Bacteria as the cause of peptic ulcer disease--a consensus statement is available

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For over a decade, the prescription drugs Tagamet and Zantac have been the standard treatment for peptic ulcers. By inhibiting the production of excessive stomach acid, both drugs facilitate healing.

Although widely prescribed to prevent recurrence, Tagamet and Zantac aren't very effective for this purpose. Half the people on these drugs suffer a relapse at six months, and about 95% at two years. Tagamet and Zantac are among the top selling prescription drugs in the U.S.

These drugs will slowly begin to take a back seat to antibiotics, now that doctors have accepted the evidence that a bacterium called Helicobacter pylori plays a major contributory role in the development of peptic ulcers. A consensus conference, held early this year at the National Institutes of Health, recently released a summary of its findings to the public.

The consensus panel of 14 experts said that a two-week course of a combination of bismuth (the active ingredient in Pepto Bismol) and antibiotics would eradicate H. pylori and cure the ulcer. This would successfully treat about 80% of people with stomach ulcers and reduce the rate of recurrence in up to 90%. Several effective drug combinations are identified, e.g., tetracycline and metronidazole (Flagyl), plus bismuth.

Tagamet or Zantac can be added to the two-week regimen to relieve symptoms. Physicians following these new practice guidelines will allow thousands of people with ulcers to discontinue long-term use of Tagamet and Zantac.

For over a half century, peptic ulcers were thought to be caused by stress and aggravated by dietary factors (e.g., spicy or greasy foods), alcohol, and smoking. Before Tagamet went on the market over 18 years ago, a bland diet was the standard treatment. By the late 1970s, the medical profession had accepted the fact that this not only didn't help people with ulcers, it often aggravated the condition.

Bacterium was a suspected cause of peptic ulcers as long ago as the late 19th century. But, according to the consensus panel, not until 1982, when Australian researchers Barry Marshall and Robin Warren isolated H. pylori, did many believe that the spiral organism plays a significant causal role in peptic ulcer disease.

Actually it took a decade of fierce debate within the medical profession to turn a heretical view into an accepted medical practice. Two studies published over the last few years in The New England Journal of Medicine and Annals of Internal Medicine confirmed the fact that peptic ulcers are the result of bacterial infection.

Their results led to the consensus conference whose recommendations go out to the medical profession and the public. Its advice does not apply to people whose stomach ulcers are the result of long-term use of nonsteroidal anti-inflammatory drugs.

• For a free, single copy of the Summary of the NIH Consensus on H. Pylori in Peptic Ulcer Disease, write to the NIH Consensus Program Information Service, P.O. Box 2577, Kensington, MD 20891, or call (800) 644-6627.

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MARYANN NAPOLI: EDITOR, CARA DUBROFF: LAYOUT

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