Why ulcers run in families

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Forget stress and spicy foods. The real culprit may be just a kiss away.

TWENTY YEARS AFTER a hemorrhaging ulcer killed Herbert Perrine, his son Philip lay on the living room couch with a horrible sense of deja vu. His own ulcer had flared again. Scattered on the coffee table were empty bottles of Pepto-Bismol, as familiar now as they'd been at his father's bedside. The pain was unbearable.

"It felt like something was gnawing on my backbone and eating its way out the front of me," recalls the 54-year-old retired electrical engineer in Charlottesville, Virginia. "I was afraid I was going to die like my dad."

As it turned out, there was something gnawing on Philip Perrine's insides, perhaps the very demon that had tormented his father. After years of skepticism, experts have come to believe that many ulcers, perhaps most, are caused by a contagious pest, Helicobacter pylori. How the bacterium spreads is unclear, but groups living in close quarters are particularly vulnerable--especially families like the Perrines. In fact, the latest studies merely confirm an age-old lament: Parents and children really are giving one another ulcers.

Not that the clues were in short supply. Since the 1950s, doctors have known that family members of ulcer patients are three times more likely than the general population to have ulcers themselves. Even among those who weren't related, sudden outbreaks were well documented. Ulcers plagued the citizens of London, for instance, during the air raids of World War II. But scientists blamed these strange clusters on stress, bad food, or--in the case of families--heredity. Sure, an infectious bug might have been the more plausible explanation. But the stomach is awash in corrosive acids, said the experts. Nothing could possibly live there.

Something does. In 1983 Barry J. Marshall, an Australian gastroenterologist, identified a mop-shaped bug in stomach tissue taken from ulcer patients. Venturing far beyond the call of scientific duty, he swallowed the thing . . . and came down with the first symptoms of an ulcer. Later he solved the riddle of the creature's survival. It snuggles deep into the stomach's mucus lining, impervious to the digestive juices churning all about. Researchers now suspect that ulcers arise when H. pylori damages this protective blanket.

Though the bug escaped detection for decades, it is everywhere. Half the world's population is believed to be infected, including an estimated 40 million in the United States. For reasons unknown, it afflicts only 10 to 20 percent of its hosts. (It may be that only particular strains cause trouble.)

Still, that's a lot of misery. Ulcers trouble one in ten Americans, and in recent surveys H. pylori has been implicated in up to 90 percent of the cases. (Most of the rest probably arise from overusing aspirin, and genetic disorders still appear to play some role.) What's more, virtually everyone who is infected gets chronic gastritis, a mild inflammation of the stomach lining. When the pest is treated with antibiotics, the illnesses usually go away.

How does it arrive in the first place? Most researchers figure H. pylori is swallowed, but nobody is sure of the source. It could be something as innocent as a lingering kiss or as obvious as bad bathroom habits. "The evidence does suggest that it's person-to-person contact of some sort, but probably not sexual," says Martin Blaser, an infectious disease specialist at Vanderbilt University.

If any family member is infected, say experts, it's likely others also harbor the nuisance. In one study of married couples, 68 percent of the spouses of infected patients had H. pylori themselves. Among those married to uninfected partners, only 9 percent had it. Perhaps because children are rarely obsessed with staying clean, they seem particularly vulnerable. In another study at the University of Toronto, 23 of 27 kids with unexplained gastritis were found to be infected. After testing 22 of their brothers and sisters, the researchers discovered that 18 were themselves carriers. The bug also was found in 25 of 34 parents of the infected kids.

Yet it's not clear who's infecting whom. Recently specialists at the University of New South Wales trailed the scourge as it spread through an Australian family of four. The mother, they found, was almost certainly the original source. She apparently passed it to an infant son, and then one of them infected the infant's twin brother.

While the mother and first twin suffered only upset stomachs, the second became seriously ill. Evaluated at a local hospital, he was found to have two ulcers, very rare in a youngster. After discovering H. pylori and treating the infant, the researchers continued to collect blood samples from the family. Eight months after the child's hospital stay, his father tested positive.

This year, for the first time, the National Institutes of Health urged U.S. doctors to test all ulcer patients for the bacterium and to treat the infected with a two-week regimen of antibiotics. The NIH committee recommended against the routine screening of family members who aren't obviously ill. But that probably won't be the last word on treatment, and for good reason. The organism has been found in a disproportionately large number of patients with certain kinds of stomach cancer. By most estimates, the infection may triple the risk of this uncommon cancer, even if it doesn't cause an ulcer.

So here's the question any parent might pose to the family doctor: If this bug is a potent factor in ulcers, gastritis, and stomach cancer, if it plagues families and it's readily detectable--what are we waiting for? If any member of the family has an ulcer, why not test the whole crew, dispense the necessary antibiotics, and rid everyone of the pest before it causes more trouble?

"If I were a family practitioner, I think I might do it," says David Graham, a gastroenterologist at Houston's Baylor College of Medicine and another member of the NIH panel. "Nobody deserves this infection. It's a major cause of illness, it's clearly linked to stomach cancer, and we have the chance to wipe it out."

Unfortunately, as Graham and others point out, treatment isn't easy. Patients have to pop 12 to 16 pills daily for two weeks. Frequently there are side effects, such as fatigue and dizziness, and children under the age of eight can't take some of the more powerful drugs. More important, patients who don't complete the regimen risk developing--and transmitting-resistant strains. That already has happened in some developing countries, where the infection is increasingly difficult to cure.

"This is still a young field," says Blaser, the Vanderbilt researcher. "We don't know all the answers. If we start treating millions of people, there will be problems. And we don't yet understand how great the benefits would be." What's really needed, says Blaser, is a vaccine to prevent infection in the first place. Unfortunately, it may be years before one hits the market.

In the meantime, Philip Perrine has some advice for you: Be sure any family member with an active ulcer is tested for H. pylori. After ten years of intermittent agony, Perrine enrolled in an experimental treatment program at the University of Virginia. The doctors discovered he was infected and prescribed three kinds of antibiotics. "I didn't really believe it would work," he says. "But I thought if they wanted a guinea pig, I couldn't possibly get any worse."

Perrine has had no stomach trouble since then. At the end of every day, he comes home to a glass of red wine, once forbidden, and at dinner he eats whatever he pleases--including his favorite spicy sausage. It's impossible to know if his father was the source of his infection. At the very least, Perfine has been spared the same fate.

ILLUSTRATION

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By MICHAEL MASON

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