Peptic Ulcer Disease: From Curse to Cure

Check DrPullen.com each Wednesday as I share my perspective on changes in medicine over the 30 years since I graduated from Tuft’s University School of Medicine in 1980. It has been an exciting time to be a physician. Much has happened and incredible progress has been made management of some health conditions, and disappointing progress in others. Today I’m going to discuss peptic ulcer disease.

Those of you who are younger may ask, “What’s the big deal about peptic ulcers?” Those physicians among you who were practicing in the early 1980s and before remember the difficulty of treating a patient with ulcers. We told patients to be careful what they ate, to take antacids that either gave them diarrhea (magnesium containing meds like Maalox) or constipation (aluminum-containing meds like Amphjel). If they got an hour or two of relief and not too many side effects we considered the treatment successful. Then when they developed complications like perforation, bleeding, or obstruction we did major surgeries to remove the part of the stomach that produced acid, or to cut the vagus nerve that plays a role in stimulating acid production. Despite all of these things patients suffered and died. My first HIV patient after residency, in 1984, died after a transfusion she had received for a bleeding ulcer years previously.

In the early 1980s, Tagamet (cimetadine) became available, and we could finally directly reduce stomach acid production. Zantac (ranitidine) and others in the class followed. Then in the 1990s Prilosec (omeprazole) came to market followed by many copy-cat meds in the proton pump inhibitor class, and we had yet more effective meds. By this time surgery for ulcer disease became quite uncommon.

In the early 1980s, Marshall and others discovered that the bacteria H. pylori was common in the stomachs of people with ulcers, and hypothesized that this bacterium was the cause of most peptic ulcers. Few physicians believed him, so to publicize his new hypothesis Marshall drank a Petri dish containing a culture of H. pylori from a patient and soon developed gastritis. By 1997 NIH undertook a major education effort to convince physicians that treating H. pylori cured, not just treated, peptic ulcers, and now antibiotic treatment of PUD is the standard of care. Marshall went on to be awarded a Nobel Prize for this discovery. We can now not only treat ulcers, but we can eradicate the cause in a patient with ulcers by antibiotic treatment most of the time. Recently several of the proton pump inhibitors (Prilosec OTC and Prevacid) became available off the shelf without prescription, and all of the H2 blockers (ranitidine, cimetadine, and famotidine) are off the shelf.

Good bench science and clinical studies have put this once-challenging disease on the back burner. Those of you who think ulcers are a minor problem, remind the rest of us that we have been around a while.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.This article originally appeared online at DrPullen.com.