Antibiotic treatment of peptic ulcers -- performed now on only about 2 percent of patients in the United States -- could dramatically decrease the incidence of the ailment, sparing Americans a lot of stomach pain and saving billions of dollars now spent on surgery and drug therapy.
However, widespread use of antibiotics for this problem could also lead to development of drug resistance in the bacteria, Heliobacter pylori, thought to cause peptic ulcers, as well as other intestinal bacteria, and should be carefully considered.
Those two views were being presented today in an article and an editorial in the Journal of the American Medical Association.
The article outlines the results of a consensus conference held in February by the National Institutes of Health calling for increased use of antibiotics to treat ulcers. The editorial, which generally endorses the conference recommendations, suggests a more cautious approach.
The editorial, written by Dr. Mark Feldman of the University of Texas Southwestern Medical School in Dallas, argues that current methods of testing for H. pylori are expensive and have limitations, that antibiotics may prompt strong adverse reactions some patients, and that safe, effective and lifelong medicine currently available has proven to be effective in about 50 percent of cases.
Peptic ulcers are a chronic inflammation of the stomach lining or the duodenum. Treatment traditionally has been with drugs to reduce secretion of digestive acids, which aggravate the condition, or to neutralize the acids. The condition also is aggravated by alcohol, smoking and by some drugs.
About 10 percent of all Americans develop ulcers at some time during their lives, and the odds of having recurring ulcers within a year after standard short-term drug treatment, which lasts two weeks, are 50 percent or higher.
But these medicines do not get rid of the underlying cause of more than 90 percent of ulcers. That cause, the NIH report said, is the H. pylori bacteria discovered in human gastric tissue in 1982.
In much of the world -- particularly Europe and Australia -- ulcers are already successfully treated with a combination of antibiotics, with relapse rates at 10 percent or lower.
"This is an unique opportunity to basically get rid of the problem of ulcer disease for the vast majority of people who have ulcers," said consensus panel leader Dr. Tadatka Yamada of the University of Michigan. "And it makes a lot of sense financially. Obviously, if you can treat people for two weeks with relatively inexpensive antibiotics and not have [ulcer] recurrences, it's a lot cheaper."
Though the consensus panel only hinted at greater benefits in the form of cancer prevention, there are those who believe that H. pylori also plays a role in stomach cancer (B-cell gastric lymphomas).
At St. James Hospital in Leeds, England, Dr. Peter Isaacson treats such cancer patients with very high doses of antibiotics, eradicating H. pylori and, he says, eliminating the cancers.
The NIH consensus panel did not, however, endorse antibiotic treatment of such cancers. "There is an association between H. pylori infection and stomach cancer, but no one has proven that treatment of H. pylori decreases those cancers," Dr. Yamada argued.