Aging Begins at 30

Dyspepsia or Difficult Digestion

Gastric surgeons may be an endangered species.

New H2 receptor blocker drugs are keeping ulcer patients at work. Histamine, a tissue amine (histos in Greek) can latch onto three different tissue anchors. Those labeled H2 cause the release of acid in the stomach and can be blocked by the new (1970's) cimetidine family of medicines.

Gastritis, duodenal and gastric ulcers may be infectious diseases treatable by antibiotics and by the 100-year-old medicine bismuth. The guilty organism, isolated in 1982, is Helicobacter pylori, the coiled bacterium that occurs at the exit gate of the stomach. It is present in 90% of duodenal and 70% of gastric ulcer patients. People with these organisms are 20 times more likely to develop ulcers than those without.

Duodenal and gastric ulcers develop when there is an imbalance between the digestive acid-pepsin fluids and the the gut wall resistance. Cimetidine cuts the acid and antibiotics prevent the Helicobacter destroying the protective mucus coat.

Half of cimetidine is like histamine and half isn't. Like a bad key, cimetidine prevents access of histamine to its H2 anchor keyhole and cuts down acid. Amoxicillin with metronidazole (Flagyl) and bismuth can eradicate Helicobacter in 75%.

A patient with an ulcer will have pain in the upper middle abdomen after eating or in the middle of the night. The pain, absent in 20% of the elderly, may spread to the back and is often relieved by food or antacids. Stress at work, smoking, excess alcohol, nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen used for joint troubles, or aspirin can cause pain. The diagnosis is made by x-ray, gastroscopy (looking inside the stomach), or by both.

Over 5 years, the recurrence rate without treatment is 100%, but ulcer disease often burns itself out over 20 years. H2 blockers reduce recurrence risk to 20% of what it was.

New peptic ulcers are treated with H2 blockers such as cimetidine or sucralfate (a stomach coater) and treatment of the Helicobacter infection is reserved for patients with recurrent disease in whom the organism is present.

Ulcers are decreasing but ulcer perforation has increased in elderly women, maybe the result of a three-fold increased use of NSAID drugs .

Research in drugs or causes of disease like Helicobacter is extremely cost effective. Hospital and medical care costs and absenteeism and death costs of peptic ulceration are enormously expensive. A gastrectomy (removal of 2/3 of the stomach) costs $8000 with a 5% ulcer recurrence rate. Cimetidine is about $50 a month for initial treatment and $20 monthly for maintenance. If Helicobacter can be eradicated by antibiotic treatment, costs will fall even further.

Surgery is now reserved for complex ulcer disease unresponsive to treatment, for perforation of previously undiagnosed ulcers, or for ulcers that have bled seriously more than once.

Gastric surgeons can now begin to feel like Maytag washer repairmen. Remember, he's "the loneliest man in town."

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See related Patient Topics Digestive System or Peptic Ulcer.

See related Provider Topics Digestive System or Peptic Ulcer.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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