GUT FEELING

Question 1

WHAT ARE THE CAUSES?

Answer 1

− A type of bacteria called Helicobacter pylori (H. pylori)

Question 2

FACTORS THE CAN INCREASE RISK OF STOMACH ULCERS

Answer 2

− Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) e.g. aspirin, naproxen, ibuprofen
− Excess acid production from gastrinomas
− Excessive drinking of alcohol
− Smoking or chewing tobacco
− Serious Illness
− Radiation treatment to the area

Question 3

WHAT ARE THE SYMPTOMS OF ULCERS.

Answer 3

− Burning in the middle of upper stomach; usually between meals or at night
− Bloating
− Heartburn
− Nausea or vomiting
− Loss of appetite

Question 4

SEVERE CASES: SYMPTOMS

Answer 4

− Dark or black stool (due to bleeding)
− Vomiting blood
− Weight loss
− Severe pain in the mid to upper abdomen

Question 5

SEVERITY OF STOMACH ULCERS

Answer 5

Often heal on their own, though ignoring the signs can lead to serious health problems including:
− Bleeding
− Perforation (a hole through the wall of the stomach)
− Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to small intestine

Question 6

CAUSES

Answer 6

− When acids that help digest food damage the wall of stomach and duodenum
− H. pylori creates holes in mucosal lining in the stomach, exposing sensitive tissue to the stomach acid
− Regular use of NSAIDs

Question 7

WHO HAS AN INCREASED RISK OF STOMACH ULCERS

Answer 7

− Elderly
− Those with history of having peptic ulcer disease
− If you’re infected with the H. pylori bacterium
− Anyone taking NSAIDs
− Family history of ulcers
− Other illnesses such as liver, kidney or lung disease
− Drinking alcohol regularly

Question 8

Endoscopy

Answer 8

a thin flexible tube is threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer.

Question 9

Barium meal

Answer 9

a chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable.

Question 10

Biopsy

Answer 10

a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found.

Question 11

C14 breath test

Answer 11

this checks for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon (C14) and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women.

Question 12

TREATMENTS

Answer 12

LIFESTYLE CHANGES:
− Stopping drinking or smoking
− Stop taking NSAIDs
ULCER MEDICATIONS:
− Proton pump inhibitors (PPI); reduced acid levels to allow ulcers to heal
− Antibiotics to treat H. pylori infection
− Bismuth
− Upper endoscopy
− Surgery

Question 13

HOW TO PREVENT ULCERS:

Answer 13

− Avoid smoking and alcohol
− Don’t overuse aspirin and/or NSAIDs
− Don’t ignore symptom

Question 14

20th CENTURY:

Answer 14

− Caused by stress and diet
− Treatment: hospitalisation, bed rest, bland foods
− Gastric acid was later blamed for stomach ulcers

Question 15

1982

Answer 15

− Australian physicians, Robin Warren and Barry Marshall identified link with H. pylori
− Concluding that it wasn’t stress or diet
− Medical community slow to accept their findings

Question 16

1994:

Answer 16

− A National Institute of Health Consensus Development Conference concluded the strong association with H. pylori and ulcers
− Recommended treatment for H. pylori if you had stomach ulcers

Question 17

1995

Answer 17

− 75% of ulcer patients are still being treated with antisecretory medications
− 5% receiving antibiotic therapy
− American Digestive Health Foundation finds 90% of ulcer sufferers are unaware of the link between H. pylori and ulcers
− 90% of those blame it on stress or worry and 60% blame diet

Question 18

1996

Answer 18

− The Food and Drug Administration approved first antibiotic treatment for ulcers

Question 19

1970

Answer 19

− Centres for Disease Control and Prevention (CDC) launch national education to inform health care providers with the link
− Reinforces that ulcers are curable

Question 20

ADDITIONAL INFO (SHEET)

Answer 20

− 1 in every 10 Australians suffer from ulcers
− Believed was caused by stress or spicy food
− An ulcer is simply a break in the lining of any local surface
− Stomach acids can dissolve anything from meat to iron nails
− Mucus lining prevents
− Ulcers can eat right through the stomach wall
− Can cause massive infection
− Long-time scientists didn’t know what caused stomach ulcers. Knew that taking drugs that reduce stomach acids (worked while taking medication, but once stopped ulcers come back)
− Bacterium (HP) squirms through layer of mucus and manufactures an enzyme (urease); creating a local alkaline environment. This neutralises the acid
− Diagnosis of HP) can be made by looking for the presence of urease or breathe test

Question 21

GIULIO BIZZOSZERO (1892):

Answer 21

− Italian pathologist
− Found unusual spiral-shaped bacteria in stomach of dogs
− Findings were ignored

Question 22

PROFESSOR OLIVER FITZGERALD (1940s):

Answer 22

− Pharmacologist
− Notices that there was usually ammonia and urea present in the stomachs of ulcer patients
− Is part of the survival for HP
− But he thought it came from the stomach, not the bacteria

Question 23

DR. KOHN LIKOUDIS (1958):

Answer 23

− Diagnosed himself as having stomach ulcers
− Treated himself with antibiotics (got better)
− Worked on other patients
− They took a powder for 7-10 days
− 1961 called it Elgaco
− 1962 bought a pill making machine
− Cured 30,000 patients
− Patients would get his medicines for free
− Fined for using unconventional therapy

Question 24

ROBIN WARREN (1937) BARRY MARSHALL (1951)

Answer 24

− (RW) Histopathologist
− Fascinated by strange bacteria
− (BM) junior hospital gut doctor looking for research
− 1982 they realised a new bacteria played a role in ulcers
− known as campylobacter pyloridis
− when realised it didn’t belong to the campylobacter family it was renamed
− medical profession wasn’t convinced so BM drank a glass of the bacteria to prove
− didn’t develop stomach ulcers, just gastritis as each person is different depending on the version of bacteria and their immune system
− 1994, American National Institute of Health was convinced
− Though in 1995, 90% of patients still blaming stress and spicy foods and 5% of prescribed antibiotics

− Discovered small curved bacterium in 50% of patients from biopsies
− Realised that signs of inflammation were always present in the gastric mucosa (close to bacteria)
− Barry Became interested in warren’s findings
− Performed biopsies on 100 patients
− H. pylori was later named
− H. pylori causes life-long infections, so getting rid of stops reoccurring
− Infection typically contracted in early childhood (transmitted from mother to child)

Question 25

WHAT ARE STOMACH ULCERS (PEPTIC ULCER DISEASE)?

Answer 25

− Painful sores or ulcers in the lining of the stomach or the beginning of the small intestine (duodenum)