Causes of Stomach Ulcers?

[admin]

Hi all you clever kids out there........

I had a recent conversation with a nurse that is a GI specialist. She told me that stomach ulcers are caused by excess stomach acid. When I was at Uni our professor who taught GI told us that yes the way to cure them is to reduce stomach acid (anti-biotics etc) but they are not caused by excess acid.

She also insisted that stress causes excess stomach acid, and that's what caused ulcers. I asked her how (as I always thought acid production involved the parasympathetic nervous system, histamine, and gastrin) so I couldn't see how the sympathetic nervous system had any effect in this process. The professor I have already mentioned also told us that stress contributes to ulcers, but from causing insufficient mucus to protect the lining from damage. Obviously there are other causes too, alcohol and NSAID's being two to mention.

Is what the professor said true, am I going mad, or is she correct?

Should I start a section in the forum for pharmacology, or is the clinical section enough?

[Steve G]

Sounds like the nurse is a bit out of date to me - the idea that stress causes ulcers went out quite a while ago. The vast majority of duodenal and gastric ulcers are caused by H.pylori, as shown by Warren and Marshall in the 80s. H.pylori is an interesting little bug. It produces an enzyme called urease, which essentially neutralises the microenvironment around the bacteria (any urea present is converted to ammonia). H.pylori produces cytotoxins which damage the mucosa, opening the way for further damage by other bacterial products and hydrogen ions.

So, get rid of the infection to get rid of the ulcer. To do this, we use an acid suppressant and two antibiotics for one week. The americans use a two week course,but this is not really needed (increased risk of side effects, decreased compliance).

Some results from a quick google search:
Home | CDC Ulcer
BBC NEWS | Health | Nobel for stomach ulcer discovery
Helicobacter Pylori and Peptic Ulcer

Of course there are other causes of ulcers, the two most important being NSAIDs and corticosteroids. Both of these exert their effect by reducing the production of the cytoprotective cyclo-oxygenase-I enzyme. COX-II inhibitors should in theory be better than non-selective NSAIDs, but this is still being debated. I think the current evidence is that COX-IIs are better for minor GI effects, but there is not much of a difference in major GI side effects (i.e. bleeding ulcers). I've not had a chance to look in depth at the MEDAL (etoricoxib vs diclofenac) yet, so don't quote me on this.

So the role of stress is a minor side issue that doesn't have any effect on how patients are treated.

[johnep]

Heliclear been mcs for months.
johnep

[Zoggite]

I thought I read a letter from Abbott a few weeks ago saying they were discontinuing Heliclear altogether? Anyone else remember reading this, or am I hallucinating again?

[Steve G]

I seem to remember the letter was from Wyeth. It's not really a problem though - the GP just has to prescribe it separately, though it does make things slightly more complicated for the patient.

[johnep]

Well at least it will stop arguments over three NHS charges.
johnep