer there. Why? Because there are no amino acids in the colon.
Besides ulcers, what other illnesses can this infection cause?

This infection appears to be a common cause of either intermittent or persistent, but chronic dyspeptic or maldigestive symptoms, like bloating, excess gas, heartburn, nausea, bad breath, sour stomach, and abdominal pain of unexplained origin.

The infection can also cause gastrointestinal bleeding or weight loss.
So how do you screen for thisinfection?

If a patient has minimal or no symptoms, but has a family history of stomach cancer, a routine blood test could be done. Your family practitioner can order it.

However, if a patient has significant symptoms, we could examine the lining of the stomach with an endoscope and take a biopsy.

 

When we take a biopsy, we are looking to see the presence of urease in the bacteria.

It is possible that the bacteria may be present, but if the urease test is negative, the individual doesn't have an increased cancer risk.

    In many patients, peptic ulcers are caused by infection.
    Eradication of the infection can lead to a long term cure from ulcers.
    About 10 – 20% of adults in the US have this infection, which is a precancerous condition for stomach cancer.
    The presence of urease, an enzyme associated with the bacteria, can react with amino acids in the stomach to cause cancer.
    The infection can be treated early with a course of antibiotics and therefore cancer risk can be reduced.

Who are the high risk groups?

    Those with a family history of stomach cancer, esophageal, or enterstomal cancer.
    Excess coffee drinkers (more than 6 cups a day) and alcoholics.
    Diabetics. They tend to have weaker stomachs not able to totally empty themselves. Diabetics also tend to be on a restricted diet, and therefore, malnourished.

"It is ironic that this is a preventable and treatable risk. Once we detect the presence of the bacteria andurease, we can treat it with a course of antibiotics."
 

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